Advertisement

International Journal of Legal Medicine

, Volume 132, Issue 5, pp 1415–1425 | Cite as

Forensic age estimation using computed tomography of the medial clavicular epiphysis: a systematic review

  • Coralie Hermetet
  • Pauline Saint-Martin
  • Arsène Gambier
  • Léo Ribier
  • Bénédicte Sautenet
  • Camille Rérolle
Review

Abstract

Medicolegal physicians are increasingly called upon to aid in determining the administrative age group affiliation of refugees with questionable unaccompanied minor claims. According to guidelines for forensic age assessment, age differentiation along the 18-year-old cut-off relies on clavicular ossification. The thin-slice computed tomography scan (TSCTs) of the medial clavicular epiphysis (MCE) is one of the methods contributing to this assessment, though it is not yet universally accepted. The aim of this systematic review was to identify scientific papers where age was assessed using TSCTs of the MCE and to observe whether this examination was reproducible and reliable in estimating a person’s age relative to the 18-year-old threshold. A search algorithm was applied to several databases to identify articles in accordance with the PRISMA (Preferred Reporting Items for Systematic-Reviews and Meta-Analyses) statement. One boxplot per article was constructed, separating by stage of maturation and sex. The 13 articles selected represented a sample of 5605 individuals (3396 males, 2209 females) aged 10 to 35 years. All individuals classified as stages 4 and 5 were aged 18 years or older. The same result was obtained concerning stage 3c, except in one article. The results thus appear reliable and reproducible, in particular, with respect to the 18-year-old threshold; medicolegal physicians should be able to estimate that all individuals in stages 4 and 5 are at least 18 years old. Additional studies applied to several other populations in the world should complement the selected studies.

Keywords

Systematic review Medial clavicular epiphysis Computed tomography Age estimation Age assessment Living individuals 

Notes

Acknowledgments

The authors would like to thank Ms. Qing Hong CAI, Xiangtan University, Xiangtan, Hunan, China, for her helpful and voluntary participation by translating the two original Chinese articles included in this work.

Compliance with ethical standards

Conflict of interest

Pauline Saint-Martin and Camille Rérolle were involved in the elaboration of the selected article, Houpert et al., as investigator, co-author, and corresponding author.

Coralie Hermetet, Arsène Gambier, Léo Ribier, and Bénédicte Sautenet do not have any conflicts of interest to declare.

Supplementary material

414_2018_1847_MOESM1_ESM.xlsx (13 kb)
Supplementary material ) (XLSX 13 kb)

