Age at Death Estimation Using Multislice Computed Tomography Reconstructions of the Posterior Pelvis*

Abstract: Thanks to recent advances, computed tomography is now seen as a tool of great value in the field of physical anthropology. In this study, we focused on the posterior pelvis and the auricular surface and evaluated the accuracy of 3D reconstructions of the auricular surface, using a methodology derived from a previous study by Lovejoy et al. We also looked for trabecular bone criteria expressing age‐related changes. Forty‐six coxal bones were scanned, and scoring of macroscopic criteria showed a good agreement between 3D reconstructions and photographs, especially for transverse organization (k = 0.90). The changes occurring in the posterior part of the sacropubic trabecular bundle were evaluated on CT reconstructions via three new criteria, which exhibited a good intra‐ and inter‐observer agreement (k = 0.77–0.89), and were particularly useful in identifying older subjects. We concluded that these CT‐evaluated trabecular bone criteria are promising and yield useful information about age at death.     

Discrete Traits of the Sternum and Ribs: A Useful Contribution to Identification in Forensic Anthropology and Medicine

During forensic anthropological investigation, biological profile is determined by age, sex, ancestry, and stature. However, several individuals may share the same profile. Observation of discrete traits can yield useful information and contribute to identification. This research establishes the frequency of discrete traits of the sternum and ribs in a modern population in southern France, using 500 computer tomography (CT) scans of individuals aged 15–60 years. Only discrete traits with a frequency lower than 10% according to the literature were considered, a total of eight traits. All scans examined were three‐dimensional (3D) volume renderings from DICOM images. In our population, the frequency of all the discrete traits was lower than 5%. None were associated with sex or age, with the exception of a single trait, the end of the xiphoid process. Our findings can usefully be applied for identification purposes in forensic anthropology and medicine.     

Gender Determination of Adult Individuals by Three‐Dimensional Modeling of Canines

Gender determination is a fundamental issue in forensic anthropology. Many techniques based on bone and dental remains have been proposed. It is not always possible to implement the techniques using bones, but teeth are often perfectly preserved. It has been demonstrated that the canine has the greatest sexual dimorphism, and the aim of this work was to provide an easy and accurate dental technique for determining the gender in the absence of other skeletal elements. The sample was composed of 210 CT scans with four healthy canines. The 840 canines were modeled using MIMICS^® 10.01 software. The total volume of each tooth was determined. Seven mathematical models were determined by binary logistic regressions and ranked in order of relative performance. The seven proposed predictive models thus performed (0.910 ≤ AUC ≤ 0.938), with overall rates of correct predictions between 82.38 and 85.24%. The 4‐canine model is the most powerful for predicting the gender.     

Photogrammetry vs CT Scan: Evaluation of Accuracy of a Low-Cost Three-Dimensional Acquisition Method for Forensic Facial Approximation

Photogrammetry is a three-dimensional acquisition method potentially applicable to the forensic field. This possibility requires the verification of its accuracy. In this study, 3D volumes of skulls are generated to compare the photogrammetry versus the CT scan. In order to provide eligible material to the photogrammetric software, photographs were captured at a distance of 30 cm from the skull placed on a support 1 m in height and illuminated with diffused laboratory ceiling artificial light. A Nikon Coolpix P7100 camera was used. Photographs capture common elements with the previous and the next photograph so as to allow the photogrammetric software to recognize these common points between photographs and create a 3D puzzle. The Zephyr Lite (3DFlow©) software was employed to register the 3D volume. CT-based skulls are taken as a metric reference. The photogrammetry-based skulls are then enlarged according to the measurements of some landmarks or Zygion and Zygion, the distance between end of nasal and base of nasal pyramid for frontal projection, and minimum breadth of the mandibular ramus for the right lateral projection. The accuracy of the photogrammetry is compared to that of the CT scan by measuring the 3D volumes of the skulls studied. Specific landmarks are used as reference points for the measures in both frontal and lateral views. Bland–Altman graph shows homogeneity. The mean difference (1.28 mm) indicates that the measurements taken on the photogrammetry-based skull tend to slightly overestimate compared with the measurements taken on the CT-based skull.     

