International Journal of Legal Medicine最新文献

{"title":"Pipamperone concentrations and organ distribution in postmortem cases with and without overdoses.","authors":"L Lucuta, L Nauroth, J Hose, M Juebner, H Andresen-Streichert","doi":"10.1007/s00414-026-03830-0","DOIUrl":"https://doi.org/10.1007/s00414-026-03830-0","url":null,"abstract":"<p><p>Pipamperone is a widely used antipsychotic, which can also be important in death cases. The interpretation of intoxication cases involving pipamperone remains difficult, due to limited postmortem and pharmacokinetic data. Hence, autopsy cases with pipamperone detection were examined regarding the organ distribution and postmortem redistribution (PMR). A liquid-liquid-chromatography with tandem mass spectrometry (LC-MS/MS) method for the detection of pipamperone in postmortem blood was developed and validated. Heart and femoral blood concentrations were determined in 32 autopsy cases, whereby organ distribution was determined in 12 cases. The method was applied to organ homogenates (brain, liver and kidney tissue), other body fluids (urine, cerebral spinal fluid (CSF)) and gastric content. Pipamperone concentrations of 0.82-19 mg/L were detected in femoral blood, 1.0-36 mg/L in heart blood. Heart and femoral blood ratios (H/F ratio) ranged from 0.5 to 3.9 (mean: 1.5 ± 0.8). Among organs, highest concentrations were determined in liver tissue (5.8-315 mg/kg). Concentrations in brain, CSF and urine/kidney were comparatively lower. The H/F ratios as well as the concentration differences in the organs and alternative body fluids lead to the assumption that pipamperone exhibits an insignificant to moderate PMR. A fatal intoxication, primarily caused by pipamperone was assumed in four cases, where the highest concentrations of pipamperone in blood (heart: 13.4-36 mg/L, femoral: 9.4-19 mg/L) were detected. Assuming a possible PMR for pipamperone, the interpretation of autopsy cases remains difficult. Drug concentrations must be assessed with care and an increase of postmortem concentrations must be considered.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative analysis of YOLOv8 and nnU-Net v2 based pipelines for sex and age estimation from maxillary sinus morphometry on panoramic radiographs.","authors":"Mert Ocak, Cumali Çatak, Seçil Aksoy, Kaan Orhan","doi":"10.1007/s00414-026-03825-x","DOIUrl":"https://doi.org/10.1007/s00414-026-03825-x","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop and compare two deep learning-based segmentation-radiomics pipelines - YOLOv8-Hybrid and nnU-Net v2 - for automated sex classification and age estimation from maxillary sinus morphometry on panoramic radiographs.</p><p><strong>Methods: </strong>A balanced dataset of 1,024 panoramic radiographs (512 males, 512 females; age 18-81 years) was collected from Near East University, North Cyprus. Ground truth sinus annotations were generated by an expert oral radiologist and validated through dual-annotator inter-observer reliability assessment (ICC (2,1) = 0.94-0.97). The YOLOv8-Hybrid pipeline employed YOLOv8n-seg coarse segmentation, U-Net boundary refinement, > 120 morphometric and radiomic features, and CatBoost/XGBoost classifiers. The nnU-Net v2 pipeline used auto-configured 2D U-Net segmentation with identical feature extraction and XGBoost prediction. Both pipelines underwent 5-fold cross-validation with patient-level splitting, transfer learning, Bayesian hyperparameter optimization, and SHAP interpretability analysis.</p><p><strong>Results: </strong>nnU-Net v2 achieved statistically significant superiority in sex classification (AUC = 0.927 [95% CI: 0.881-0.964]) over YOLOv8-CatBoost (AUC = 0.893 [0.841-0.938]; DeLong p = 0.024, Cohen's d = 0.48). Both pipelines demonstrated comparable age estimation performance (MAE ≈ 7.2 years). YOLOv8 showed exceptional consistency (mAP@50 = 98.19%, CV = 0.77%). SHAP analysis identified bilateral area difference as the most determinant feature (sex: 0.42, age: 0.51). External validation on 50 independent images confirmed model generalizability.</p><p><strong>Conclusions: </strong>This study provides the first systematic comparison of YOLOv8 and nnU-Net v2 for forensic maxillary sinus analysis. nnU-Net v2 is recommended for precision-critical forensic reporting, while YOLOv8-Hybrid is suited for high-throughput screening. The > 120 radiomic/morphometric features establish a comprehensive framework for automated biological profiling.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postmortem genetic testing in sudden death: clinical and medico-legal implications.","authors":"María Sabater-Molina, Elisa Nicolas Rocamora, Serena Munteanu, Maria Dolores Fuentes Bermejo, Eduardo Osuna, Maria D Pérez-Cárceles, Francisco Pastor Quirante, Juan Ramón Gimeno Blanes, Juan Pedro Hernández Del Rincón","doi":"10.1007/s00414-026-03771-8","DOIUrl":"https://doi.org/10.1007/s00414-026-03771-8","url":null,"abstract":"<p><strong>Background: </strong>Anatomopathological autopsy and postmortem genetic testing play a crucial role in forensic medicine, particularly in elucidating the causes of sudden death (SD) that remain unexplained by conventional methods. This study explores their value in detecting inherited cardiac conditions with medico-legal and preventive implications.