References

  1. 1.
    Schmeling A, Dettmeyer R, Rudolf E, Vieth V, Geserick G (2016) Forensic age estimation. Dtsch Arztebl Int 113:44–50.  https://doi.org/10.3238/arztebl.2016.0044 PubMedPubMedCentralGoogle Scholar
  2. 2.
    Amadasi A, Merusi N, Cattaneo C (2015) How reliable is apparent age at death on cadavers? Int J Legal Med 129:913–918.  https://doi.org/10.1007/s00414-014-1042-9 CrossRefPubMedGoogle Scholar
  3. 3.
    Baccino E, Sinfield L, Colomb S, Baum TP, Martrille L (2014) Technical note: the two step procedure (TSP) for the determination of age at death of adult human remains in forensic cases. Forensic Sci Int 244:247–251.  https://doi.org/10.1016/j.forsciint.2014.09.005 CrossRefPubMedGoogle Scholar
  4. 4.
    Schmeling A, Reisinger W, Geserick G, Olze A (2006) Age estimation of unaccompanied minors. Part I. General considerations. Forensic Sci Int 159(Suppl 1):S61–S64.  https://doi.org/10.1016/j.forsciint.2006.02.017 CrossRefPubMedGoogle Scholar
  5. 5.
    Schmeling A, Olze A, Reisinger W, Geserick G (2004) Forensic age diagnostics of living people undergoing criminal proceedings. Forensic Sci Int 144:243–245.  https://doi.org/10.1016/j.forsciint.2004.04.059 CrossRefPubMedGoogle Scholar
  6. 6.
    Greulich WW, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist (Second ed.). Stanford University press, Stanford, CalifGoogle Scholar
  7. 7.
    Demirjian A, Goldstein H (1976) New systems for dental maturity based on seven and four teeth. Ann Hum Biol 3:411–421CrossRefPubMedGoogle Scholar
  8. 8.
    Demirjian A (1978) Dental development: index of physiologic maturation. Med Hyg (Geneve) 36:3154–3159Google Scholar
  9. 9.
    Demirjian A (1980) Dental development: an index of physiological maturity. Union Med Can 109:832–839PubMedGoogle Scholar
  10. 10.
    Mincer HH, Harris EF, Berryman HE (1993) The A.B.F.O. study of third molar development and its use as an estimator of chronological age. J Forensic Sci 38:379–390CrossRefPubMedGoogle Scholar
  11. 11.
    Schmeling A, Grundmann C, Fuhrmann A, Kaatsch H-J, Knell B, Ramsthaler F, Reisinger W, Riepert T, Ritz-Timme S, Rösing FW, Rötzscher K, Geserick G (2008) Criteria for age estimation in living individuals. Int J Legal Med 122:457–460.  https://doi.org/10.1007/s00414-008-0254-2 CrossRefPubMedGoogle Scholar
  12. 12.
    Schmeling A, Reisinger W, Geserick G, Olze A (2005) The current state of forensic age estimation of live subjects for the purpose of criminal prosecution. Forensic Sci Med Pathol 1:239–246.  https://doi.org/10.1385/FSMP:1:4:239 CrossRefPubMedGoogle Scholar
  13. 13.
    Wittschieber D, Schulz R, Pfeiffer H, Schmeling A, Schmidt S (2017) Systematic procedure for identifying the five main ossification stages of the medial clavicular epiphysis using computed tomography: a practical proposal for forensic age diagnostics. Int J Legal Med 131:217–224.  https://doi.org/10.1007/s00414-016-1444-y CrossRefPubMedGoogle Scholar
  14. 14.
    Schmeling A, Schmidt S, Schulz R, Wittschieber D, Rudolf E (2014) Studienlage zum zeitlichen Verlauf der Schlüsselbeinossifikation. Rechtsmedizin 24:467–474.  https://doi.org/10.1007/s00194-014-0989-7 CrossRefGoogle Scholar
  15. 15.
    Jasuja OP, Khandelwal N, Kaur G (2009) Estimation of age from ossification of clavicle: a comprehensive review. J Indian Acad Forensic Med 31:277–284Google Scholar
  16. 16.
    Schulz R, Mühler M, Mutze S, Schmidt S, Reisinger W, Schmeling A (2005) Studies on the time frame for ossification of the medial epiphysis of the clavicle as revealed by CT scans. Int J Legal Med 119:142–145.  https://doi.org/10.1007/s00414-005-0529-9 CrossRefPubMedGoogle Scholar
  17. 17.
