Karakas Hakkı Muammer, Harma Ahmet, Alicioglu Banu
Fatih Sultan Mehmet Training and Research Hospital, Department of Radiology, Istanbul, Turkey.
J Forensic Leg Med. 2013 Nov;20(8):1004-9. doi: 10.1016/j.jflm.2013.08.013. Epub 2013 Aug 31.
The investigation of new anatomical criteria and revalidation of existing ones in sex determination for different populations are among main research foci of forensic anthropometry. In that context, the pelvis is the most extensively studied bone. A number of qualitative classifications, dimensional measurements and indices have been proposed for investigative anthropometry and forensic studies. Independent use of these parameters generally provided an accuracy rate of 70-75%. In this study, the accuracy rate of the subpubic angle in sex determination was investigated in living Anatolian Caucasians.
The subpubic angle was identified and measured on three-dimensional computed tomographic images of pelves. Data were obtained using 64-detector computed tomography (MDCT) with an isotrophic resolution of 500 μm. The sample included 66 males (41.6 ± 14.9 years of age) and 43 females (41.1 ± 14.2 years of age). Measurements were taken on a dedicated three-dimensional image analysis workstation. The subpubic angle was electronically measured. The technique and methodology was validated on a standard skeletal model. Intraobserver agreement was analyzed with intraclass correlation coefficient, and intraobserver variability was evaluated with technical error of measurement (inter- and intra-observer TEM), relative technical error of measurement (rTEM) and coefficient of reliability (R) measures. The subpubic angle for the study group and for both sexes was reported as minimum-maximum (mean ± SD). Independent-Samples T Test for equality of means was used to determine the difference between the two sexes regarding the subpubic angle. The correlation between the subpubic angle and the age of subjects were using Pearson Correlation Coefficients in males and in females. Logistic regression model was used to classify subjects according to their sex. Receiver operating characteristic curve analysis was performed to determine a cut-off value for further studies and to test the performance of the binary classification test.
Intraclass correlation for the subpubic angle (0.990), TEM (1082), rTEM (1.492), and R (0.990) represented almost complete reliability and accuracy of the measurement method. The subpubic angle was between 48° and 81° (65.9° ± 7.2°) in males and was between 64° and 100° (82.6° ± 7.7°) in females. Statistically significant difference was found between males and females regarding the subpubic angle (p < 0.0001). The subpubic angle was not significantly correlated with age in males (p = 0.953), or in females (r = 0.975). The accuracy of the subpubic angle in sex determination was 90.8%. With a cut-off value of 74°, sensitivity of subpubic angle to detect female phenotype was 88% and its specificity was 95%.
The subpubic angle is an accurate parameter in sex determination with high sensitivity and specificity.
研究不同人群性别鉴定的新解剖学标准并重新验证现有标准是法医人体测量学的主要研究重点之一。在此背景下，骨盆是研究最为广泛的骨骼。已经提出了许多定性分类、尺寸测量和指数用于调查人体测量学和法医研究。单独使用这些参数通常能提供70 - 75%的准确率。在本研究中，对生活在安纳托利亚高加索人中耻骨下角在性别鉴定中的准确率进行了调查。
在骨盆的三维计算机断层扫描图像上识别并测量耻骨下角。数据通过具有500μm各向同性分辨率的64排探测器计算机断层扫描（MDCT）获取。样本包括66名男性（年龄41.6 ± 14.9岁）和43名女性（年龄41.1 ± 14.2岁）。测量在专用的三维图像分析工作站上进行。耻骨下角通过电子方式测量。该技术和方法在标准骨骼模型上得到验证。观察者内一致性通过组内相关系数进行分析，观察者内变异性通过测量技术误差（观察者间和观察者内TEM）、相对测量技术误差（rTEM）和可靠性系数（R）测量进行评估。研究组男女的耻骨下角报告为最小值 - 最大值（平均值 ± 标准差）。使用独立样本T检验均值相等性来确定男女在耻骨下角方面的差异。使用皮尔逊相关系数分析男性和女性耻骨下角与受试者年龄之间的相关性。使用逻辑回归模型根据性别对受试者进行分类。进行受试者操作特征曲线分析以确定进一步研究的临界值并测试二元分类测试的性能。
耻骨下角的组内相关性（0.990）、TEM（1082）、rTEM（1.492）和R（0.990）表明测量方法几乎具有完全的可靠性和准确性。男性的耻骨下角在48°至81°之间（65.9° ± 7.2°），女性的耻骨下角在64°至100°之间（82.6° ± 7.7°）。男女在耻骨下角方面存在统计学显著差异（p < 0.0001）。男性（p = 0.953）和女性（r = 0.975）的耻骨下角与年龄均无显著相关性。耻骨下角在性别鉴定中的准确率为90.8%。临界值为74°时，耻骨下角检测女性表型的敏感性为88%，特异性为95%。
耻骨下角是性别鉴定中的一个准确参数，具有高敏感性和特异性。