</p><p><strong>Methods: </strong>From a 15-year forensic cohort, 12 cases of sudden unexpected death in which conventional autopsy was inconclusive or where a hereditary cardiac condition was suspected, were analyzed. Each case underwent histology, toxicology, and targeted next-generation sequencing panels covering genes associated with channelopathies and cardiomyopathies. Variants were classified according to ACMG/AMP guidelines, and family studies were performed when feasible.</p><p><strong>Results: </strong>Integrated pathological and genetic analysis identified pathogenic or likely pathogenic variants in several cases, notably in RYR2 and CALM2 (channelopathies) and FLNC and PPP1R13L (cardiomyopathies). In these cases, genetic findings confirmed the diagnosis, while variants of uncertain significance were detected in others. Postmortem genetic testing proved essential in cases with structurally normal hearts or sub-diagnostic findings, such as concealed arrhythmogenic cardiomyopathy. Familial cascade testing uncovered additional carriers, enabling targeted surveillance and preventive measures.</p><p><strong>Conclusion: </strong>Combining pathological autopsy and postmortem genetic testing significantly improves the diagnostic yield in unexplained SD, uncovers hidden hereditary cardiac conditions, and provides critical information for risk assessment in relatives. Beyond clinical implications, these findings contribute to accurate forensic determinations and prevention of miscarriages of justice. Integrating genetic studies into forensic protocols should become standard practice to ensure both scientific rigor and legal fairness.</p><p><strong>Clinical trial registration: </strong>Not applicable.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delta-9-tetrahydrocannabinol detection times using mass spectroscopy in oral fluid: a systematic review using a 5 ng/mL cut-off value.","authors":"Christine McNeil","doi":"10.1007/s00414-026-03805-1","DOIUrl":"https://doi.org/10.1007/s00414-026-03805-1","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Cannabis use is becoming increasingly accepted, with many countries legalising medicinal and recreational use (Nabil et al. Chem Rev Lett 7(5):827-828, [1]). A significant issue arising from this is how to reliably detect recent use that may pose a risk of impairment while avoiding detection of distant use. Oral fluid (OF) testing is one proposed method of detecting recent use (Hubbard et al. J Anal Toxicol 45(8):820-828, [23]; Wennberg et al. Heliyon 9(4):e14630, [24]). This is of particular relevance in the context of workplace testing in safety sensitive workplaces. This review attempts to provide further guidance and specifically assess probabilities of detection at ≥ 5 ng/mL(via mass-spectroscopy) following THC use. The ≥ 5 ng/mL limit has been used as this is the current cut-off value for reporting a positive oral fluid drug screen result in Australia under AS/NZS 4760:2019. Experimental studies providing individual participant mass-spectroscopy monitoring data for at least 6 h after use of THC have been examined and compared to the 5 ng/mL limit noting the sensitivity of detecting use at different time periods. Sixteen articles met the inclusion criteria. Studies were grouped into four categories: 1) Frequent users after inhaled use, 2) Occasional users after inhaled use, 3) Passive exposure (inhaled) and 4) Other methods of use. These 16 articles included 37 different research situations: 5 papers examined occasional smokers, 6 examined frequent or heavy smokers, 6 examining passive exposure, and 5 examining other methods of use. In the other methods of use group, 3 articles examined THC in baked products, 1 examined \"light\" cannabis, and 1 examined medicinal oil. Initial post exposure OF levels over all studies and subjects varied from 0 to 71747 ng/mL OF across 241 subjects. For all groups, THC was detectable (at OF levels ≥ 5 ng/mL) at 0-0.25 h after intake (There was a single negative result at the 0.17 h, however the next readings were 29 and 25, this appears to be most likely a measurement error). All groups except passive users were 100% positive at this early time point (passive smokers were 57% positive). At two hours post-use, 83% of frequent smokers, 38% of occasional smokers, 6% of passive users and 59% of edible users were positive. Maximum detection time (defined as 1 in 100 still positive using study data) was estimated using linear regression. Values were calculated by grouping data by study (12 groups) and by initial OF level (14 groups with group mean initial OF levels ranging from 18.6 [passive] to 13989 ng/mL [highest initial OF level frequent smokers]) for the different exposure methods. The maximum detection time ranged from 3.3 h (range 2.7 to 4.3 h) for the passive smokers to 162 h (range 34 to NQ (In the frequent smokers group there were very few tests able to be used for regression analysis resulting in very large confidence intervals with the upper limit not quantifiable. See text.)) for frequent users wit","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI-based cervical ring apophysis maturation: a probabilistic approach to legal age thresholds.","authors":"Oguzhan Ekizoglu, Elif Hocaoglu, Sophie Colomb, Eric Baccino, Laurent