    Kellinghaus M, Schulz R, Vieth V, Schmidt S, Pfeiffer H, Schmeling A (2010) Enhanced possibilities to make statements on the ossification status of the medial clavicular epiphysis using an amplified staging scheme in evaluating thin-slice CT scans. Int J Legal Med 124:321–325.  https://doi.org/10.1007/s00414-010-0448-2 CrossRefPubMedGoogle Scholar
  18. 18.
    Meier N, Schmeling A, Loose R, Vieth V (2015) Altersdiagnostik und Strahlenexposition. Rechtsmedizin 25:30–33.  https://doi.org/10.1007/s00194-014-1005-y CrossRefGoogle Scholar
  19. 19.
    Malmqvist E, Furberg E, Sandman L (2017) Ethical aspects of medical age assessment in the asylum process: a Swedish perspective. Int J Legal Med.  https://doi.org/10.1007/s00414-017-1730-3
  20. 20.
    Arbeitsgemeinschaft für Forensische Altersdiagnostik. (AGFAD). http://agfad.uni-muenster.de/agfad_start.html. Accessed 3 Jul 2017
  21. 21.
    Kreitner KF, Schweden F, Schild HH, Riepert T, Nafe B (1997) Computerized tomography of the epiphyseal union of the medial clavicle: an auxiliary method of age determination during adolescence and the 3d decade of life? Rofo 166:481–486.  https://doi.org/10.1055/s-2007-1015463 CrossRefPubMedGoogle Scholar
  22. 22.
    Kreitner KF, Schweden FJ, Riepert T, Nafe B, Thelen M (1998) Bone age determination based on the study of the medial extremity of the clavicle. Eur Radiol 8:1116–1122.  https://doi.org/10.1007/s003300050518 CrossRefPubMedGoogle Scholar
  23. 23.
    Standring S (2015) Gray’s anatomy—the anatomical basis of clinical practice, 41st edition. ElsevierGoogle Scholar
  24. 24.
    Cunha E, Baccino E, Martrille L, Ramsthaler F, Prieto J, Schuliar Y, Lynnerup N, Cattaneo C (2009) The problem of aging human remains and living individuals: a review. Forensic Sci Int 193:1–13.  https://doi.org/10.1016/j.forsciint.2009.09.008 CrossRefPubMedGoogle Scholar
  25. 25.
    Baccino E, Cunha E, Cattaneo C (2013) Aging the dead and the living. In: Siegel JA, Saukko PJ, Houck MM (eds) Encyclopedia of Forensic Sciences. Academic Press, Waltham, pp 42–48Google Scholar
  26. 26.
    American Immigration Council (2015) A guide to children arriving at the border: Laws, Policies and ResponsesGoogle Scholar
  27. 27.
    European Parliament, Council of the European Union (2011) Directive 2011/95/EU of the European Parliament and the council of 13 December 2011 on standards for the qualification of third-country nationals or stateless persons as beneficiaries of international protection, for a uniform status for refugees or for persons eligible for subsidiary protection, and for the content of the protection granted. Off J Eur Union:9–26Google Scholar
  28. 28.
    United Nation High Commisionner for Refugees (2016) Global Report 2016. 216Google Scholar
  29. 29.
    UNACCOMPANIED MINORS | Canadian Council for Refugees. http://ccrweb.ca/en/content/unaccompanied-minors. Accessed 13 Dec 2017
  30. 30.
    Haut Conseil de la Santé Publique (HCSP) (2014) Évaluation de la minorité d’un jeune étranger isolé. Haut Conseil de la Santé Publique, ParisGoogle Scholar
  31. 31.
    Doineau É, Godefroy J-P (2017) Rapport d’information fait au nom de la commission des affaires sociales (1) sur la prise en charge sociale des mineurs non accompagnésGoogle Scholar
  32. 32.
    Asylum Information Database (AIDA) (2017) Country Report - France | Asylum Information Database. http://www.asylumineurope.org/. Accessed 13 Mar 2018
  33. 33.
    Pruvost M-O, Boraud C, Chariot P (2010) Skeletal age determination in adolescents involved in judicial procedures: from evidence-based principles to medical practice. J Med Ethics 36:71–74.  https://doi.org/10.1136/jme.2009.031948 CrossRefPubMedGoogle Scholar
  34. 34.
    Council of the European Union (1997) Council directive 97/43/EURATOM of 30 June 1997Google Scholar
  35. 35.
