Dental and Skeletal Imaging in Forensic Age Estimation: Disparities in Current Approaches and the Continuing Search for Optimization

Abstract

Medical imaging for forensic age estimation in living adolescents and young adults continues to be controversial and a subject of discussion. Because age estimation based on medical imaging is well studied, it is the current gold standard. However, large disparities exist between the centers conducting age estimation, both between and within countries. This review provides an overview of the most common approaches applied in Europe, with case examples illustrating the differences in imaging modalities, in staging of development, and in statistical processing of the age data. Additionally, the review looks toward the future because several European research groups have intensified studies on age estimation, exploring four strategies for optimization: (1) increasing sample sizes of the reference populations, (2) combining single-site information into multifactorial information, (3) avoiding ionizing radiation, and (4) conducting a fully automated analysis.

Keywords

age determination by skeleton - age determination by teeth - adolescent - adult - magnetic resonance imaging

Notes

This review article was partly based on a chapter in the PhD thesis of the first author, defended on March 22, 2019.[30]

Publikationsverlauf

Artikel online veröffentlicht:
09. Oktober 2020

• References

• 1 Axelsson I. Bone maturation cannot be used to estimate chronological age in asylum-seeking adolescents. Acta Paediatr 2019; 108 (04) 590-592
• 2 Aynsley-Green A, Cole TJ, Crawley H, Lessof N, Boag LR, Wallace RM. Medical, statistical, ethical and human rights considerations in the assessment of age in children and young people subject to immigration control. Br Med Bull 2012; 102: 17-42
• 3 Milani S, Benso L. Why we can't determine reliably the age of a subject on the basis of his maturation degree. J Forensic Leg Med 2019; 61: 97-101
• 4 Mishori R. The use of age assessment in the context of child migration: imprecise, inaccurate, inconclusive and endangers children's rights. Children (Basel) 2019; 6 (07) 6
• 5 Ording Müller LS, Offiah A, Adamsbaum C. et al. Bone age for chronological age determination—statement of the European Society of Paediatric Radiology musculoskeletal task force group. Pediatr Radiol 2019; 49 (07) 979-982
• 6 Schmeling A, Grundmann C, Fuhrmann A. et al. Criteria for age estimation in living individuals. Int J Legal Med 2008; 122 (06) 457-460
• 7 Schmeling A, Dettmeyer R, Rudolf E, Vieth V, Geserick G. Forensic age estimation. Dtsch Arztebl Int 2016; 113 (04) 44-50
• 8 Thevissen PW, Alqerban A, Asaumi J. et al. Human dental age estimation using third molar developmental stages: accuracy of age predictions not using country specific information. Forensic Sci Int 2010; 201 (1–3): 106-111
• 9 Thevissen PW, Fieuws S, Willems G. Human third molars development: comparison of 9 country specific populations. Forensic Sci Int 2010; 201 (1–3): 102-105
• 10 Schmeling A, Reisinger W, Loreck D, Vendura K, Markus W, Geserick G. Effects of ethnicity on skeletal maturation: consequences for forensic age estimations. Int J Legal Med 2000; 113 (05) 253-258
• 11 Elamin F, Liversidge HM. Malnutrition has no effect on the timing of human tooth formation. PLOS One 2013; 8 (08) e72274
• 12 Meijerman L, Maat GJR, Schulz R, Schmeling A. Variables affecting the probability of complete fusion of the medial clavicular epiphysis. Int J Legal Med 2007; 121 (06) 463-468
