European Radiology

, Volume 27, Issue 12, pp 5041–5048 | Cite as

Forensic age estimation by magnetic resonance imaging of the knee: the definite relevance in bony fusion of the distal femoral- and the proximal tibial epiphyses using closest-to-bone T1 TSE sequence

  • Christian Ottow
  • Ronald Schulz
  • Heidi Pfeiffer
  • Walter Heindel
  • Andreas Schmeling
  • Volker Vieth
Forensic Medicine



To clarify the relevance of the bony fusion of the distal femoral and the proximal tibial epiphyses by means of magnetic resonance imaging (MRI), a prospective cross-sectional cohort study was performed with a special focus on a reliable determination of the 14th, 16th and 18th years of life.


We scanned 658 German volunteers in the age bracket 12–24 years using a 3.0 T MR-scanner and utilising a T1 turbo spin-echo sequence representing true bone anatomy. Minimum, maximum, mean ± standard deviation and median with lower and upper quartiles were defined. Intra- and interobserver agreements were determined (Cohen’s kappa). The statistical relevance of sex-related differences was analysed (Mann-Whitney U test, p < 0.05, exact, two-sided).


The bony fusion took place before the 18th year of life in both epiphyses. The Mann-Whitney U test results imply significant sex-related differences for most stages. For both epiphyses, the intra observer (κ femur 0.961; tibia 0.971) and interobserver (κ femur 0.941; tibia 0.951) agreement levels were very good.


The 14th and the 16th years of life can be determined in both sexes, but the completion of the 18th year of life cannot solely be determined by the bony fusion, as depicted by closest-to-bone MRI.

Key Points

• Forensic age estimation by means of MRI of the knee is feasible.

• MRI provides data about the ossification process without using ionising radiation.

• The method allows the determination of the 14th and 16th years of life.

• The bony fusion is not suitable as the sole indicator of majority.

• The chosen classification is easy to use for specially trained professional personnel.


Age estimation Forensic age diagnostics Ossification process Knee MRI 



Magnetic resonance imaging


Turbo spin echo


Compliance with ethical standards


The scientific guarantor of this publication is Professor Dr. med. Andreas Schmeling.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.


This study received funding by the European Refugee Fund, the German Federal Office for Migration and Refugees and the Westphalian Wilhelms-University of Münster, Germany.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The study uses a dataset that was acquired by the European study ‘Age estimation in unaccompanied minors by means of MRI’. Multiple regions of interest of several hundreds of volunteers were scanned and are currently being analysed. Due to this, parts of the cohort’s results for other regions of interest have already been reported.

The cohort’s results that are relevant to this study – concerning the knee joint – have not yet been reported.

Some study subjects or cohorts have been previously reported in:

Timme M, Ottow C, Schulz R et al. (2016) Magnetic resonance imaging of the distal radial epiphysis: A new criterion of maturity for determining whether the age of 18 has been completed? Int J Legal Med. 2016 Dec 6. [Epub ahead of print] PMID: 27924404

Guo Y, Olze A, Ottow C et al.(2015) Dental age estimation in living individuals using 3.0 T MRI of lower third molars. Int J Legal Med. 2015 Nov;129(6):1265-70. doi:  10.1007/s00414-015-1238-7. PMID: 26232290

C. Ottow, J.A. Krämer, A. Olze et al. (2014) Magnetresonanztomographiestudie zur Altersschätzung von unbegleiteten minderjährigen Flüchtlingen. Rechtsmedizin 2015; 25:12–20. doi  10.1007/s00194-014-0991-0


• prospective

• cross-sectional study

• performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Department of Clinical RadiologyUniversity Hospital MünsterMünsterGermany
  2. 2.Institute of Legal MedicineUniversity Hospital MünsterMünsterGermany
  3. 3.Clinic for RadiologyKlinikum IbbenbürenIbbenbürenGermany

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