Accepted Manuscript

Stature estimation from sternum length using computed tomography - volume

rendering technique images of western Chinese

Kui Zhang, Ying-zhen Luo, Fei Fan, Jie-qian Zheng, Min Yang, Tao Li, Tao Pang,
Jian Zhang, Prof. Zhen-hua Deng

PII: S1752-928X(15)00139-0
DOI: 10.1016/j.jflm.2015.07.003
Reference: YJFLM 1205

To appear in: Journal of Forensic and Legal Medicine

Received Date: 20 January 2015

Revised Date: 20 June 2015
Accepted Date: 23 July 2015

Please cite this article as: Zhang K, Luo Y-z, Fan F, Zheng J-q, Yang M, Li T, Pang T, Zhang J,
Deng Z-h, Stature estimation from sternum length using computed tomography - volume rendering
technique images of western Chinese, Journal of Forensic and Legal Medicine (2015), doi: 10.1016/
j.jflm.2015.07.003.

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 ACCEPTED MANUSCRIPT

Stature estimation from sternum length using computed tomography - volume

rendering technique images of western Chinese

a, 1
Kui Zhang , Ying-zhen Luo a, 1, Fei Fan a, Jie-qian Zheng b, Min Yang c, Tao Li d,

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Tao Pang e, Jian Zhang f, Zhen-hua Deng a, §

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a
Department of Forensic pathology, West China School of Preclinical and Forensic Medicine,

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Sichuan University, Chengdu, Sichuan 610041, P.R. China;

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b
Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041,
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P.R. China;

c
Nan Chong Public Security Bureau, Nan Chong, Sichuan 610000, P.R. China;
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d
Peng An Public Security Bureau, Nan Chong, Sichuan 610000, P.R. China;
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e
Gao Ping Public Security Bureau, Nan Chong, Sichuan 610000, P.R. China;
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f
Xi Chong Public Security Bureau, Nan Chong, Sichuan 610000, P.R. China;

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These authors contributed equally to this work.
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§
Corresponding author
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Address reprint requests to: Prof. Zhen-hua Deng , Tel.: +86 2885501553, Fax: +86 2885501544,
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Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine,

Sichuan University, Chengdu 610041, PR China, Email: newman-zhk@163.com.

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Stature estimation from sternum length using computed tomography - volume

rendering technique images of western Chinese

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Abstract

The objective of the present investigation was to generate linear regression models for

stature estimation on the basis of sternum length derived from computed tomography

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- volume rendering technique (CT-VRT) images for Western Chinese. The study

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sample comprised 288 individuals of Western Chinese, including 124 females and 164

males, with documented ages between 19 and 78 years, and was randomly divided

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into two subgroups. The linear regression analysis for the calibration sample data

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yielded the following formulae: male stature (cm) = 137.28 + 1.99*combined length
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of manubrium and mesosternum and female stature (cm) = 111.59 + 3.51* combined

length of manubrium and mesosternum. Pearson’s correlation coefficients for the

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regression models were r = 0.459 and r = 0.541 for the male and female formulae,
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respectively. The standard errors of the estimate (SEE) were 4.76 cm for the male
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equation and 6.73 cm for the female equation. The 95%confidence intervals of the

predicted values encompassed the correct stature of all specimen in the validation
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sample. The regression equations derived from the sternum length in the present study
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can be used for stature estimation and the length of the sternum is a reliable predictor
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of stature in Chinese when better predictors of stature like the long bones are not

available, and the CT-VRT method may be a practical method for stature estimation.

Keywords: Forensic science; Forensic anthropology; CT-VRT; Linear regression

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Introduction

Forensic anthropology plays a crucial role in the medico-legal investigation of

unidentified skeletonized or decomposed human remains. The estimation of stature is

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an important component. The most accurate method for reconstructing stature

involves the measurement of all skeletal elements that contribute to living height1, 2.

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Although highly accurate, this anatomical method cannot be applied in many cases in

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which human remains have been dismembered or mutilated. As a result, the most

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commonly alternatives are based on the positive linear relationship between stature
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and the length of various parts of the body. Several post-cranial elements have been

used for the derivation of regression equations for the estimation of stature, such as
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long bones3-8, scapula9-11, metacarpals12, metatarsals13, and vertebral column14-17.

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Recently, regression equations for stature estimation based on the length of the
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sternum have been developed from the measurement of digital radiographs18,

multidetector computed tomography images19, however, mostly are recorded from

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direct measurement of cadavers20-24. The rapid technological development of

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multi-row computed tomography (CT) in the last two decades has resulted in an
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increase in CT examinations on the whole, the volume rendering technique (VRT) has

the advantage of real time operation of the object mass. Currently, the virtual

anthropology techniques initiated by the Virtopsy (virtual autopsy) project25, which

rely on three-dimensional (3D) reconstructions of computed tomography (CT) scans

of skeletal remains. Analysts can perform morphological and metric analyses to

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establish the biological profile from the 3D images26, and the data can provide an

objective and observer-independent method for recording features that are normally

difficult to quantify and can allow easy access to reports and data for peer review.