• 13 Schmeling A, Schulz R, Danner B, Rösing FW. The impact of economic progress and modernization in medicine on the ossification of hand and wrist. Int J Legal Med 2006; 120 (02) 121-126
• 14 De Tobel J, Hillewig E, de Haas MB. et al. Forensic age estimation based on T1 SE and VIBE wrist MRI: do a one-fits-all staging technique and age estimation model apply?. Eur Radiol 2019; 29 (06) 2924-2935
• 15 Schmeling A. The Current Medical-Ethical Debate on Forensic Age Estimation in Unaccompanied Minor Refugees [master's thesis]. Münster, Germany: Westfälische Wilhelms-Universität Münster; 2018
• 16 Thevissen PW, Kvaal SI, Willems G. Ethics in age estimation of unaccompanied minors. J Forensic Odontostomatol 2012; 30 (Suppl. 01) 84-102
• 17 European Asylum Support Office (EASO). Practical Guide on Age Estimation, 2nd ed. In: EASO Practical Guide Series. Marsa, Malta: EASO; 2018
• 18 Schumacher G, Schmeling A, Rudolf E. Medical age assessment of juvenile migrants: an analysis of age marker-based assessment criteria. Joint Research Centre (JRC) Science for Policy Report. Available at: https://publications.jrc.ec.europa.eu/repository/bitstream/JRC109278/medical_age_assessment_of_juvenile_migrants_(final_pdf).pdf . Accessed February 25, 2020
• 19 Bleka Ø, Rolseth V, Dahlberg PS, Saadé A, Saadé M, Bachs L. BioAlder: a tool for assessing chronological age based on two radiological methods. Int J Legal Med 2019; 133 (04) 1177-1189
• 20 De Tobel J, Fieuws S, Hillewig E. et al. Multi-factorial age estimation: a Bayesian approach combining dental and skeletal magnetic resonance imaging. Forensic Sci Int 2020; 306: 110054
• 21 Gelbrich B, Frerking C, Weiss S. et al. Combining wrist age and third molars in forensic age estimation: how to calculate the joint age estimate and its error rate in age diagnostics. Ann Hum Biol 2015; 42 (04) 389-396
• 22 Kumagai A, Willems G, Franco A, Thevissen P. Age estimation combining radiographic information of two dental and four skeletal predictors in children and subadults. Int J Legal Med 2018; 132 (06) 1769-1777
• 23 Schmidt S, Schramm D, Ribbecke S. et al. Forensic age estimation in juveniles and young adults: reducing the range of scatter in age diagnosis by combining different methods [in German]. Arch Kriminol 2016; 237 (1–2): 25-37
• 24 Stern D, Payer C, Giuliani N, Urschler M. Automatic age estimation and majority age classification from multi-factorial MRI data. IEEE J Biomed Health Inform 2019; 23 (04) 1392-1403
• 25 Lockemann U, Fuhrmann A, Püschel K, Schmeling A, Geserick G. Working group for forensic age diagnostics of the German Society for Forensic Medicine. Rechtsmedizin 2004; 14: 123-126
• 26 Sypek SA, Benson J, Spanner KA, Williams JL. A holistic approach to age estimation in refugee children. J Paediatr Child Health 2016; 52 (06) 614-620
• 27 Vaska AI, Benson J, Eliott JA, Williams J. Age determination in refugee children: a narrative history tool for use in holistic age assessment. J Paediatr Child Health 2016; 52 (05) 523-528
• 28 Fieuws S, Willems G, Larsen-Tangmose S, Lynnerup N, Boldsen J, Thevissen P. Obtaining appropriate interval estimates for age when multiple indicators are used: evaluation of an ad-hoc procedure. Int J Legal Med 2016; 130 (02) 489-499
• 29 Thevissen PW, Fieuws S, Willems G. Human dental age estimation using third molar developmental stages: does a Bayesian approach outperform regression models to discriminate between juveniles and adults?. Int J Legal Med 2010; 124 (01) 35-42
