Retrospective evaluation of medial clavicular epiphysis computed tomography images in terms of employability in age assessment

Age assessment plays an important role among forensic medicine practises. Recently, radiological methods are most frequently adopted in age assessment and reference atlases based on skeletal maturity and changes in bones are used for the assessment of bone age. However, since epiphyseal closure of evaluated bones occurs by the end of age 22, limited data is available for ages over 22. With the advances in technology, age assessment studies on the use of radiological methods other than x-rays started to be performed in different societies. Especially following the routine use of Computed Tomography, some epiphyseal plates previously undetectable in x-rays are employed in age assessment. In our study, we aimed to evaluate the employability of medial clavicular epiphysis thoracic computed tomography images in age assessment cases, due to age 22 restriction of x-rays. Archived images of 2294 cases from both genders, aged from 0 to 40 on the day of application to Ege University Medical Faculty Hospital, who had undergone Multislice Thorax CT scanning for various reasons at the Department of Radiology, EUMF have been examined retrospectively. Right and left medial clavicular epiphysial plates have been staged according to "Schmeling staging". ANOVA model has been employed for statistical evaluation. Thorax computed tomography images of 1051 men and 611 women aged between 0 and 40 have been evaluated. It has been found that a woman assassed to be Stage 1 can be 5.65±4.42 years old on average, a man assessed to be Stage 1 can be 6.39±4.78 years old on average, Stage 2 women average age is 17.08±2.25, men average age is 18.73±2.40, Stage 3 women average age is 22.00±2.46, men average age is 22.87±3.21, Stage 4 women average age is 28.04±4.30, men avarage is 28.30±3.09, Stage 5 women average is 35.35±3.68, men average age is 34.52±3.75. Analysis of variance revealed stage, gender and stage-gender interaction effect to be significant. According to this, stages have been compared to each other using Tukey's Studentized Range (HDS) test. As a result of these comparisons, all stages have been found be significantly different than each other (p<0.05). Effect of the gender factor has been evaluated for each stage using t-test. Evaluation revealed significant difference in averages with regards to gender for Stages 2 and 5 (p<0.05), and insignificant difference for other stages (p>0.05). Among the cases examined, an even number of cases from each stage has been selected and 151 cases have been evaluated by a second observer. Interobserver reliability has been found to be statistically significant and significant reliability has been secured (p<0.01). Nonetheless, to evaluate intraobserver reliability of the first observer, same cases have been re-evaluated by the first observer at a different time. Adequate intraobserver reliability has been secured and shown to be statistically significant (p<0.01). As a result, due to intra and inter-observer reliability, CT has been found to be a decent radiological technique for the evaluation of clavicular epiphyseal line. Evaluation of CT images of clavicular medial epiphysis has been found to be an adequate method for age estimation; however simultaneous assessment of all radiological images may help provide more accurate results.