    Trinquart L, Fanet A, Grabar N, Guiquerro S, Colombet I (2010) A unique web service to facilitate the study selection process in systematic reviewsGoogle Scholar
  36. 36.
    Schulze D, Rother U, Fuhrmann A, Richel S, Faulmann G, Heiland M (2006) Correlation of age and ossification of the medial clavicular epiphysis using computed tomography. Forensic Sci Int 158:184–189.  https://doi.org/10.1016/j.forsciint.2005.05.033 CrossRefPubMedGoogle Scholar
  37. 37.
    Kellinghaus M, Schulz R, Vieth V, Schmidt S, Schmeling A (2010) Forensic age estimation in living subjects based on the ossification status of the medial clavicular epiphysis as revealed by thin-slice multidetector computed tomography. Int J Legal Med 124:149–154.  https://doi.org/10.1007/s00414-009-0398-8 CrossRefPubMedGoogle Scholar
  38. 38.
    Franklin D, Flavel A (2015) CT evaluation of timing for ossification of the medial clavicular epiphysis in a contemporary Western Australian population. Int J Legal Med 129:583–594.  https://doi.org/10.1007/s00414-014-1116-8 CrossRefPubMedGoogle Scholar
  39. 39.
    Lipscomb CE (2000) Medical subject headings (MeSH). Bull Med Libr Assoc 88:265–266PubMedPubMedCentralGoogle Scholar
  40. 40.
    Leeflang MMG, Deeks JJ, Gatsonis C, Bossuyt PMM, Cochrane Diagnostic Test Accuracy Working Group (2008) Systematic reviews of diagnostic test accuracy. Ann Intern Med 149:889–897CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Cucherat M (1997) Méta-analyse des essais thérapeutiques. MassonGoogle Scholar
  42. 42.
    Booth A, Papaioannou D, Sutton A (2012) Systematic approaches to a successful literature review. SAGE Publications LimitedGoogle Scholar
  43. 43.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:W65–W94CrossRefPubMedGoogle Scholar
  44. 44.
    PRISMA. http://www.prisma-statement.org/. Accessed 3 Aug 2017
  45. 45.
    Mühler M, Schulz R, Schmidt S, Schmeling A, Reisinger W (2006) The influence of slice thickness on assessment of clavicle ossification in forensic age diagnostics. Int J Legal Med 120:15–17.  https://doi.org/10.1007/s00414-005-0010-9 CrossRefPubMedGoogle Scholar
  46. 46.
    Kaur G, Khandelwal N, Jasuja OP (2010) Computed tomographic studies on ossification status of medial epiphysis of clavicle: effect of slice thickness and dose distribution. J Indian Acad Forensic MedGoogle Scholar
  47. 47.
    Buckley MB, Clark KR (2017) Forensic age estimation using the medial clavicular epiphysis: a study review. Radiol Technol 88:482–498PubMedGoogle Scholar
  48. 48.
    Wittschieber D, Schulz R, Vieth V, Küppers M, Bajanowski T, Ramsthaler F, Püschel K, Pfeiffer H, Schmidt S, Schmeling A (2014) Influence of the examiner’s qualification and sources of error during stage determination of the medial clavicular epiphysis by means of computed tomography. Int J Legal Med 128:183–191.  https://doi.org/10.1007/s00414-013-0932-6 CrossRefPubMedGoogle Scholar
  49. 49.
    Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Cochrane Handbook for Systematic Reviews of Interventions. http://handbook-5-1.cochrane.org/. Accessed 3 Aug 2017
  51. 51.
    Zhao H, Dong X-A, Zheng T, Qing S-H, Deng Z-H, Zhu G-Y (2011) Skeletal age estimation of sternal end of clavicle in Sichuan Han nationality youth using thin-section computed tomography. Fa Yi Xue Za Zhi 27:417–420PubMedGoogle Scholar
  52. 52.
    El-Gerby KM, Mohammed AS, Gomaa MS (2013) Using thin-slice multidetector computed tomography in forensic age estimation based on the ossification status of the medial clavicular epiphysis among Egyptian subjects. Med J Cairo Univ 81:221–227Google Scholar
  53. 53.
    Wang Y-H, Wei H, Ying C-L, Wan L, Zhu G-Y (2013) [The staging method of sternal end of clavicle epiphyseal growth by thin layer CT scan and imaging reconstruction]. Fa Yi Xue Za Zhi 29:168–171, 179Google Scholar
  54. 54.
