Ekizoglu Oguzhan, Er Ali, Hocaoglu Elif, Bozdag Mustafa, Grabherr Silke
Department of Forensic Medicine, Tepecik Training and Research Hospital, Güney Mahallesi 1140/1 Yenisehir, Konak, Izmir, Turkey.
University Centre of Legal Medicine Lausanne-Geneva, Geneva University Hospital and University of Geneva, Geneva, Switzerland.
Int J Legal Med. 2025 Jan;139(1):245-252. doi: 10.1007/s00414-024-03345-6. Epub 2024 Oct 12.
The timing of growth plate fusion is a key indicator for age estimation and is primarily used in forensic investigations. On the other hand, non-ionizing techniques such as MRI are being developed to provide safer and more ethical evaluations in forensic casework. This study aims to evaluate the closure process of growth plates in the distal femoral and proximal tibial epiphyses using Multiple Echo Recombined Gradient Echo (MERGE) MRI sequences and provide age estimation data based on staging methods for forensic purposes. We retrospectively analyzed 559 patients (294 males, 265 females, aged 8-25 years) diagnosed with trauma and knee pain at Tepecik Training and Research Hospital from 2016 to 2019. MRI scans were performed using a 1.5-T system with MERGE sequences and evaluated by two observers using a new staging system. Observer agreement was assessed using Cohen's κ test, yielding high agreement values (κ > 0.8). Positive correlations were found between age and ossification stages (p < 0.001). Minimum age thresholds for stages 5a and 5b of the distal femoral epiphysis were 16 and 18 years for females and 17 and 19 years for males, respectively. For the proximal tibial epiphysis, the minimum ages for stages 5a and 5b were 15 years for females and 17 years for males. The MERGE sequence provides a viable method for assessing skeletal maturity in living individuals with significant ethical advantages due to non-ionizing radiation. This study supports the potential application of the MERGE sequence in forensic age estimation, demonstrating high observer agreement and consistency. Future research should focus on comparing different sequences and populations to enhance the methodology's applicability.
生长板融合的时间是年龄估计的关键指标，主要用于法医调查。另一方面，诸如MRI等非电离技术正在被开发，以便在法医案件工作中提供更安全且更符合伦理的评估。本研究旨在使用多回波重组梯度回波（MERGE）MRI序列评估股骨远端和胫骨近端骨骺生长板的闭合过程，并基于分期方法提供用于法医目的的年龄估计数据。我们回顾性分析了2016年至2019年在特佩奇克培训与研究医院被诊断为创伤和膝关节疼痛的559例患者（294例男性，265例女性，年龄8 - 25岁）。使用配备MERGE序列的1.5-T系统进行MRI扫描，并由两名观察者使用一种新的分期系统进行评估。使用科恩κ检验评估观察者间的一致性，得到较高的一致性值（κ＞0.8）。发现年龄与骨化阶段之间存在正相关（p＜0.001）。股骨远端骨骺5a和5b期的最小年龄阈值，女性分别为16岁和18岁，男性分别为17岁和19岁。对于胫骨近端骨骺，5a和5b期的最小年龄，女性为15岁，男性为17岁。MERGE序列为评估活体骨骼成熟度提供了一种可行的方法，由于非电离辐射，具有显著的伦理优势。本研究支持MERGE序列在法医年龄估计中的潜在应用，显示出较高的观察者间一致性和一致性。未来的研究应侧重于比较不同序列和人群，以提高该方法的适用性。