Bidimensional Data Allow for Better Age Estimation on Immature Specimens than Unidimensional Data: A Preliminary Study on the Ilium

Most biometric age estimation methods used in anthropological and forensic science for juveniles are based on unidimensional measurements (length or width). Here, a new method using bidimensional data was tested. A 3D morphometric analysis was performed on 108 CT scans of ilium bone of juveniles (from 20 gestational weeks to 12 years old). The sample was divided into training and validation groups. Best predictors were determined by comparing the efficiency of each variable (length, width, area, and module: a product of length and width). We established linear and polynomial regressions for each parameter for both sides. Applying the equations to the validation sample showed no significant difference between real and predicted ages. For age estimation, the area and module parameters yielded better results than unidimensional measurements. The results from this preliminary study were highly conclusive, and it would be interesting to extend the work, covering larger samples, and other bones.     

A Preliminary Investigation into the Accuracy of 3D Modeling and 3D Printing in Forensic Anthropology Evidence Reconstruction,

There is currently no published empirical evidence‐base demonstrating 3D printing to be an accurate and reliable tool in forensic anthropology, despite 3D printed replicas being exhibited as demonstrative evidence in court. In this study, human bones (n = 3) scanned using computed tomography were reconstructed as virtual 3D models (n = 6), and 3D printed using six commercially available printers, with osteometric data recorded at each stage. Virtual models and 3D prints were on average accurate to the source bones, with mean differences from ?0.4 to 1.2 mm (?0.4% to 12.0%). Interobserver differences ranged from ?5.1 to 0.7 mm (?5.3% to 0.7%). Reconstruction and modeling parameters influenced accuracy, and prints produced using selective laser sintering (SLS) were most consistently accurate. This preliminary investigation into virtual modeling and 3D printer capability provides a novel insight into the accuracy of 3D printing osteological samples and begins to establish an evidence‐base for validating 3D printed bones as demonstrative evidence.     

Quantitative Analysis of the Morphological Changes of the Pubic Symphyseal Face and the Auricular Surface and Implications for Age at Death Estimation

Age estimation methods are often based on the age‐related morphological changes of the auricular surface and the pubic bone. In this study, a mathematical approach to quantify these changes has been tested analyzing the curvature variation on 3D models from CT and laser scans. The sample consisted of the 24 Suchey–Brooks (SB) pubic bone casts, 19 auricular surfaces from the Buckberry and Chamberlain (BC) “recording kit” and 98 pelvic bones from the Terry Collection (Smithsonian Institution). Strong and moderate correlations between phases and curvature were found in SB casts (ρ 0.60–0.93) and BC “recording kit” (ρ 0.47–0.75), moderate and weak correlations in the Terry Collection bones (pubic bones: ρ 0.29–0.51, auricular surfaces: ρ 0.33–0.50) but associated with large individual variability and overlap of curvature values between adjacent decades. The new procedure, requiring no expert judgment from the operator, achieved similar correlations that can be found in the classic methods.     

Determination of Sex: Interest of Frontal Sinus 3D Reconstructions

Frontal sinuses (FSs) have been studied in radiology, anthropology, and forensic anthropology. This study aimed to determine whether it was possible to predict the age and sex of an individual using FS volume. Sixty‐nine anonymized CT scans were imported to MIMICS 10.01^® software (Materialise N.V.), and each FS volume was calculated in mm³. There was an absence of significant difference between right and left FS volume (p = 0.173) and an absence of correlation between age and FS volume (Pearson's test; p = 0.705). Sexual dimorphism was significantly different (p = 0.001). However, the most discriminant datum for determining sex was found to be the total FS volume (sum of an individual's right and left FS volumes) with linear discriminant Fisher's function coefficients of ?2.759 for the male group and ?1.275 for the female group. With this model, 72.5% of our sample was correctly classified according to sex.     

Application of the Iscan method to two- and three-dimensional imaging of the sternal end of the right fourth rib

Age determination is a major field of interest in physical and forensic anthropology. Among the different methods based on macroscopic skeletal study, the Iscan method, which analyzes the sternal end of the right fourth rib, is one of the most reliable. We applied the Iscan method to two- and three-dimensional multislice computed tomography (MSCT) reconstructions of the sternal end of the right fourth rib on 39 ribs. The intra-observer variability on MSCT reconstructions was good (gamma coefficient equal to 0.86; value of the Krippendorff's alpha reliability equal to 0.79); inter-observer variability on MSCT reconstructions was also good (gamma coefficient ranging from 0.82 to 0.88; value of the Krippendorff's alpha reliability ranging from 0.78 to 0.86). We demonstrated excellent agreement between the results of analysis of bone samples and those of the two- and three-dimensional images, in particular regarding bone projections, morphology of the pit and of its rim. The accuracy of age estimation did not significantly differ between the Iscan method applied to dry bones and the same method applied to MSCT images. Determination of the Krippendorff's alpha reliability coefficient for the inter-error method confirmed the agreement between phase estimations obtained with the two methods (ranging from 0.55 to 0.71). The real civil age was comprised in 21 cases out of 36 for assessment performed on dry bones and in 23 cases out of 36 on MSCT reconstructions, which represented 58.3% and 63.9%, respectively. Use of MSCT reconstructions in forensic anthropology offers many advantages: no bone preparation, no damage to bone material, and the possibility of application to living individuals.     

