Background. The sternoclavicular joint is a fundamental resource in the process of estimating the age of a person, both through the analysis of the ossification of the medial clavicular epiphysis and through the evaluation of degenerative morphological changes of the clavicular articular surface. Aim of the study. The present work consists of two parts. A systematic review concerning the radiological use of the sternoclavicular joint in order to estimate the age of a person. An experimental microradiological study that aims to determine the effectiveness of μCT in the evaluation of degenerative changes on both the surfaces of the sternoclavicular joint and of the MCO stage, in order to estimate the age classes. Material and Methods. In the review process three different databases were consulted (Pubmed, Scopus and Web of Science), using appropriately modified search strings for each database. Three examinators independently examined the titles, then the abstracts and finally the full text for each article, according to the inclusion and exclusion criteria established previously. After this step, data extraction tables were developed, that are available in the appendix. As for the experimental study, sternoclavicular bone specimens were collected during forensic autopsies and microCT images were acquired for the evaluation of the MCO stage, according to the Schmealing and Kellinghaus staging systems, and the degenerative morphometrical changes of both joint ends, applying a modification of the FalysPrangle method. Results. The review work included 57 studies from the 1000 collected with the database research: 14 concerning Rx, 26 regarding CT, 10 referring to MRI, 6 concerning Ultrasound and only 1 about μCT. The sample of the study consists of 41 sternoclavicular joints. The MCO stage was evaluable in a single person. The evaluation of the degenerative morphological characteristics showed a positive correlation with age for both articular heads, higher in the sternum than in the clavicle; however, the clavicle holds a stronger discriminative power as it allows the allocation of the individual into three distinct age classes. Conclusions. The review highlighted that CT is the gold standard for the evaluation of the MCO stage of the clavicle, while the use of radiography is recommended only in particular situations. The use of MRI is still controversial, while ultrasound is not recommended. The evaluation of the MCO stage presents itself as a safe system for estimating the age of a person in adolescents (13 - 20 years) and in the transition phase (20 - 30 years); as for over-40s we recommend, instead, the evaluation of bone mineral density and degenerative changes of the bone. From the results of the study, the μCT could be an effective tool both for the evaluation of the medial ossification nucleus and of the degenerative changes on both articular surfaces of the sternoclavicular joint, allowing the possibility of estimate the age class of a person.
Background. L’articolazione sterno-clavicolare rappresenta una risorsa fondamentale nel processo di stima dell’età di un individuo, sia attraverso l’analisi del nucleo di ossificazione mediale della clavicola, che attraverso la valutazione di cambiamenti morfologici degenerativi della superficie articolare clavicolare. Scopo dello studio. Il presente lavoro si compone di due parti: una revisione sistematica riguardante l’utilizzo radiologico dell’articolazione sterno-clavicolare per il processo di stima dell’età di un individuo; uno studio micro-radiologico sperimentale che si pone l’obiettivo di determinare l’efficacia della μTC nella valutazione delle superfici dell’articolazione sterno-clavicolare e dell’MCO stage, valutando la possibilità di inserire il campione in classi di età predeterminate ai fini della stima dell’età in ambito antropologico forense. Materiali e Metodi. Nel processo di revisione tre differenti database sono stati consultati (Pubmed, Scopus e Web of Science), adoperando stringhe di ricerca opportunamente modificate per ogni database. Tre valutatori hanno esaminato indipendentemente prima i titoli, poi gli abstract e infine i full text per ogni articolo, secondo dei criteri di inclusione ed esclusione stabiliti precedentemente. Dopo questo passaggio, sono state elaborate delle tabelle di estrazione dei dati presenti in allegato. Per quanto riguarda lo studio casistico-sperimentale, sono stati raccolti in sede autoptica dei campioni ossei sterno-clavicolari e acquisite immagini micro-tomografiche per la valutazione dell’MCO stage secondo i sistemi di stadiazione di Schmealing e Kellinghaus e dei cambiamenti morfometrici degenerativi di entrambi i capi dell’articolazione, applicando una modifica del metodo Falys-Prangle. Risultati. Il lavoro di revisione ha incluso 57 articoli dai 1000 raccolti con la ricerca sui database: 14 articoli