dr. sc. MIHANOVIĆ FRANE mag. med. rad.
„USE OF X-RAY IMAGES IN DETERMINING THE STAGE OF FUSION OF EPIPHYSES AND DIAPHYSES OF LONG BONES OF THE KNEE JOINT IN ASSESSMENT OF AGE IN TWO DIFFERENT POPULATIONS“
prof. dr.sc. JANKOVIĆ STIPAN
Qualifying research publications:
Galić I, Mihanović F, Giuliodori A, Conforti F, Cingolani M, Cameriere R. Accuracy of scoring oft he epiphyses at the knee joint (SKJ) for assessing legal adult age of 18 years. International journal of legal medicine 2016;130:1129-42.
(Prvo autorstvo s jednakim doprinosom, engl. Contributed equally to this work).
IF (JCR 2015) 2.862
Galic I, Vodanović M, Janković S, Mihanović F, Nakaš E, Prohić S, Galić E, Brkić H. (2013). Dental age estimation on Bosnian-Herzegovinian children aged 6-14 years: Evaluation of Chaillet's international maturity standards.
Journal of forensic and legal medicine 2013;20(1), 40-45. (5 year IF=1.013)
IF (JCR 2013) 0.989
Important aspects of forensic practice are age estimation and discrimination of individuals of unknown age as adults and minors. The developing knee joint was recognized as a potential site for age examination in late adolescence.
In this retrospective study we analyzed anteroposterior x-rays of the left knee joint in two populations (Umbria, Italy and Herzegovina, Bosnia and Herzegovina). We analyzed a sample of anteroposterior x-rays of the knee joints from 446 living individuals from Umbria, Italy (234 males and 212 females), aged between 12 and 26 years, and 684 living individuals from Herzegovina, Bosnia and Herzegovina (374 males and 310 females), aged between 10 and 27 years.
We evaluated the ossification of the distal femoral (DF), proximal tibial (PT) and proximal fibular (PF) epiphyses and we took into account possible persistence of the epiphyseal scars in the ossified epiphyses by the adopted stages of those previously introduced by Cameriere et al. We also used measurements from all three epiphyses to calculate the total score of maturation for the knee joint (SKJ).
Cohen Kappa coefficients of intra-rater agreement for staging the DF, PT and PF epiphyses were 0.839, 0.894, 0.907, while inter-rater agreement was 0.919, 0.791, 0.907 respectively. The resulting receiver operating characteristic (ROC) curves of SKJ showed better discriminatory power than those for DF, PT, PF epiphyses in predicting that the participant, either male or female, was an adult or a minor. The areas under the curves (AUC) for SKJ in Umbria were 0.99 and 0.97 while individual AUC for DF, PT and PF were 0.94, 0.96, 0.97 for male participants vs. 0.89, 0.91, 0.92 for females, respectively. The AUC for SKJ in the study population from Herzegovina were 0.97 for male and 0.94 for female, while individual AUC for DF, PT and PF were 0.92, 0.93, 0.94 for male and 0.86, 0.88, 0.89 for female, respectively.
The results in the study population from Umbria showed that SKJ score ≥ 4 in males and SKJ score ≥ 5 in females were the most suitable cut-off value in discriminating between adults and minors. The sensitivity test for males was 0.94 (95 % CI 0.90 to 0.98) and specificity was 0.96 (95 % CI 0.91 to 0.98). The proportion of correctly classified individuals was 0.95 (95 % CI 0.91 to 0.97). For females, the sensitivity test was 0.89 (95 % CI 0.84 to 0.92) and specificity was 0.92 (95 % CI 0.87 to 0.96), while the proportion of correctly classified individuals was 0.90 (95 % CI 0.85 to 0.94).
The results in the study population from Herzegovina showed that SKJ score ≥ 5 in males and SKJ score ≥ 5 in females were the most suitable cut-off value in discriminating between adults and minors. The sensitivity test for males was 0.93 (95 % CI 0.88 to 0.95) and specificity was 0.91 (95 % CI 0.88 to 0.95). The proportion of correctly classified individuals was 0.95 (95 % CI 0.91 to 0.97). For females, the sensitivity test was 0.98 (95 % CI 0.95 to 0.98) and specificity was 0.92 (95 % CI 0.87 to 0.96), while the proportion of correctly classified individuals was 0.83 (95 % CI 0.80 to 0.84).
The results of this study evaluated the validity and reliability of the distal femoral, proximal tibial and proximal fibular epiphyses ossification measurements using SKJ method in two different populations. The SKJ method should be evaluated in different populations to verify its usefulness and possible ethnic, racial and socio-economic influence on recommended SKJ cutt-off values in forensic procedures for discriminating individuals of legal adult age of 18 years.