Difficulties of sex determination from forensic bone degraded DNA: A comparison of three methods

Sex determination is of paramount importance in forensic anthropology. Numerous anthropological methods have been described, including visual assessments and various measurements of bones. Nevertheless, whatever the method used, the percentage of correct classification of a single bone usually varies between 80% and 95%, due to significant intra- and inter-population variations, and sometimes variations coming from secular trends. DNA is increasingly used in a forensic context. But forensic DNA extraction from bone raises several issues, because the samples are very often badly altered and/or in very small quantity. Nuclear DNA is difficult to get from degraded samples, according to low copy number, at least in comparison with mitochondrial DNA. In a forensic context (as in a paeleoanthropological context) DNA sex determination is usually complicated by the weak amount of DNA, the degraded nature of nucleic acids, the presence of enzymatic inhibitors in DNA extracts, the possible faint amplification of Y band and the risk of contamination during either excavation or manipulation of samples.The aim of this work was to compare three methods of DNA sex determination from bones: procedure #1 using a single PCR amplification, procedure #2 using a double PCR amplification, and procedure #3 adding bleaching for decontamination of the bone, instead of simply rubbing the bone. These processes were applied to samples of bones (49 samples coming from 39 individuals) that were in various states of post mortem alteration.The main results are the following. (i) No DNA could be extracted from three skulls (parietal bones, mastoid process), the compact bone of one rib, and the diaphysis of one femur; (ii) there was a contamination in three skulls; and (iii) the Y band did not appear in two male cases, with one of the three procedures (male tibia, procedure #2) and with procedures #2 and #3 (male femur).This study emphasises the main issue while working with altered bones: the impossibility to extract DNA in some cases, and, worth of all, the contamination of the sample or the faint amplification of Y band which leads to a wrong sex answer. Multiple and significant precautions have to be taken to avoid such difficulties.     

Hyperostosis frontalis interna as an age-related phenomenon – Differences between males and females and possible use in identification

Hyperostosis frontalis interna (HFI) is a condition manifested by thickening of the inner surface of the frontal bone and it could be useful when dealing with the identification of human remains in various anthropological and forensic investigations. We compared the macroscopic appearance and morphologic (metric) features of the skulls in cases with and without HFI, in both sexes, and wanted to establish whether age determined occurrence of HFI. To achieve this aim, we performed prospective autopsy study, covering ten-year period (2007–2016). Study group consisted of southeast Europe Caucasian subjects, with determined age and sex. The severity of HFI was classified by two forensic pathologists independently, according to the four types (A–D) proposed by Hershkovitz et al. Thicknesses of the frontal and temporal bones, as well as the longitudinal and frontal diameters of the skulls were measured. The sample consisted of 35 males and 112 females with HFI, and 55 males and 202 females without HFI (404 individuals in total). Type B was the most common type of HFI among males (45%) and type C among females (41%). HFI type D was almost four times more common in females than in males (OR?=?3.73). Frontal and temporal bones were thicker in all subjects who have HFI. Thickness of the skull was not age-dependent, in the entire sample, or in subjects with HFI, or in the control group (in all the cases Spearman's Rho was <0.3). Age seemed to be a predicting factor for HFI occurrence only in females. Females younger than 55?years have similar risk for HFI occurrence as males. An unidentified skull with the general markers of old age and severe form HFI is most probably from a female decedent.     

