TY - JOUR
T1 - Staging Clavicular Development on MRI
T2 - Pitfalls and Suggestions for Age Estimation
AU - De Tobel, Jannick
AU - Hillewig, Elke
AU - van Wijk, Mayonne
AU - Fieuws, Steffen
AU - de Haas, Michiel Bart
AU - van Rijn, Rick R.
AU - Thevissen, Patrick Werner
AU - Verstraete, Koenraad Luc
N1 - Publisher Copyright:
© 2019 International Society for Magnetic Resonance in Medicine
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Background: MRI of the clavicle's sternal end has been studied for age estimation. Several pitfalls have been noted, but how they affect age estimation performance remains unclear. Purpose/Hypothesis: To further study these pitfalls and to make suggestions for a proper use of clavicle MRI for forensic age estimation. Our hypotheses were that age estimation would benefit from 1) discarding stages 1 and 4/5; 2) including advanced substages 3aa, 3ab, and 3ac; 3) taking both clavicles into account; and 4) excluding morphological variants. Study Type: Prospective cross-sectional. Population: Healthy Caucasian volunteers between 11 and 30 years old (524; 277 females, 247 males). Field Strength/Sequence: 3T, T1-weighted gradient echo volumetric interpolated breath-hold examination (VIBE) MR-sequence. Assessment: Four observers applied the most elaborate staging technique for long bone development that has been described in the current literature (including stages, substages, and advanced substages). One of the observers repeated a random selection of the assessments in 110 participants after a 2-week interval. Furthermore, all observers documented morphological variants. Statistical Tests: Weighted kappa quantified reproducibility of staging. Bayes' rule was applied for age estimation with a continuation ratio model for the distribution of the stages. According to the hypotheses, different models were tested. Mean absolute error (MAE) differences between models were compared, as were MAEs between cases with and without morphological variants. Results: Weighted kappa equaled 0.82 for intraobserver and ranged between 0.60 and 0.64 for interobserver agreement. Stages 1 and 4/5 were allocated interchangeably in 4.3% (54/1258). Age increased steadily in advanced substages of stage 3, but improvement in age estimation was not significant (right P = 0.596; left P = 0.313). The model that included both clavicles and discarded stages 1 and 4/5 yielded an MAE of 1.97 years, a root mean squared error of 2.60 years, and 69% correctly classified minors. Morphological variants rendered significantly higher MAEs (right 3.84 years, P = 0.015; left 2.93 years, P = 0.022). Data Conclusion: Our results confirmed hypotheses 3) and 4), while hypotheses 1) and 2) remain to be investigated in larger studies. Level of Evidence: 1. Technical Efficacy: Stage 2. J. Magn. Reson. Imaging 2020;51:377–388.
AB - Background: MRI of the clavicle's sternal end has been studied for age estimation. Several pitfalls have been noted, but how they affect age estimation performance remains unclear. Purpose/Hypothesis: To further study these pitfalls and to make suggestions for a proper use of clavicle MRI for forensic age estimation. Our hypotheses were that age estimation would benefit from 1) discarding stages 1 and 4/5; 2) including advanced substages 3aa, 3ab, and 3ac; 3) taking both clavicles into account; and 4) excluding morphological variants. Study Type: Prospective cross-sectional. Population: Healthy Caucasian volunteers between 11 and 30 years old (524; 277 females, 247 males). Field Strength/Sequence: 3T, T1-weighted gradient echo volumetric interpolated breath-hold examination (VIBE) MR-sequence. Assessment: Four observers applied the most elaborate staging technique for long bone development that has been described in the current literature (including stages, substages, and advanced substages). One of the observers repeated a random selection of the assessments in 110 participants after a 2-week interval. Furthermore, all observers documented morphological variants. Statistical Tests: Weighted kappa quantified reproducibility of staging. Bayes' rule was applied for age estimation with a continuation ratio model for the distribution of the stages. According to the hypotheses, different models were tested. Mean absolute error (MAE) differences between models were compared, as were MAEs between cases with and without morphological variants. Results: Weighted kappa equaled 0.82 for intraobserver and ranged between 0.60 and 0.64 for interobserver agreement. Stages 1 and 4/5 were allocated interchangeably in 4.3% (54/1258). Age increased steadily in advanced substages of stage 3, but improvement in age estimation was not significant (right P = 0.596; left P = 0.313). The model that included both clavicles and discarded stages 1 and 4/5 yielded an MAE of 1.97 years, a root mean squared error of 2.60 years, and 69% correctly classified minors. Morphological variants rendered significantly higher MAEs (right 3.84 years, P = 0.015; left 2.93 years, P = 0.022). Data Conclusion: Our results confirmed hypotheses 3) and 4), while hypotheses 1) and 2) remain to be investigated in larger studies. Level of Evidence: 1. Technical Efficacy: Stage 2. J. Magn. Reson. Imaging 2020;51:377–388.
KW - adolescent
KW - adult
KW - age determination by skeleton
KW - clavicle
KW - magnetic resonance imaging
UR - http://www.scopus.com/inward/record.url?scp=85070092387&partnerID=8YFLogxK
U2 - 10.1002/jmri.26889
DO - 10.1002/jmri.26889
M3 - Article
C2 - 31373087
AN - SCOPUS:85070092387
SN - 1053-1807
VL - 51
SP - 377
EP - 388
JO - Journal of Magnetic Resonance Imaging
JF - Journal of Magnetic Resonance Imaging
IS - 2
ER -