3.0 T MR görüntülemelerde distal femur ve proksimal tibiada adli yaş tespiti: Türk popülasyonunda vieth metodunun uygulanabilirliği retrospektif çalışması
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Date
2019
Authors
Temel, Furkan
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Tıp ve hukuk alanındaki yaşa bağımlı uygulamalar nedeniyle yaş tespiti adli tıp için önemli bir ilgi alanıdır. Bu pilot çalışmamızda, Vieth ve ark.’nın distal femoral ve proksimal tibial epifiz için önerdiği 5’li evreleme yöntemi kullanılarak elde edilen sonuçların uygulanabilir olup olmadığı ile beraber bölgemize özgü cetvelin oluşturulması amaçlandı.
Bursa Uludağ Üniversitesi Tıp Fakültesi Radyoloji Anabilim Dalı tarafından 3.0 Tesla (T) Manyetik Rezonans Görüntüleme (MRG) cihazı ile diz MRG yapılan, yaşları 10-30 arasında değişen, 595 olgunun diz MRG’leri değerlendirildi. Olguların 367’si erkek ve 228’i kadındı. Koronal oryantasyonda T1 ağırlıklı turbo spin eko (T1-w TSE) ve T2 ağırlıklı turbo spin eko (T2-w TSE SPAIR) sekanslarındaki görüntüler çalışma kapsamında değerlendirildi. Değerlendirme iki gözlemci tarafından birbirinden bağımsız olarak gerçekleştirildi. Distal femoral epifizde 6. evrenin izlendiği en küçük yaşlar erkekte 20,61 yıl, kadında 20,15 yıl bulundu. Proksimal tibial epifizde 6. evrenin izlendiği en küçük yaşlar erkekte 18,91 yıl, kadında 16,8 yıl bulundu. Her iki epifiz için çoğu evrede cinsiyetler arasında farklılık anlamlı bulundu. Gözlemciler arası uyumluluk distal femoral epifiz (κ=0,797) için iyi, proksimal tibial epifiz (κ=0,810) için çok iyi bulundu. Gözlemci içi uyumluluk her iki epifiz için (κ>0,80) çok iyi bulundu.
Sonuç olarak, çalışmamızda Vieth ve ark.’nın evreleme yöntemine göre distal femoral epifizin 6. evresi; minimum yaş kavramı çerçevesinde, Türk popülasyonunda her iki cinsiyet için reşitliğin -18 yaşını tamamlama- tespitinde kullanılabilir. Vieth ve ark. tarafından tanımlanan 5’li evreleme yönteminin adli yaş tayininde gözlemciler için kolay ve pratik bir yöntem olduğunu düşünmekteyiz.
Age determination is an important area of interest for forensic medicine due to age-related practices in medicine and law. In this pilot study, it was aimed to create a scale specific to our region with the results obtained by using the staging method proposed by Vieth et al. for the distal femoral and proximal tibial epiphysises. The MRI of 595 patients, aged between 10-30 years, who underwent MRI with 3.0 Tesla (T) Magnetic Resonance Imaging (MRI) device by the Department of Radiology of Bursa Uludağ University Medical Faculty were evaluated. 367 of the cases were male and 228 were female. In coronal orientation, images in T1 weighted turbo spin echo (T1-w TSE) and T2 weighted turbo spin echo (T2-w TSE SPAIR) sequences were evaluated within the scope of the study. The evaluation was performed independently by two observers. In males, the minimum age for stage 6 of the distal femoral epiphysis was 20.61 years, in females it was 20.15 years. In males, the minimum age for stage 6 of the proximal tibial epiphysis was 18.91 years, in females, it was 16.8 years. Sex-related differences was statistically significant in most stages for both epiphysis. The interobserver agreement levels for distal femoral epiphysis and proximal tibial epiphysis were good (κ=0.797) and very good (κ=0.81), respectively. The intraobserver agreement levels for both epiphysis were very good (κ>0.80). In conclusion, according to staging method proposed by Vieth et al., the 6th phase of the distal femoral epiphysis can be used in the Turkish population for the determination of majority - completion of the 18th year of iv life- within the framework of the minimum age concept. We believe that the five staged method defined by Vieth et al. is easy and practical for observers for forensic estimation of age.
Age determination is an important area of interest for forensic medicine due to age-related practices in medicine and law. In this pilot study, it was aimed to create a scale specific to our region with the results obtained by using the staging method proposed by Vieth et al. for the distal femoral and proximal tibial epiphysises. The MRI of 595 patients, aged between 10-30 years, who underwent MRI with 3.0 Tesla (T) Magnetic Resonance Imaging (MRI) device by the Department of Radiology of Bursa Uludağ University Medical Faculty were evaluated. 367 of the cases were male and 228 were female. In coronal orientation, images in T1 weighted turbo spin echo (T1-w TSE) and T2 weighted turbo spin echo (T2-w TSE SPAIR) sequences were evaluated within the scope of the study. The evaluation was performed independently by two observers. In males, the minimum age for stage 6 of the distal femoral epiphysis was 20.61 years, in females it was 20.15 years. In males, the minimum age for stage 6 of the proximal tibial epiphysis was 18.91 years, in females, it was 16.8 years. Sex-related differences was statistically significant in most stages for both epiphysis. The interobserver agreement levels for distal femoral epiphysis and proximal tibial epiphysis were good (κ=0.797) and very good (κ=0.81), respectively. The intraobserver agreement levels for both epiphysis were very good (κ>0.80). In conclusion, according to staging method proposed by Vieth et al., the 6th phase of the distal femoral epiphysis can be used in the Turkish population for the determination of majority - completion of the 18th year of iv life- within the framework of the minimum age concept. We believe that the five staged method defined by Vieth et al. is easy and practical for observers for forensic estimation of age.
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Keywords
Adli tıp, Yaş tayini, Diz, Manyetik rezonans görüntüleme, Forensic medicine, Age estimation, Knee, Magnetic resonance imaging
Citation
Temel, F. (2019). 3.0 T MR görüntülemelerde distal femur ve proksimal tibiada adli yaş tespiti: Türk popülasyonunda vieth metodunun uygulanabilirliği retrospektif çalışması. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.