• 30 De Tobel J. Multi-Factorial Forensic Age Estimation: Combining Magnetic Resonance Imaging of the Third Molars, the Left Wrist and Both Clavicles [dissertation]. Ghent, Belgium: Ghent University-KU Leuven; 2019: 314
• 31 Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol 1973; 45 (02) 211-227
• 32 Köhler S, Schmelzle R, Loitz C, Püschel K. Development of wisdom teeth as a criterion of age determination [in German]. Ann Anat 1994; 176 (04) 339-345
• 33 Rozkovcova E, Dostalova T, Markova M, Broukal Z. The third molar as an age marker in adolescents: new approach to age evaluation. J Forensic Sci 2012; 57 (05) 1323-1328
• 34 Sironi E, Pinchi V, Pradella F, Focardi M, Bozza S, Taroni F. Bayesian networks of age estimation and classification based on dental evidence: a study on the third molar mineralization. J Forensic Leg Med 2018; 55: 23-32
• 35 Olze A, Solheim T, Schulz R, Kupfer M, Schmeling A. Evaluation of the radiographic visibility of the root pulp in the lower third molars for the purpose of forensic age estimation in living individuals. Int J Legal Med 2010; 124 (03) 183-186
• 36 Olze A, Solheim T, Schulz R, Kupfer M, Pfeiffer H, Schmeling A. Assessment of the radiographic visibility of the periodontal ligament in the lower third molars for the purpose of forensic age estimation in living individuals. Int J Legal Med 2010; 124 (05) 445-448
• 37 Al Qattan F, Alzoubi EE, Lucas V, Roberts G, McDonald F, Camilleri S. Root Pulp Visibility as a mandibular maturity marker at the 18-year threshold in the Maltese population. Int J Legal Med 2020; 134 (01) 363-368
• 38 Chaudhary MA, Liversidge HM. A radiographic study estimating age of mandibular third molars by periodontal ligament visibility. J Forensic Odontostomatol 2017; 35 (02) 79-89
• 39 Greulich W, Pyle SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist. 2nd ed. Stanford, CA: Stanford University Press; 1959
• 40 Tanner JM, Whitehouse RH, Cameron N. et al. Assessment of Skeletal Maturity and Prediction of Adult Height (TW2 method). 2nd ed. London, UK: Academic Press; 1983
• 41 Thiemann HH, Nitz I, Schmeling A. Röntgenatlas of the Normal Hand in Childhood [in German]. Stuttgart, Germany: Thieme; 2006
• 42 Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke KD, Geserick G. Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 2004; 118 (01) 5-8
• 43 Kellinghaus M, Schulz R, Vieth V, Schmidt S, Pfeiffer H, Schmeling A. Enhanced possibilities to make statements on the ossification status of the medial clavicular epiphysis using an amplified staging scheme in evaluating thin-slice CT scans. Int J Legal Med 2010; 124 (04) 321-325
• 44 Rudolf E, Kramer J, Gebauer A. et al. Standardized medical age assessment of refugees with questionable minority claim—a summary of 591 case studies. Int J Legal Med 2015; 129 (03) 595-602
• 45 Thevissen P, Willems G. The Triple Test: The K.U. Leuven-protocol for age estimation of unaccompanied minor refugees [in Dutch]. In: Aps JKM, Brand HS, Duyck J. , et al, eds. Het Tandheelkundig Jaar 2013. Houten, Netherlands: Bohn Stafleu van Loghum; 2013: 175-190
• 46 Wittschieber D, Ottow C, Schulz R. et al. Forensic age diagnostics using projection radiography of the clavicle: a prospective multi-center validation study. Int J Legal Med 2016; 130 (01) 213-219
• 47 Gunst K, Mesotten K, Carbonez A, Willems G. Third molar root development in relation to chronological age: a large sample sized retrospective study. Forensic Sci Int 2003; 136 (1-3): 52-57
