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      Can forensic radiological skeletal age estimation be performed by examining ischiopubic-ilioischial-iliopubic synchondrosis in computed tomography images?

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          Abstract

          Introduction

          In this study, we evaluated whether it is possible to perform forensic radiological skeletal age estimation via radiological examination of the ilioischial, ischiopubic, and iliopubic synchondrosis regions of the pelvis.

          Methods

          This study was conducted by retrospectively examining the abdominopelvic images of individuals aged 8–16 who had applied to the hospital for any reason without having a chronic disorder and who had undergone computed tomography. Two radiologists retrospectively reviewed the images. The BT images of the pelvis ilioischial, ischiopubic, and iliopubic synchondrosis regions were evaluated as follows: 0: open, 1: semiclosed, and 2: closed. The data were evaluated using the SPSS 17 program.

          Results

          Two hundred sixty-three children (118 girls and 145 boys) between the ages of 8 and 16 years without any health problems participated. There was a significant difference between the groups for all the evaluated synchondrosis joints in girls and boys (p<0.001 for each group comparison). We observed that ilioischial, ischiopubic, and iliopubic synchondrosis closed earlier in girls than boys. In addition, we found that the joints were closed at the age of 15 and over in boys and at 14 and over in girls.

          Discussion

          Some studies have previously evaluated synchondrosis by using computed tomography. We showed that forensic radiological skeletal age estimation could be performed by examining ischiopubic-ilioischial-iliopubic synchondrosis in pelvis computed tomography images. The pelvis is more resistant to decay than other parts of the body. Furthermore, pelvis bones can withst and the effects of postmortem animal attacks for a longer period. Therefore, we believe that forensic age estimation can be made on corpses with no extremity, a damaged chest, or whose only pelvic bones are assessable through the method we use.

          Conclusion

          In our study, the ischiopubic-ilioischial-iliopubic joints were open in those aged nine and under and closed in those aged 15 and above. Ilioischial, ischiopubic, and iliopubic synchondrosis were observed to close earlier in girls than in boys. We consider that our study will be beneficial in the 8-16-year-old age group if used. In addition, our study can be used to determine the radiological bone age in cases with wrist bone abnormalities or wrist amputation.

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          Most cited references36

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          Criteria for age estimation in living individuals.

          This paper presents updated recommendations of the Study Group on Forensic Age Diagnostics for age estimations in living individuals in criminal proceedings. In order to increase the diagnostic accuracy and to improve the identification of age-relevant developmental disorders, a physical examination, an X-ray examination of the left hand, as well as a dental examination including the determination of the dental status and an X-ray of the dentition should be performed in each case. If the skeletal development of the hand is completed, an additional radiological examination of the clavicles should be carried out. Minimum requirements for reference studies are defined and recommendable studies are listed. Instructions for the examination and the preparation of expert reports are presented. The committee of the study group organizes annual proficiency tests for quality assurance.
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            Bone age: assessment methods and clinical applications

            Mari Satoh (2015)
            Abstract. The main bone age assessment methods are the Greulich-Pyle and Tanner-Whitehouse 2 methods, both of which involve left hand and wrist radiographs. Several other bone age assessment methods have been developed, including ultrasonographic, computerized, and magnetic resonance (MR) imaging methods. The ultrasonographic method appears unreliable in children with delayed and advanced bone age. MR imaging is noninvasive; however, bone age assessment using MR imaging is relatively new, and further examinations are needed. An automated method for determining bone age, named BoneXpert, has been validated for Caucasian children with growth disorders and children of various ethnic groups. Sex hormones are necessary for bone growth and maturation in children with a bone age corresponding to normal pubertal age, and estrogen is essential for growth plate closure. Bone age is an effective indicator for diagnosing and treating various diseases. A new method for adult height prediction based on bone age has been developed using BoneXpert, in addition to the commonly used Bayley-Pinneau and Tanner-Whitehouse mark II methods. Furthermore, bone age may become a predictor for the timing of peak height velocity and menarche.
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              Bone age in children of diverse ethnicity.