Martrille","doi":"10.1007/s00414-026-03824-y","DOIUrl":"https://doi.org/10.1007/s00414-026-03824-y","url":null,"abstract":"<p><p>The primary question in forensic age assessment is whether an individual has reached a legally defined age threshold. Cervical ring apophysis maturation has been proposed as a potential age indicator; however, it has previously been studied only with ionizing imaging. This study aimed to evaluate cervical ring apophysis maturation using magnetic resonance imaging (MRI) and to determine stage-specific probabilities for legally relevant age thresholds.This retrospective cross-sectional study included 1000 individuals (552 females, 448 males) aged 9.64-26.67 years. Maturation of the ring apophysis at C2-C4 was assessed using a five-stage MRI-adapted system. Sex-specific descriptive statistics were calculated. Age-related stage transitions were modeled using multinomial logistic regression, and conditional probabilities were estimated for the 15-, 16-, 18-, and 21-year thresholds. Observer agreement was assessed using weighted kappa.Maturation progressed sequentially from C2 to C4 in both sexes, with a broad transitional zone between stages 3 and 4. In females, median age at stage 4 ranged from 18.5 to 20.2 years in males, approximately 22 years. However, minimal ages for stage 4 were markedly lower (12.5 years in females, 13.1 years in males), and stage 3 persisted into the third decade. At stage 4, the probability of being ≥ 18 years reached 0.96-0.98 in males but only 0.54-0.61 in females. For the ≥ 21-year threshold, probabilities at stage 4 were approximately 0.65-0.70 in males and 0.34-0.40 in females.Cervical ring apophysis maturation on MRI represents a continuous and overlapping biological process. It should therefore be interpreted as a probabilistic indicator for legal thresholds rather than a definitive test of adulthood.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic MRI-based machine learning models for age estimation and age threshold classification in living children and young adults.","authors":"Fei Fan, Miaomiao Zheng, Lirong Qiu, Qinjin Liu, Yihui Luo, Xinyi Wang, Mengjun Zhan, Bo Ren, Zhenhua Deng","doi":"10.1007/s00414-026-03826-w","DOIUrl":"https://doi.org/10.1007/s00414-026-03826-w","url":null,"abstract":"<p><strong>Objectives: </strong>Accurate bone age assessment is crucial in forensic medicine and pediatrics. This study aimed to systematically characterize the MRI developmental patterns of the iliac crest and ischial tuberosity and to develop machine learning models for age estimation and age threshold classification.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on pelvic MRI scans from 680 individuals aged 6-30 years. A four-stage method was used to assess ossification stages of the iliac crest and ischial tuberosity, followed by a descriptive analysis. We trained and test multiple machine learning models for: (1) regression models for continuous age prediction, and (2) classification models for determining legal age thresholds (12, 14, 16, 18 years). Models were validated on both internal and external test sets.</p><p><strong>Results: </strong>Inter- and intra-observer agreements were good (k > 0.9). the minimum ages for complete fusion of iliac crest and ischial tuberosity were 15.00 years and 15.75 years in males, while both 14.00 years in females. Chronological age and ossification stage showed strong positive correlations (r > 0.8). No significant differences were found regarding sex, sequence, or side (p > 0.05), except the side difference in female ischial tuberosity (p = 0.008). For age regression, the optimal model achieved a mean absolute error of 2.957 years on the internal set and 2.252 years on the external set. For classifying legal age thresholds (12, 14, 16, 18 years), models demonstrated outstanding performance, with the highest AUCs of 0.977, 0.992, 0.969, and 0.931 on the internal set, and 0.955, 0.984, 0.997, and 0.997 on the external set.</p><p><strong>Conclusion: </strong>This study provided foundational MRI reference data for pelvic apophyseal development and showed the exciting potential of integrating pelvic MRI with machine learning for age estimation.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generative artificial intelligence in forensic medicine: a pilot study on AI-simulated medico-legal reports in healthcare liability cases.","authors":"Federica Ministeri, Massimiliano Esposito, Martina Francaviglia, Lucio Di Mauro, Grazia Giulia Pantè, Monica Salerno, Cristoforo Pomara, Francesco Sessa","doi":"10.1007/s00414-026-03820-2","DOIUrl":"https://doi.org/10.1007/s00414-026-03820-2","url":null,"abstract":"","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-based application of the Iscan method on isolated ribs: reliability, accuracy, and the role of joint fossa sclerosis in age estimation on a contemporary European skeletal sample.","authors":"Laura Filograna, Giulia Ceccobelli, Alessandro Mauro Tavone, Andrea Micillo, Raimondo Vella, Arianna D'Altorio, Flavia Chirico, Silvia Daria Beca, Alessandro Carini, Francesco Garaci, Maria Cristina Martinez-Labarga, Gian Luca Marella, Guglielmo Manenti","doi":"10.1007/s00414-026-03808-y","DOIUrl":"https://doi.org/10.1007/s00414-026-03808-y","url":null,"abstract":"<p><p>This study evaluates