Additionally, advantages include no deterioration of data over time, no skeletal

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preparation, no damage to skeletal material, and potential application to living

individuals27, 28.

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Therefore, the primary objective of the present investigation was to generate linear

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regression models for stature estimation on the basis of sternum length derived from

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3D-VRT images in different population groups. This was done due to inherent
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population differences in various dimensions that are attributed to genetic and

environmental factors29, 30. Furthermore, a test of the utility of sternal measurements

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to predict stature in Western Chinese was carried out.

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Materials and methods

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The present study was performed with the approval of the ethics committee of the
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West China Hospital of Sichuan University and all the participants provided written
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informed consent.

The data used in the present study were obtained from participants undergoing routine

examination at the West China Hospital of Sichuan University. The study sample

comprised 288 individuals from western China, including 124 females and 164 males,

with documented ages between 19 and 78 years (Table 1). Subjects with a history of
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chronic illness, trauma, physical deformity, or any surgical procedure that might

affect stature or sternum dimensions were excluded from the study.

The stature was measured during standing in full extension as the maximum length

between the skull vertex and the heel in millimeters. The data collection was

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conducted during a two-month period between 9:00 am and 10:00 am to avoid the

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influence of diurnal variation as it affects the standards generated and equations

developed for the estimation of stature31.

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Multidetector CT was carried out on Somatom definition AS 128 slice CT Machine

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by Siemens Germany Ltd. After obtaining the scout projection, the area of scanning
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was defined to include the region from fifth cervical vertebra until the first lumbar

vertebra. The scanning protocol was as follows: collimation of 1 mm, reconstruction

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interval of 1 mm, tube voltage of 120 kV, tube current of 110 mA, and scanning time
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of 0.3s. Image data were processed on a workstation (Syngo CT 2011A) to obtain

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volume-rendering technique images.

A 3D reconstructed image was used for assessment. The linear distances from the
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centre of suprasternal notch or incisura jugularis (jugular notch) to the centre of

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manubrio-mesosternal junction (sternal synchondrosis) in mid-sagittal plane and the

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manubrio mesosternal junction to the mesosterno xiphoidal junction of the sternum

in the mid-sagittal plane were defined as the Length of manubrium (M) and Length of

mesosternum (B), respectively (Figure 1). The manubrium and mesosternum often do

not fuse even in later life32, and as a result, the Combined length of manubrium and

mesosternum was used for statistical analysis.

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All the measurements recorded by the same author twice to minimize the error in

measurement, and the results of measurements were made to the nearest 1 mm, the

mean value was used for analysis. Mean intra-observer error, calculated following the

equation presented by Albanese et al.33, 34, was less than 1.1 % for all dimensions and

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thus within the acceptable limit (below 2.0 - 2.5 %).

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Given that previous studies have demonstrated that stature formulae are not only

population-specific but also sex-specific23, 35, 36, separate linear regression equations

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for estimating stature on the basis of sternum length were then devised for males and

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females. The study sample was randomly divided into two subgroups. A calibration
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sample, which consisted of 113 females and 146 males, was used to develop the

sex-specific linear regression equations. A validation sample comprising the

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remaining 11 female and 18 male individuals was then used to test the predictive
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accuracy of the two models. The normality of the sternal length data for both sex
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samples was verified with K-S test (Z = 0.851, P = 0.464 for female, and Z = 0.893, P

= 0.402 for male). For assessing the correlation between the stature and combined
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length of manubrium and mesosternum, the Pearson’s correlation coefficient was

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calculated and its significance was tested by t test. P value of less than 0.05 was
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considered as significant. Specifically, model accuracy was assessed by observing the

number of individuals in the validation sample whose corrected stature fell within the

95 % confidence interval of the predicted value, following the developed equation.

The data were analyzed by using the SPSS (VERSION 13.0 for Windows).
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Results

Descriptive statistics for the calibration sample and validation sample was shown in

Table 1.

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The linear regression analysis for the calibration sample data yielded the following

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formulae: male stature (cm) = 137.28 + 1.99*combined length of manubrium and

mesosternum and female stature (cm) = 111.59 + 3.51*combined length of

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manubrium and mesosternum. Combined length of manubrium and mesosternum

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showed a significant positive correlation with stature in both males and females (p <
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0.01). Pearson’s correlation coefficients for the regression models were r = 0.459 and

r=0.541 for the male and female formulae, respectively. The standard errors of the
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estimate were 4.76 cm for the male equation and 6.73 cm for the female equation.
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When the combined length of manubrium and mesosternum data of the validation
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sample were applied to the above derived linear regression equations, the corrected

stature of all 29 individuals fell within the 95 % confidence interval of the predicted
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value (Table 2).