    Pattamapaspong N, Madla C, Mekjaidee K, Namwongprom S (2015) Age estimation of a Thai population based on maturation of the medial clavicular epiphysis using computed tomography. Forensic Sci Int 246:123.e1–123.e5.  https://doi.org/10.1016/j.forsciint.2014.10.044 CrossRefGoogle Scholar
  55. 55.
    Ekizoglu O, Hocaoglu E, Inci E, Sayin I, Solmaz D, Bilgili MG, Can IO (2015) Forensic age estimation by the Schmeling method: computed tomography analysis of the medial clavicular epiphysis. Int J Legal Med 129:203–210.  https://doi.org/10.1007/s00414-014-1121-y CrossRefPubMedGoogle Scholar
  56. 56.
    Zhang K, Chen X-G, Zhao H, Dong X-A, Deng Z-H (2015) Forensic age estimation using thin-slice multidetector CT of the clavicular epiphyses among adolescent western Chinese. J Forensic Sci 60:675–678.  https://doi.org/10.1111/1556-4029.12739 CrossRefPubMedGoogle Scholar
  57. 57.
    Ekizoglu O, Hocaoglu E, Inci E, Can IO, Aksoy S, Sayin I (2015) Estimation of forensic age using substages of ossification of the medial clavicle in living individuals. Int J Legal Med 129:1259–1264.  https://doi.org/10.1007/s00414-015-1234-y CrossRefPubMedGoogle Scholar
  58. 58.
    Houpert T, Rérolle C, Savall F, Telmon N, Saint-Martin P (2016) Is a CT-scan of the medial clavicle epiphysis a good exam to attest to the 18-year threshold in forensic age estimation? Forensic Sci Int 260:103.e1–103.e3.  https://doi.org/10.1016/j.forsciint.2015.12.007 CrossRefGoogle Scholar
  59. 59.
    Gurses MS, Inanir NT, Gokalp G, Fedakar R, Tobcu E, Ocakoglu G (2016) Evaluation of age estimation in forensic medicine by examination of medial clavicular ossification from thin-slice computed tomography images. Int J Legal Med 130:1343–1352.  https://doi.org/10.1007/s00414-016-1408-2 CrossRefPubMedGoogle Scholar
  60. 60.
    Gurses MS, Inanir NT, Soylu E, Gokalp G, Kir E, Fedakar R (2017) Evaluation of the ossification of the medial clavicle according to the Kellinghaus substage system in identifying the 18-year-old age limit in the estimation of forensic age-is it necessary? Int J Legal Med 131:585–592.  https://doi.org/10.1007/s00414-016-1515-0 CrossRefPubMedGoogle Scholar
  61. 61.
    Ramadan SU, Gurses MS, Inanir NT, Hacifazlioglu C, Fedakar R, Hizli S (2017) Evaluation of the medial clavicular epiphysis according to the Schmeling and Kellinghaus method in living individuals: a retrospective CT study. Leg Med (Tokyo) 25:16–22.  https://doi.org/10.1016/j.legalmed.2016.12.012 CrossRefGoogle Scholar
  62. 62.
    Berrington de González A, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, Land C (2009) Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 169:2071–2077.  https://doi.org/10.1001/archinternmed.2009.440 CrossRefPubMedGoogle Scholar
  63. 63.
    Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, Berrington de González A, Miglioretti DL (2009) Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 169:2078–2086.  https://doi.org/10.1001/archinternmed.2009.427 CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Ferretti G, Jankowski A (2010) Radiation doses of radiological examinations of the thorax. Rev Mal Respir 27:644–650.  https://doi.org/10.1016/j.rmr.2010.03.024 CrossRefPubMedGoogle Scholar
  65. 65.
    Miglioretti DL, Johnson E, Williams A, Greenlee RT, Weinmann S, Solberg LI, Feigelson HS, Roblin D, Flynn MJ, Vanneman N, Smith-Bindman R (2013) The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 167:700–707.  https://doi.org/10.1001/jamapediatrics.2013.311 CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Rausch I, Füchsel FG, Kuderer C, Hentschel M, Beyer T (2016) Radiation exposure levels of routine SPECT/CT imaging protocols. Eur J Radiol 85:1627–1636.  https://doi.org/10.1016/j.ejrad.2016.06.022 CrossRefPubMedGoogle Scholar
  67. 67.
