The epiphyseal scar: changing perceptions in relation to skeletal age estimation

Davies, Catriona; Hackman, Lucina; Black, Sue

doi:10.3109/03014460.2015.1031825

Cited by 9 publications

(6 citation statements)

References 39 publications

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“…The value of the physeal scar for age estimation has always been doubted, in studies on the clavicle, 4,6 as well as in studies on other long bones. [19][20][21] Correspondingly, the current findings suggested no loss in age estimation performance by merging stages 4 and 5. However, the disappearance of the physeal scar might be important in individuals who are older than the current sample.…”

Section: Discussionsupporting

confidence: 66%

Staging Clavicular Development on MRI: Pitfalls and Suggestions for Age Estimation

Tobel¹,

Hillewig

Wijk

et al. 2019

Magnetic Resonance Imaging

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Background MRI of the clavicle's sternal end has been studied for age estimation. Several pitfalls have been noted, but how they affect age estimation performance remains unclear. Purpose/Hypothesis To further study these pitfalls and to make suggestions for a proper use of clavicle MRI for forensic age estimation. Our hypotheses were that age estimation would benefit from 1) discarding stages 1 and 4/5; 2) including advanced substages 3aa, 3ab, and 3ac; 3) taking both clavicles into account; and 4) excluding morphological variants. Study Type Prospective cross‐sectional. Population Healthy Caucasian volunteers between 11 and 30 years old (524; 277 females, 247 males). Field Strength/Sequence 3T, T1‐weighted gradient echo volumetric interpolated breath‐hold examination (VIBE) MR‐sequence. Assessment Four observers applied the most elaborate staging technique for long bone development that has been described in the current literature (including stages, substages, and advanced substages). One of the observers repeated a random selection of the assessments in 110 participants after a 2‐week interval. Furthermore, all observers documented morphological variants. Statistical Tests Weighted kappa quantified reproducibility of staging. Bayes' rule was applied for age estimation with a continuation ratio model for the distribution of the stages. According to the hypotheses, different models were tested. Mean absolute error (MAE) differences between models were compared, as were MAEs between cases with and without morphological variants. Results Weighted kappa equaled 0.82 for intraobserver and ranged between 0.60 and 0.64 for interobserver agreement. Stages 1 and 4/5 were allocated interchangeably in 4.3% (54/1258). Age increased steadily in advanced substages of stage 3, but improvement in age estimation was not significant (right P = 0.596; left P = 0.313). The model that included both clavicles and discarded stages 1 and 4/5 yielded an MAE of 1.97 years, a root mean squared error of 2.60 years, and 69% correctly classified minors. Morphological variants rendered significantly higher MAEs (right 3.84 years, P = 0.015; left 2.93 years, P = 0.022). Data Conclusion Our results confirmed hypotheses 3) and 4), while hypotheses 1) and 2) remain to be investigated in larger studies. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:377–388.

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Section: Discussionsupporting

confidence: 66%

Staging Clavicular Development on MRI: Pitfalls and Suggestions for Age Estimation

Tobel¹,

Hillewig

Wijk

et al. 2019

Magnetic Resonance Imaging

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“…Radiological studies have also shown visible remnants of the growth plate (physeal scar) on radiographs both in the knee 25 and upper extremity. 26 , 27 Faisant et al. 25 showed a physeal scar in at least one of the bones of the knee joint in 96% of females and 98% of the males in a population aged between 15 and 40 years.…”

Section: Discussionmentioning

confidence: 99%

Comparison of reliability of magnetic resonance imaging using cartilage and T1-weighted sequences in the assessment of the closure of the growth plates at the knee

Kvist

Dallora

Nilsson

et al. 2020

Acta Radiologica Open

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Background Growth development is traditionally evaluated with plain radiographs of the hand and wrist to visualize bone structures using ionizing radiation. Meanwhile, MRI visualizes bone and cartilaginous tissue without radiation exposure. Purpose To determine the state of growth plate closure of the knee in healthy adolescents and young adults and compare the reliability of staging using cartilage sequences and T1-weighted (T1W) sequence between pediatric and general radiologists. Material and Methods A prospective, cross-sectional study of MRI of the knee with both cartilage and T1W sequences was performed in 395 male and female healthy subjects aged between 14.0 and 21.5 years old. The growth plate of the femur and the tibia were graded using a modified staging scale by two pediatric and two general radiologists. Femur and tibia were graded separately with both sequences. Results The intraclass correlation was overall excellent. The inter- and intra-observer agreement for pediatric radiologists on T1W was 82% (κ = 0.73) and 77% (κ = 0.65) for the femur and 90% (κ = 0.82) and 87% (κ = 0.75) for the tibia. The inter-observer agreement for general radiologists on T1W was 69% (κ = 0.56) for the femur and 56% (κ = 0.34) for the tibia. Cohen’s kappa coefficient showed a higher inter- and intra-observer agreement for cartilage sequences than for T1W: 93% (κ = 0.86) and 89% (κ = 0.79) for the femur and 95% (κ = 0.90) and 91% (κ = 0.81) for the tibia. Conclusion Cartilage sequences are more reliable than T1W sequence in the assessment of the growth plate in adolescents and young adults. Pediatric radiology experience is preferable.