              Determination of skeletal or bone age is often used in pediatrics and orthopedics. The most commonly used bone age standards in the United States, those published by Greulich and Pyle, were derived from white children of the upper socioeconomic class in 1931-1942. We examined whether these standards apply to the current assessment of bone age in children of diverse ethnicity. Hand radiographs of children less than 19 years old at our institution were evaluated for bone age using the standards of Greulich and Pyle. Differences between bone age and chronologic age were calculated, and the mean differences were compared among subgroups of children on the basis of sex, age, and ethnicity. In Asian and white girls, bone age approximated chronologic age throughout childhood, with the only significant discrepancy being in adolescent white girls, in whom bone age exceeded chronologic age by an average of 4 months. In black girls, bone age exceeded chronologic age except during middle childhood. In late childhood and adolescence, bone age exceeded chronologic age by approximately 10 months. In Hispanic adolescent girls, bone age exceeded chronologic age by nearly 9 months. In black adolescent boys, bone age exceeded chronologic age by 5 months, with no significant discrepancies between bone age and chronologic age at other ages. In white preadolescent boys, bone age lagged behind chronologic age to a statistically significant degree, ranging from approximately 4 to 8 months. Preadolescent Asian boys also showed significant delays in bone age, particularly in middle childhood, when bone age lagged behind chronologic age by nearly 15 months. In adolescent Asian boys, bone age exceeded chronologic age by 9 months 15 days. In adolescent Hispanic boys, bone age exceeded chronologic age by 11 months 15 days. In younger Hispanic boys, delays in bone age occurred but were significant only in early childhood (4-month delay). Using the standards of Greulich and Pyle to determine bone age must be done with reservations, particularly in black and Hispanic girls and in Asian and Hispanic boys in late childhood and adolescence, when bone age may exceed chronologic age by 9 months to 11 months 15 days.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: MethodologyRole: ResourcesRole: SoftwareRole: Visualization
                Role: Data curationRole: Formal analysisRole: SoftwareRole: SupervisionRole: Visualization
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                28 April 2022
                2022
                : 17
                : 4
                : e0266682
                Affiliations
                [1 ] Faculty of Medicine, Department of Forensic Medicine, Hitit University, Çorum, Turkey
                [2 ] Faculty of Medicine, Department of Radiology, Binali Yildirim Erzincan University, Erzincan, Turkey
                [3 ] Faculty of Medicine, Department of Radiology, Sakarya University, Adapazarı, Turkey
                Sam Houston State University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-2331-7196
                Article
                PONE-D-21-24189
                10.1371/journal.pone.0266682
                9049324
                35482736
                6b1cd4fd-81f1-412d-a123-b32f123b0784
                © 2022 Gümüş et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 4 August 2021
                : 24 March 2022
                Page count
                Figures: 8, Tables: 2, Pages: 14
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Research and Analysis Methods
                Imaging Techniques
                Neuroimaging
                Computed Axial Tomography
                Biology and Life Sciences
                Neuroscience
                Neuroimaging
                Computed Axial Tomography
                Medicine and Health Sciences
                Diagnostic Medicine
                Diagnostic Radiology
                Tomography
                Computed Axial Tomography
                Research and Analysis Methods
                Imaging Techniques
                Diagnostic Radiology
                Tomography
                Computed Axial Tomography
                Medicine and Health Sciences
                Radiology and Imaging
                Diagnostic Radiology
                Tomography
                Computed Axial Tomography
                Medicine and Health Sciences
                Diagnostic Medicine
                Clinical Laboratory Sciences
                Forensics
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Pelvis
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Pelvis
                Biology and Life Sciences
                Anatomy
                Body Limbs
                Arms
                Wrist
                Medicine and Health Sciences
                Anatomy
                Body Limbs
                Arms
                Wrist
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
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                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Skeletal Joints
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Skeletal Joints
                Research and Analysis Methods
                Imaging Techniques
                Medicine and Health Sciences
                Radiology and Imaging
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