    Cunningham C, Scheuer L, Black S (2016) Developmental Juvenile Osteology - 2nd Edition, 2nd ed.Google Scholar
  68. 68.
    Council of the European Union (2013) Council directive 2013/59/EURATOM of 5 December 2013Google Scholar
  69. 69.
    Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke K-D, Geserick G (2004) Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 118:5–8.  https://doi.org/10.1007/s00414-003-0404-5 CrossRefPubMedGoogle Scholar
  70. 70.
    Watine J (2004) Systematic reviews and meta-analysis in laboratory medicine: principles and methods. Ann Biol Clin (Paris) 62:611–627Google Scholar
  71. 71.
    Shimizu S, Shirato H, Kagei K, Nishioka T, Bo X, Dosaka-Akita H, Hashimoto S, Aoyama H, Tsuchiya K, Miyasaka K (2000) Impact of respiratory movement on the computed tomographic images of small lung tumors in three-dimensional (3D) radiotherapy. Int J Radiat Oncol Biol Phys 46:1127–1133CrossRefPubMedGoogle Scholar
  72. 72.
    Rodríguez-Romero R, Castro-Tejero P (2014) The influence of respiratory motion on CT image volume definition. Med Phys 41:041701.  https://doi.org/10.1118/1.4866889 CrossRefPubMedGoogle Scholar
  73. 73.
    Hsieh J (2015) Computed tomography: principles, design, artifacts, and recent advances, 3rd ed. BellinghamGoogle Scholar
  74. 74.
    Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46.  https://doi.org/10.1177/001316446002000104 CrossRefGoogle Scholar
  75. 75.
    Schmeling A, Schulz R, Danner B, Rösing FW (2006) The impact of economic progress and modernization in medicine on the ossification of hand and wrist. Int J Legal Med 120:121–126.  https://doi.org/10.1007/s00414-005-0007-4 CrossRefPubMedGoogle Scholar
  76. 76.
    Schmeling A, Olze A, Reisinger W, König M, Geserick G (2003) Statistical analysis and verification of forensic age estimation of living persons in the Institute of Legal Medicine of the Berlin University Hospital Charité. Leg Med (Tokyo) 5(Suppl 1):S367–S371CrossRefGoogle Scholar
  77. 77.
    Meijerman L, Maat GJR, Schulz R, Schmeling A (2007) Variables affecting the probability of complete fusion of the medial clavicular epiphysis. Int J Legal Med 121:463–468.  https://doi.org/10.1007/s00414-007-0189-z CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Kirisci K (1991) Refugee movements and Turkey. Int Migr 29:545–560CrossRefPubMedGoogle Scholar
  79. 79.
    United Nations High Commissioner for Refugees UNHCR (2016) UNHCR Turkey’s Monthly Statistics as of January 2016Google Scholar
  80. 80.
    Inter-agency regional analysts network (an ACF and IRIS initiative) (2016) Responding to the migrant crisis: Europe at a JunctureGoogle Scholar
  81. 81.
    Adeloye D, Thompson JY, Akanbi MA, Azuh D, Samuel V, Omoregbe N, Ayo CK (2016) The burden of road traffic crashes, injuries and deaths in Africa: a systematic review and meta-analysis. Bull World Health Organ 94:510–521A.  https://doi.org/10.2471/BLT.15.163121 CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Haddaway NR, Collins AM, Coughlin D, Kirk S (2015) The role of Google Scholar in evidence reviews and its applicability to Grey literature searching. PLoS One 10:e0138237.  https://doi.org/10.1371/journal.pone.0138237 CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Minasny B, Hartemink AE, McBratney A, Jang HJ (2013) Citations and the h index of soil researchers and journals in the Web of Science, Scopus, and Google Scholar. PeerJ 1:e183.  https://doi.org/10.7717/peerj.183 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculté de médecineUniversité François-RabelaisToursFrance
  2. 2.Institut médico-légalCHRU ToursToursFrance
  3. 3.Pôle d’imagerie médicaleCHRU ToursToursFrance
  4. 4.Service de néphrologie et d′immunologie cliniqueCHRU ToursToursFrance

Personalised recommendations