• 48 Netherlands Forensic Institute. [Protocol Age Assessment] Dutch; 2019. Available at: https://www.forensischinstituut.nl/publicaties/publicaties/2020/01/22/protocol-leeftijdsonderzoek . Accessed on February 25, 2020
• 49 Mostad P, Tamsen F. Error rates for unvalidated medical age assessment procedures. Int J Legal Med 2019; 133 (02) 613-623
• 50 Ottow C, Schulz R, Pfeiffer H, Heindel W, Schmeling A, Vieth V. Forensic age estimation by magnetic resonance imaging of the knee: the definite relevance in bony fusion of the distal femoral- and the proximal tibial epiphyses using closest-to-bone T1 TSE sequence. Eur Radiol 2017; 27 (12) 5041-5048
• 51 Vieth V, Schulz R, Heindel W. et al. Forensic age assessment by 3.0T MRI of the knee: proposal of a new MRI classification of ossification stages. Eur Radiol 2018; 28 (08) 3255-3262
• 52 Thevissen PW. Dental Age Estimation: Striving for an Optimal Approach [dissertation]. Leuven, Belgium: Leuven University Press; 2013
• 53 Haglund M, Mörnstad H. A systematic review and meta-analysis of the fully formed wisdom tooth as a radiological marker of adulthood. Int J Legal Med 2019; 133 (01) 231-239
• 54 Alshamrani K, Messina F, Offiah AC. Is the Greulich and Pyle atlas applicable to all ethnicities? A systematic review and meta-analysis. Eur Radiol 2019; 29 (06) 2910-2923
• 55 Hermetet C, Saint-Martin P, Gambier A, Ribier L, Sautenet B, Rérolle C. Forensic age estimation using computed tomography of the medial clavicular epiphysis: a systematic review. Int J Legal Med 2018; 132 (05) 1415-1425
• 56 Konigsberg LW. Multivariate cumulative probit for age estimation using ordinal categorical data. Ann Hum Biol 2015; 42 (04) 368-378
• 57 Varkkola O, Ranta H, Metsäniitty M, Sajantila A. Age assessment by the Greulich and Pyle method compared to other skeletal X-ray and dental methods in data from Finnish child victims of the Southeast Asian Tsunami. Forensic Sci Med Pathol 2011; 7 (04) 311-316
• 58 Maret D, Peters OA, Dedouit F, Telmon N, Sixou M. Cone-beam computed tomography: a useful tool for dental age estimation?. Med Hypotheses 2011; 76 (05) 700-702
• 59 Schulz R, Schmidt S, Pfeiffer H, Schmeling A. Sonographic examinations of various skeletal regions. Rechtsmedizin 2014; 24: 480-484
• 60 Benito M, Muñoz A, Beltrán I, Labajo E, Perea B, Sánchez JA. Assessment of adulthood in the living Spanish population based on ossification of the medial clavicle epiphysis using ultrasound methods. Forensic Sci Int 2018; 284: 161-166
• 61 Gonsior M, Ramsthaler F, Birngruber C, Obert M, Verhoff MA. The completely fused medial clavicular epiphysis in high-frequency ultrasound scans as a diagnostic criterion for forensic age estimations in the living. Int J Legal Med 2016; 130 (06) 1603-1613
• 62 De Tobel J, Bauwens J, Parmentier GIL. et al. The use of magnetic resonance imaging in forensic age estimation of living children and subadults systematically reviewed. Pediatr Radiol. In press
• 63 Ottow C, Schmidt S, Heindel W. Forensic age assessment by 3.0T MRI of the wrist: adaption of the Vieth-Classification. Euro Radiol 2019. In press
• 64 De Tobel J, Phlypo I, Fieuws S, Politis C, Verstraete KL, Thevissen PW. Forensic age estimation based on development of third molars: a staging technique for magnetic resonance imaging. J Forensic Odontostomatol 2017; 35 (02) 117-140
• 65 De Tobel J, Hillewig E, van Wijk M. et al. Staging clavicular development on magnetic resonance imaging: pitfalls and recommendations for age estimation. J Magn Reson Imaging 2020; 51 (02) 377-388
