title: Forensic age estimation from the clavicle using 1.0T MRI--preliminary results.
abstract: OBJECTIVE
  As forensic age estimations in the living are performed without medical indication, there is a need for the development of non-ionizing methods. This study investigates the use of 1.0T MRI to visualize the ossification status of the medial end of the clavicle.
  
  
  METHODS
  T2 weighted 3D images were collected from a 1.0T MR system. We prospectively scanned 102 subjects, 47 autopsy cases and 55 living volunteers (12-33 years). Images were scored in blind trials by three observers using a 4-stage system. Observers differed by level of training and radiological expertise.
  
  
  RESULTS
  Motion artefacts reduced image resolution in living subjects. However, mean age at stage 4 was significantly different from mean age at stage 2 and 3. The minimum age at stage 4 was 19.8 years. Inter-observer agreement was moderate for autopsy cases and slight for living subjects. By contrasting subjects of "incomplete fusion" (≤ stage 3 on both sides) against "fused" (at least one stage 4), agreement rate rose to moderate (K=0.414) for living subjects. Despite the low agreement rate, no subject younger than 18 years was assessed as having "fused" clavicles.
  
  
  CONCLUSIONS
  At lower image resolution, a 2-stage system increases agreements rates among observers. To further increase accuracy, clavicle staging needs to be performed by trained observers. If available, a 1.0T MR system may be used for age estimation in the living. However, further studies are needed to ensure that the ability to discriminate adults from minors, i.e. 18 years, is maintained.
authors.affiliation: Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V Vej 11, DK-2100 Copenhagen Ø, Denmark. Electronic address: saral@sund.ku.dk.
authors.forename: Sara
authors.initials: S
authors.lastname: Tangmose
authors.affiliation: Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 3, DK-2100 Copenhagen Ø, Denmark.
authors.forename: Karl Erik
authors.initials: KE
authors.lastname: Jensen
authors.affiliation: Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V Vej 11, DK-2100 Copenhagen Ø, Denmark. Electronic address: Chiara.villa@forensic.ku.dk.
authors.forename: Chiara
authors.initials: C
authors.lastname: Villa
authors.affiliation: Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V Vej 11, DK-2100 Copenhagen Ø, Denmark. Electronic address: Nly@sund.ku.dk.
authors.forename: Niels
authors.initials: N
authors.lastname: Lynnerup
mesh_terms: D000293:Adolescent; D000328:Adult; D000365:Age Determination by Skeleton / Q000379:methods*; D000704:Analysis of Variance; D002648:Child; D002968:Clavicle / Q000033:anatomy & histology* / Q000502:physiology*; D005260:Female; D018732:Forensic Anthropology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D015588:Observer Variation; D010012:Osteogenesis / Q000502:physiology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D055815:Young Adult
keywords: Age estimation; Clavicle ossification; Forensic radiology; Magnetic resonance imaging