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“…Although sometimes utilized as a synonym for epiphyseal scar (Albert & Maples, ; Cardoso, ), we use the term epiphyseal line to refer to the “line” marking the junction between epiphyses and metaphyses on the surface of a dry bone. Unlike what was observed for the epiphyseal line, the epiphyseal scar (observed radiographically) on the tibia and radius does not seem to be related to age (Davies et al, , , ). In addition, Faisant et al (), who analyzed the knee joint, found no indication that the longevity of the epiphyseal scar might be a possible indicator of recent fusion, therefore lacking a correlation with biological age.…”

Section: Discussionmentioning

confidence: 93%

“…Some studies conducted by radiography have stressed that, once the epiphyseal‐diaphyseal fusion is completed, the persistence of an epiphyseal scar may still be visible in some adults (Baumann et al, ; Cameriere, Cingolani, Giuliodori, De Luca, & Ferrante, ; Cope, ; Flecker, ; Krogman & İşcan, ; O'Connor, Coyle, Spence, & Last, ; Schmeling et al, ; Schulz et al, ; Schulz, Mühler, Reisinger, Schmidt & Schmeling, ; Todd, ; Walker & Lovejoy, ). In seeking a possible correlation between this trait and age, a persistence of the scar has been observed until the fifth decade of life, but with no significant correlation, suggesting that its occurrence might depend on other factors, such as living conditions and environmental influences on its distribution (Davies, Hackman, & Black, , , ; Faisant et al, ). In dry bone examinations, it has been observed that the epiphyseal line persists into adulthood (Albert & Maples, ; MacLaughlin, ; Stevenson, ).…”

Section: Introductionmentioning

confidence: 99%

Variations in epiphyseal fusion and persistence of the epiphyseal line in the appendicular skeleton of two identified modern (19th–20th c.) adult Portuguese and Italian samples

Belcastro

Pietrobelli

Rastelli

et al. 2019

American J Phys Anthropol

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Objectives: The aim of this work is to study age, sex, and population variations in epiphyseal fusion and persistence of the epiphyseal line in the appendicular skeleton of two identified modern (19th-20th c.) adult skeletal samples, using a specifically designed macroscopic scoring method. The use of epiphyseal closure and persistence of the epiphyseal line as an adult-age marker is also discussed. Materials and methods: This study examined 981 adult skeletons of both sexes from two identified modern (20th c.) skeletal samples from the Sassari Collection (Museum of Anthropology, University of Bologna, Italy) and the Colecção de Esqueletos Identificados (Museum of Anthropology, University of Coimbra, Portugal). Our scoring method considers a five-degree scale, from nonfusion (Degree 0) to complete fusion (Degree 4). In addition, the persistence of the epiphyseal line, a feature that is not commonly collected during routine anthropological analyses, is taken into account here as Degree 3.Results: Intra-and interobserver errors of 1.2% and 5.2%, respectively, were found, suggesting a good reproducibility of this scoring method. Some sites show variable degrees of epiphyseal fusion still in adult skeletons (e.g., secondary center of ossification of the clavicle, iliac crest, ischial tuberosity, distal epiphysis of the radius and ulna).Conclusions: Population differences have been observed, showing a delay in the complete epiphyseal closure for the Sassari sample compared to the Coimbra sample.Degree 3 seems to be a good adult-age indicator for individuals less than 35-year-old.

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The epiphyseal scar: changing perceptions in relation to skeletal age estimation

Abstract: Background: It is imperative that all methods applied in skeletal age estimation

Cited by 9 publications

References 39 publications

Staging Clavicular Development on MRI: Pitfalls and Suggestions for Age Estimation

Staging Clavicular Development on MRI: Pitfalls and Suggestions for Age Estimation

Comparison of reliability of magnetic resonance imaging using cartilage and T1-weighted sequences in the assessment of the closure of the growth plates at the knee

Variations in epiphyseal fusion and persistence of the epiphyseal line in the appendicular skeleton of two identified modern (19th–20th c.) adult Portuguese and Italian samples

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