Comparison Among Manual Facial Approximations Conducted by Two Methodological Approaches of Face Prediction

This study verified the difference between two methods of forensic facial approximation (FFA) regarding recognition and resemblance rates. Three‐dimensional models of skulls were obtained from computerized tomography (CT) scans of two subjects (targets). Two manual FFAs were performed for each target, by applying two different guidelines for the facial structures (what we called “American method” (AM) and “Combined method” (CM)). Unfamiliar assessors evaluated the sculptures by recognition and resemblance tests. The AM was that which allowed more correct responses of recognition and higher resemblance's scores for the male target (p < 0.001). Regarding guidelines for modeling characteristics of the face, the ones that are practical and easily performed for sculptures, such as the length of the anterior nasal spine multiplied by 3 for nose prediction, may offer better results in terms of resemblance.     

Pubic Symphyseal Age Estimation from Three‐Dimensional Reconstructions of Pelvic CT Scans of Live Individuals

Skeletal age estimation using the pubic symphysis is a reliable and popular practice among forensic anthropologists. In instances in which accessing the skeleton is impossible, such as in the case of living individuals, three‐dimensional (3D) reconstructions of computed tomography (CT) scans can be created and analyzed for aspects of the biological profile. This study examined 3D reconstructions of pelvic CT scans of a sample of 44 live adults to estimate age using the Suchey–Brooks J Hum Evol 1990;5(3):227‐38 method. Images were created using OsiriX software (Pixmeo, Geneva, Switzerland). Estimated age ranges based on the 3D‐CT images captured the true age of the individual at the time of the CT scan 79.5% of the time with good intra‐observer reliability. The features best visualized on the 3D images included the ossific nodule and the pubic symphyseal rim. This study shows that clinical CT scanning parameters are adequate for creating 3D images to be analyzed for age using the pubic symphysis.     

An Analysis of Hounsfield Unit Values and Volumetrics from Computerized Tomography of the Proximal Femur for Sex and Age Estimation

Sex and age are two elements in the establishment of a biological profile for forensic identification. While the pelvic bones are the most ideal structures for sex estimation, the condition of a body is not always ideal due to the nature of death, such as in mass disasters, or postmortem processes. This study utilized CT scans and resultant 3D models of 100 male and 100 female adults of known ages ranging from 18 to 98 years old to collect volumetric and Hounsfield unit measurements of the proximal femur. Equations were created to establish logistic regression models for sex estimation and linear regression models for age estimation. The resultant sex estimation method had an accuracy of 93.5% and utilized the volume of the proximal femur. This study provides three linear regression models for age with an accuracy range of 86%–92% ±12 years. As imaging technologies are increasingly adopted for forensic purposes, the power of 3D data will provide the opportunity for more quantitative and reproducible analyses. The proposed method for sex and age estimation provides a reliable tool that can be utilized in both day-to-day casework and disaster victim identification.     

Virtual determination of sex: metric and nonmetric traits of the adult pelvis from 3D computed tomography models

Examination of the adult os coxae and sacrum is one of the most common methods of sex estimation from bone. Medical imaging, such as computed tomography (CT), provides the opportunity for three-dimensional (3D) imaging of the skeleton from clinical scans of known individuals in situ. In this study, a randomly selected subset of abdominopelvic CT-derived models were used to evaluate simple, repeatable metric methods of sex estimation based on a combination of obstetric measurements and the traditionally nonmetric Phenice-derived traits. A four-variable discriminant function for sex estimation was developed based on statistical analyses. Overall, the cross-validated accuracy of this method was 100%, with inter-observer error showing an average of only 2.2%. Comparative analysis was run on the data set using FORDISC 3.0. This study shows that current sex determination standards from the pelvis should be updated to include more in vivo data to increase the accuracy of identification.     

Three-dimensional modeling of the various volumes of canines to determine age and sex: a preliminary study

Canines are usually used in anthropological and forensic sciences for sex and age determination. The best methods to estimate age are based on secondary dentine apposition, evaluated from periapical X-rays. The aim of this study was to propose a new method of sex and age estimation using 3D models to obtain more precise predictions using tooth volumes. Fifty-eight dental CT scans of patients aged 14-74 with a well-balanced sex ratio composed the sample. One hundred and thirty-three healthy canines were modeled (Mimics 12.0). The sample was divided into a training sample and a validation sample. An age formula was determined using the "pulp volume/tooth volume" ratio. Sex prediction was adjusted with total volumes. Applying the equations to the validation sample, no significant difference was found between the real and predicted ages, and 100% of the sex predictions were correct. This preliminary study gives interesting results, and this method is worth being tested on a larger data sample.     