the applicability of the Iscan method to Post-Mortem Computed Tomography (PMCT) for age estimation through morphological analysis of the sternal end of the fourth right rib. Employing a double-blind design, two observers independently assessed a sample of 112 fragments of fourth ribs from individuals of European origin, isolated and processed before CT imaging. The findings indicate that Iscan's method applied via CT scans demonstrates strong reproducibility and substantial inter-operator reliability, as shown by weighted Cohen's kappa values ranging from 0.75 (inter-operator) to 0.92-0.98 (intra-operator). The method exhibited higher accuracy and consistency for middle-aged and older individuals, particularly in phases 3 to 5, whereas younger and elderly age groups showed lower reliability, with phase 8 requiring further refinement due to significant variability. Furthermore, the study introduced and evaluated a new CT-specific parameter-joint fossa sclerosis-to enhance age-at-death predictions. Regression analysis incorporating this parameter demonstrated improved accuracy and refined age-range estimations, particularly highlighting sex-specific variations: in males, sclerosis tended to shift estimates toward higher age phases, while in females, it primarily improved precision within established phase limits without significantly altering phase assignments. These observations underscore potential sex-based differences in bone remodeling dynamics that influence the Iscan phase classification. This research paves the way for future identification, introduction, and refinement of additional morphological parameters aimed at enhancing predictive accuracy. The substantial age-range overlaps inherent to Iscan's traditional method significantly limit its practical forensic applicability, emphasizing the need for methodological advancements to ensure reliable and accurate age estimation in forensic settings.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative assessment of the repeatability of PermaGel as a ballistic tissue simulant.","authors":"James Read, Samuel Yates, Rupert Williams, Rachael Hazael, Richard Critchley","doi":"10.1007/s00414-026-03821-1","DOIUrl":"https://doi.org/10.1007/s00414-026-03821-1","url":null,"abstract":"<p><p>The awareness of economic, environmental and ethical considerations centred on replication of human tissue have increased in recent years. This has driven the need to find repeatable products which can be re-used without detriment to datasets whilst providing economic benefit to research programmes and reducing the quantity of material disposed of at the end of the trials phase. This study is focussed on the ability of PermaGel to provide a repeatable medium for both survivability and lethality applications when re-used continuously. A baseline series of tests were undertaken using a single stage gas gun, with the material samples then undergoing a series of melt/recast cycles before being tested again to examine any differences in performance. The results show that a 30.40% difference in depth of penetration was observed post thermal cycling of the material, whilst a 5.36% increase in the maximum diameter of the temporary cavity was also observed. These results have raised concerns on PermaGel's ability to be re-used accurately and recommendations on its use provided to ensure data inaccuracy risk is minimised. The findings herein have confirmed the concerns raised within the literature, provided the research community with a single point of source data, and recommended areas for future work to ensure continued characterisation is undertaken.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dental age assessment: A proposal for refining and extending the Demirjian stages for third molar mineralization evaluation.","authors":"Maximilian Timme, Andreas Olze, Julian Wirtz, Sven Schmidt, Andreas Schmeling","doi":"10.1007/s00414-026-03819-9","DOIUrl":"https://doi.org/10.1007/s00414-026-03819-9","url":null,"abstract":"<p><p>Dental methods are now an integral component of forensic age assessment procedures. The stage classification for evaluating the mineralization of third molars in radiographs, as originally proposed by Demirjian et al. (1973), is well-established for this purpose. In practice, a modified version of this classification, based on the work of Mincer et al. (1993), is commonly employed. However, the verbal definitions of the stages exhibit notable inconsistencies. This method paper introduces a revised stage classification. Specifically, the stage definitions have been clarified, and the guidelines for applying the classification have been updated to align with the digital age. Additionally, new schematic illustrations are provided. These modifications aim to improve the reliability of the classification's application. In a second approach, four new intermediate stages-some of which have been previously proposed by other researchers-have been incorporated into the classification. The inclusion of these additional stages seeks to enhance the accuracy of age estimation. Whether the modified stages and the newly introduced intermediate stages provide significant added value will need to be determined through future studies.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}