Comprehensive sternum maturation models: employing multidetector computed tomography-enhanced approaches for forensic...

Accurate age estimation significantly influences legal outcomes in several contexts. The sternum is one of the most important landmarks that identify age. This cross-sectional study aims to propose Sternum Maturation Models for age estimation, recruiting 247 Egyptian subjects who underwent chest Multidetector Computed Tomography (MDCT) imaging. The maturation of the manubriosternal joint (MSJ), the xiphisternal joint (XSJ), and the junctions between the four sternebrae (S1, S2, and S3) were investigated through a three-element fusion staging. MS-XS Score, an S1-S3 Score, an Overall Score, and an Overall Score excluding the MSJ were calculated. Despite the observed variability, 97% of females reached full sternal fusion by approximately 67 years, whereas males reached this stage a decade later. The ages of fusion initiation and termination were earlier in females, whereas males showed stronger correlations between age and all scores (rho values ranging from 0.552 to 0.750). For all individuals, including those aged ≤ 25 years, the Overall Score excluding the MSJ was the best age predictor, followed by the Overall Score. Above 25 years, the Overall Score excluding MSJ was the best age predictor, followed by the MS-XS Score. The Overall Scores, excluding and including the MSJ, ≥ 6, exhibited high accuracy in predicting ages ≥ 18 and 21 years in males (AUC ≥ 0.973) and substantial agreement with actual ages (kappa coefficients ≥ 0.840). Meanwhile, the performance of both models declined in older ages above 40 years, and in females. The MDCT-based Sternal Maturation Models are reliable, non-invasive approaches for forensic age estimation.