• 66 De Tobel J, Parmentier GIL, Phlypo I. et al. Magnetic resonance imaging of third molars in forensic age estimation: comparison of the Ghent and Graz protocols focusing on apical closure. Int J Legal Med 2019; 133 (02) 583-592
• 67 Dvorak J, George J, Junge A, Hodler J. Age determination by magnetic resonance imaging of the wrist in adolescent male football players. Br J Sports Med 2007; 41 (01) 45-52
• 68 Ekizoglu O, Hocaoglu E, Can IO. et al. Spheno-occipital synchondrosis fusion degree as a method to estimate age: a preliminary, magnetic resonance imaging study. Aust J Forensic Sci 2016; 48: 159-170
• 69 Terada Y, Tamada D, Kose K. et al. Acceleration of skeletal age MR examination using compressed sensing. J Magn Reson Imaging 2016; 44 (01) 204-211
• 70 Neumayer B, Lesch A, Thaler F. et al. The four-minute approach revisited: accelerating MRI-based multi-factorial age estimation. Int J Legal Med In press.
• 71 Tangmose S, Jensen KE, Villa C, Lynnerup N. Forensic age estimation from the clavicle using 1.0T MRI—preliminary results. Forensic Sci Int 2014; 234: 7-12
• 72 De Tobel J, van Wijk M, Alberink I. et al. The influence of motion artefacts on magnetic resonance imaging of the clavicles for age estimation. Int J Legal Med 2020 ; January 8 (Epub ahead of print)
• 73 Rudolf E, Kramer J, Schmidt S, Vieth V, Winkler I, Schmeling A. Anatomic shape variants of extremitas sternalis claviculae as collected from sternoclavicular thin-slice CT-studies of 2820 male borderline-adults. Int J Legal Med 2019; 133 (05) 1517-1528
• 74 Bertels J, Banar N, Laurent F. et al. Fully automated third molar development staging in panoramic radiographs. Paper presented at: 8th Annual Congress of the International Society of Forensic Radiology Imaging; May 16–18, 2019; Berlin, Germany
• 75 Thodberg HH, van Rijn RR, Jenni OG, Martin DD. Automated determination of bone age from hand X-rays at the end of puberty and its applicability for age estimation. Int J Legal Med 2017; 131 (03) 771-780
• 76 Halabi SS, Prevedello LM, Kalpathy-Cramer J. et al. The RSNA Pediatric Bone Age Machine Learning Challenge. Radiology 2019; 290 (02) 498-503
• 77 Olze A, van Niekerk P, Schmidt S. et al. Studies on the progress of third-molar mineralisation in a Black African population. Homo 2006; 57 (03) 209-217
• 78 Tisè M, Mazzarini L, Fabrizzi G, Ferrante L, Giorgetti R, Tagliabracci A. Applicability of Greulich and Pyle method for age assessment in forensic practice on an Italian sample. Int J Legal Med 2011; 125 (03) 411-416
• 79 Wittschieber D, Schulz R, Vieth V. et al. The value of sub-stages and thin slices for the assessment of the medial clavicular epiphysis: a prospective multi-center CT study. Forensic Sci Med Pathol 2014; 10 (02) 163-169
• 80 Schmeling A, Kreitner KF, Heindel W, Vieth V. Imaging in forensic age estimation of youngsters and young adults. Radiologie 2019; 19: 63-75
• 81 Chaumoitre K, Saliba-Serre B, Adalian P, Signoli M, Leonetti G, Panuel M. Forensic use of the Greulich and Pyle atlas: prediction intervals and relevance. Eur Radiol 2017; 27 (03) 1032-1043
• 82 Guo Y, Olze A, Ottow C. et al. Dental age estimation in living individuals using 3.0 T MRI of lower third molars. Int J Legal Med 2015; 129 (06) 1265-1270
• 83 Schmidt S, Ottow C, Pfeiffer H. et al. Magnetic resonance imaging-based evaluation of ossification of the medial clavicular epiphysis in forensic age assessment. Int J Legal Med 2017; 131 (06) 1665-1673