The value of sub-stages and thin slices for the assessment of the medial clavicular epiphysis: a prospective multi-cente
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ORIGINAL ARTICLE
The value of sub-stages and thin slices for the assessment of the medial clavicular epiphysis: a prospective multi-center CT study Daniel Wittschieber • Ronald Schulz • Volker Vieth • Martin Ku¨ppers • Thomas Bajanowski • Frank Ramsthaler • Klaus Pu¨schel • Heidi Pfeiffer Sven Schmidt • Andreas Schmeling
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Accepted: 15 October 2013 Ó Springer Science+Business Media New York 2013
Abstract The clavicle plays an important role for forensic age estimation in living individuals, particularly with regard to the age of majority. The present prospective study aims to evaluate the age-dependent ossification process of the medial clavicular epiphysis in order to establish the clavicular sub-stages introduced in 2010 as well as the advantages and possibilities of thin-slice computed tomography (CT). For this purpose, 0.6 mm thin-slice CT scans of sternoclavicular joints of 572 bodies aged between 10 and 40 years were evaluated by means of two D. Wittschieber (&) R. Schulz M. Ku¨ppers H. Pfeiffer S. Schmidt A. Schmeling Institute of Legal Medicine, University Hospital Mu¨nster, Ro¨ntgenstraße 23, 48149 Mu¨nster, Germany e-mail: [email protected] V. Vieth Institute of Clinical Radiology, University Hospital Mu¨nster, Mu¨nster, Germany T. Bajanowski Institute of Legal Medicine, University Hospital Essen, Essen, Germany F. Ramsthaler Institute of Legal Medicine, University Hospital Frankfurt/Main, Frankfurt/Main, Germany F. Ramsthaler Institute of Legal Medicine, University of the Saarland, Homburg/Saar, Germany K. Pu¨schel Institute of Legal Medicine, University Hospital HamburgEppendorf, Hamburg, Germany S. Schmidt Institute of Legal Medicine and Forensic Sciences, Charite´, University Medicine Berlin, Berlin, Germany
complementary classification systems: a five-stage system and a sub-staging system for the main stages 2 and 3. Assessment was possible in 493 cases. The results for stages 4 and 5 are in line with previous studies that found the ages of 21 years and 26 years, respectively, as minimum ages for these stages. Sub-stage 3c was first found at the age of 19 years in both sexes, thereby corroborating the value of this sub-stage as to statements about the age of majority. In comparison to other CT studies, stage 3a was first observed *1 year earlier (16.4 years in males and 15.5 years in females). Stage 2c only occurred in 3 cases. In conclusion, the data corroborate the significance of diagnosing sub-stages as well as the value of thin-slice CT. For forensic practice, the concomitant and complementary use of both classification systems applied in this study can be recommended. Keywords Medial clavicular epiphysis Forensic age estimation Thin-slice multi-detector computed tomography Influence of the slice thickness Ossification stage and sub-stage
Introduction In previous decades, forensic age estimation in living individuals has developed and become a widely expanded field of research within the forensic sciences, with a number of different novel approaches and co
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