Magnetic resonance imaging of the knee for chronological age estimation-a systematic review

Abstract

Introduction: Radiographs of the hand and teeth are frequently used for medical age assessment, as skeletal and dental maturation correlates with chronological age. These methods have been criticized for their lack of precision, and magnetic resonance imaging (MRI) of the knee has been proposed as a more accurate method. The aim of this systematic review is to explore the scientific and statistical evidence for medical age estimation based on skeletal maturation as assessed by MRI of the knee.

Materials and methods: A systematic review was conducted that included studies published before April 2021 on living individuals between 8 and 30 years old, with presumptively healthy knees for whom the ossification stages had been evaluated using MRI. The correlation between "mature knee" and chronological age and the risk of misclassifying a child as an adult and vice versa was calculated.

Results: We found a considerable heterogeneity in the published studies -in terms of study population, MRI protocols, and grading systems used. There is a wide variation in the correlation between maturation stage and chronological age.

Conclusion: Data from published literature is deemed too heterogenous to support the use of MRI of the knee for chronological age determination. Further, it is not possible to assess the sensitivity, specificity, negative predictive value, or positive predictive value for the ability of MRI to determine whether a person is over or under 18 years old.

Key points: • There is an insufficient scientific basis for the use of magnetic resonance imaging of the knee in age determination by skeleton. • It is not possible to assess the predictive value of MRI of the knee to determine whether a person is over or under 18 years of age.

Keywords: Age determination by skeleton; Knee joint; Magnetic resonance imaging; Predictive value of tests; Systematic review.

Fig. 1

Flow chart of literature selection

Fig. 2

The proportion of males or females (%) for the respective MRI grading system with a “mature” knee

Fig. 3

Correct classification and misclassification per age (15–21 years of age) subdivided for males and females (%) based on the study by Ottow et al

Fig. 4

Illustration of how PPV and NPV vary depending on the age composition of the populations tested. Based on data from Ottow et al (male)