A Reliable Regression‐Based Approach for Reassociating Human Skeletal Elements of the Lower Limbs from Commingled Assemblages

Accurate sorting of commingled human remains comprises a fundamental requirement for all further anthropological analyses. The lower limb bones are particularly important for reconstructing biological profiles. This study introduces a metric technique for sorting these elements using eight standard anthropological measurements and 222 adult individuals from Greece. The bones utilized were the os coxae, the femora, the tibiae and the tali. Simple regression analyses were used to develop functions for reassociating articulating bones, providing strong correlations (r = 0.74–0.95, p‐value <0.05) and high coefficients of determination (r²=0.54–0.91). Blind tests demonstrated that combining metric and morphoscopic techniques provides an excellent sorting accuracy for the hip and knee joints (ten of ten individuals), allowing for a reliable reassociation between a sex and age indicator (os coxae) and a body size indicator (femur). Overall, these results indicate the high value of metric methods in sorting commingled human remains.     

眶下裂和眶下沟横断面CT表现及其解剖基础研究

目的研究正常人眶下裂和眶下沟横断面CT表现及其解剖基础,避免将其误认为眶壁骨折。方法正常颅骨25个,肉眼观察眶下裂和眶下沟解剖形态。5个颅骨和20名正常人,眶横断面CT扫描,观察眶后外侧形态,15例辅以多平面重建和三维立体重建。结果在标本和正常人横断面上,眶后外侧面同时反映眶外侧壁和大部分眶下壁,其表现有:(1)单处缺裂,两侧对称或不对称;(2)双处缺裂,缺裂之间夹有片状小骨,小骨长轴与眶外侧壁平行一致;(3)类似双处缺裂,缺裂之间出现片状小骨,小骨呈锥状,长轴在前后方向上。大体标本和眼眶重建图像显示,上述三种情况分别对应的解剖基础是:(1)棒球杆样眶下裂;(2)V形眶下裂,即眶下裂分内外两支,内支位于蝶骨大翼下缘与下颌骨后缘间,外支位于蝶骨大翼下缘与颧骨之间,内外支间形成一向上开口的“V”字形;(3)深陷的眶下沟,伴有突出并向内倾斜的外侧壁。结论熟悉正常人眶下裂和眶下沟的横断面CT表现及其解剖学基础,可以避免将其误认为眶壁骨折。     

西南地区成人男性颅骨的相关回归分析

目的研究颅骨部分测量指标间的相关性,以期建立在对破损颅骨进行颅骨面貌复原时,利用尚存指标推断缺失指标的方法。方法用人体骨骼测量仪对41个男性颅骨的颅长、颅宽、颅高等14个指标进行测量,将测量值输入SPSS统计软件,找出相关性好的指标,建立各指标间相互推断的回归方程。结果部分测量指标间呈中度以上相关,应用逐步回归的方法得出回归方程24个,方差检验均具统计学意义(P<0.01)。结论本研究所建立的回归方程可为法医人类学和考古人类学的颅骨修复提供备选方法。     

Evaluation of pediatric skull fracture imaging techniques

Radiologic imaging is crucial in the diagnosis of skull fracture, but there is some doubt as to whether different imaging modalities can accurately identify fractures present on a human skull. While studies have been performed to evaluate the efficacy of radiologic imaging at other anatomical locations, there have been no systematic studies comparing various CT techniques, including high resolution imaging with and without 3D reconstructions to conventional radiologic imaging in children, we investigated which imaging modalities: high-resolution CT scan with 3D projections, clinical-resolution CT scans or X-rays, best showed fracture occurrence in a pediatric human cadaver skull by having an expert pediatric radiologist examine radiologic images from fractured skulls. The skulls used were taken from pediatric cadavers ranging in age from 5 months to 16 years. We evaluated the sensitivity and specificity for the imaging modalities using dissection findings as the gold standard. We found that high-resolution CT scans with 3D projections and conventional CT provided the most accurate fracture diagnosis (single-fracture sensitivity of 71%) followed by X-rays (single-fracture sensitivity of 63%). Linear fractures outsider the region of the sutures were more identifiable than diastatic fractures, though the incidence of false positives was greater for linear fractures. In the two cases where multiple fractures were present on the same anatomical skull location, the radiologist was less likely to identify the presence of additional fractures than a single fracture. Overall, the high-resolution and clinical-resolution CT scans had the similar accuracy for detecting skull fractures while the use of the X-ray was both less accurate and had a lower specificity.