riguardanti l’Rx, 26 riguardanti la CT, 10 riguardanti la RMN, 6 riguardanti l’Ecografia e 1 solo interessante la μCT. Il campione dello studio si compone di 41 articolazioni sterno-clavicolari. L’MCO stage è risultato valutabile in una sola persona. La valutazione delle caratteristiche morfologiche degenerative ha evidenziato una correlazione positiva con l’età per entrambi i capi articolari, maggiore nello sterno che nella clavicola; tuttavia, la clavicola detiene un potere discriminativo maggiore in quanto permette la collazione dell’individuo in tre classi di età distinte, contro le sole due discriminabili attraverso la valutazione del solo capo sternale. Conclusioni. Dal lavoro di revisione emerge come la TC rimanga il gold standard per la valutazione dell’MCO stage della clavicola, mentre l’uso della radiografia è consigliato solo in situazioni di urgenza. L’uso della RMN resta controverso, mentre l’ecografia è assolutamente sconsigliata. La valutazione dell’MCO stage si presenta come un sistema sicuro per la stima dell’età di una persona nella fascia di età che comprende l’adolescenza (13 - 20 anni) e la fase di transizione (20 - 30 anni); in riferimento agli over-40 si consiglia, invece, la valutazione della densità minerale ossea e di cambiamenti degenerativi dell’osso. Dai risultati dello studio, la μTC emerge come uno strumento efficace sia per la valutazione del nucleo di ossificazione mediale, che dei cambiamenti degenerativi su entrambe le superfici articolari dell’articolazione sterno-clavicolare, permettendo la possibilità di stimare efficacemente la classe di età di un individuo.
Stima dell'età alla morte attraverso l'analisi radiologica dell'articolazione sterno-clavicolare: revisione sistematica della letteratura e studio microradiologico sperimentale
PADALINO, PASQUALE
2021/2022
Abstract
Background. The sternoclavicular joint is a fundamental resource in the process of estimating the age of a person, both through the analysis of the ossification of the medial clavicular epiphysis and through the evaluation of degenerative morphological changes of the clavicular articular surface. Aim of the study. The present work consists of two parts. A systematic review concerning the radiological use of the sternoclavicular joint in order to estimate the age of a person. An experimental microradiological study that aims to determine the effectiveness of μCT in the evaluation of degenerative changes on both the surfaces of the sternoclavicular joint and of the MCO stage, in order to estimate the age classes. Material and Methods. In the review process three different databases were consulted (Pubmed, Scopus and Web of Science), using appropriately modified search strings for each database. Three examinators independently examined the titles, then the abstracts and finally the full text for each article, according to the inclusion and exclusion criteria established previously. After this step, data extraction tables were developed, that are available in the appendix. As for the experimental study, sternoclavicular bone specimens were collected during forensic autopsies and microCT images were acquired for the evaluation of the MCO stage, according to the Schmealing and Kellinghaus staging systems, and the degenerative morphometrical changes of both joint ends, applying a modification of the FalysPrangle method. Results. The review work included 57 studies from the 1000 collected with the database research: 14 concerning Rx, 26 regarding CT, 10 referring to MRI, 6 concerning Ultrasound and only 1 about μCT. The sample of the study consists of 41 sternoclavicular joints. The MCO stage was evaluable in a single person. The evaluation of the degenerative morphological characteristics showed a positive correlation with age for both articular heads, higher in the sternum than in the clavicle; however, the clavicle holds a stronger discriminative power as it allows the allocation of the individual into three distinct age classes. Conclusions. The review highlighted that CT is the gold standard for the evaluation of the MCO stage of the clavicle, while the use of radiography is recommended only in particular situations. The use of MRI is still controversial, while ultrasound is not recommended. The evaluation of the MCO stage presents itself as a safe system for estimating the age of a person in adolescents (13 - 20 years) and in the transition phase (20 - 30 years); as for over-40s we recommend, instead, the evaluation of bone mineral density and degenerative changes of the bone. From the results of the study, the μCT could be an effective tool both for the evaluation of the medial ossification nucleus and of the degenerative changes on both articular surfaces of the sternoclavicular joint, allowing the possibility of estimate the age class of a person.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/36448