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Discussion

Recent studies have evaluated the potential of using the 3D CT images to estimate

stature from pelvic bones 37, radial and ulnar lengths 38, and scapula 9, examining 3D

reconstructions of pelvic CT scans of live adults to estimate age39, and applying of

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postmortem 3D-CT facial reconstruction for personal identification16. The present

investigation demonstrate that combined length of the manubrium and mesosternum

derived from 3D -VRT has a statistically significant association with stature in the

Western Chinese. To date, some researchers have applied CT scanning to the field of

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anthropology, revealing that there was no significant difference between the actual

bone dimensions and the measurements on the 3D CT images37, 40. In addition, CT

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enables forensic investigators to perform measurements on bone images instead of

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fresh bones that require preparations such as removing and cleansing the skeleton if

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surrounding tissues remain17. Moreover, digital CT images can be preserved almost
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permanently in little or no physical space, enabling repeated measurements and

potentially decreasing intraobserver and interobserver error26.

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It is well known that cadaver stature is different from living stature 41 because of rigor
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mortis and positional differences23, 42

. A number of previous studies3, 5, 43-45
have
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demonstrated that an adjustment factor should be applied to cadaver length given that

living height is consistently less than the value recorded postmortem. This
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discrepancy is primarily due to the compression of inter vertebral disks and other
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joints when a person is standing, the position adopted for the measurement of stature
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in the living43, 44. It is generally accepted that the extent to which the body lengthens

3, 5, 45
after death is approximately 2.0 cm . The regression model in the present study

was based on living standing height.

The estimate for the stature formulae derived from the sternum length in the current

study are generally comparable to those previous investigations in other population

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groups. For example, Menezes et al. reported a standard error of 5.64 cm for South

Indian males24 and 4.11 cm for South Indian females20. Similarly, Singh et al.23 in

their study of a Northwest Indian population sample, obtained a standard error of 6.83

cm for males and 6.65 cm for females, respectively. Macaluso and Lucena 18 reported

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the standard errors of 6.20 cm for the males and 5.56 cm for the females in Spanish

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population and the correlation coefficients for the regression models were r=0.391 and

r=0.461 for the male and female formulae, respectively. Yonguc et al.22 derived

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regression equations for estimating stature from measured sternal lengths in Turks and

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the length of the manubrium and body had the highest correlation coefficient in both
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males and females (correlation coefficient: 0.721 and 0.740, respectively). The

present study concludes that the length of the sternum is a reliable predictor of stature
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in Chinese and can be used as a tool for stature estimation when better predictors of
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stature like the long bones are not available when examining skeletal remains.
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Conclusions
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The regression equations derived from the sternum length in the present study may be
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used for stature estimation in Western Chinese although they can only provide a wide

95% confidence intervals, and the CT-VRT method can be a practical method for

stature estimation.
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Disclosure Statement

None to declare.

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Table 1 Sex, age, stature, and combined length of manubrium and mesosternum distribution of the utilized study sample.

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Sex group n Age (years) Stature (cm) Combined length of manubrium

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and mesosternum (cm)

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mean±Std. Deviation Minimum Maximum mean±Std. Deviation Minimum Maximum mean ± Std. Deviation Minimum Maximum

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Calibration sample

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Female 113 47.0±12.3 19 78 157.1±6.5 138.9 171.9 12.9±1.0 10.0 15.8

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Male 146 48.9±12.1 25 78 166.6±6.3 151.9 185.9 14.8±1.4 9.5 23.0

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Validation sample

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Female 11 45.5±8.3 33 59 156.5±3.2 150.0 160.4 12.6±0.9 11.1 14.4
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Male 18 47.9±7.7 35 60 168.1±2.5 163.5 171.4 14.8±0.9 13.2 16.3
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Table 2 Accuracy assessment of the derived stature equations when applied to the
validation sample.

Sex Age Combined length of manubrium and mesosternum (cm)

(years)
Corrected stature Predicted stature Lower 95 % CI Upper 95 % CI
Female 59 150.1 153.2 139.7 166.6
Female 52 157.5 155.5 142.0 168.9

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Female 38 160.5 156.3 142.8 169.7
Female 43 159.5 156.3 142.8 169.7
Female 43 153.5 153.0 139.5 166.4

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Female 34 158.4 158.1 144.6 171.5
Female 33 158.5 158.2 144.7 171.6

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Female 51 152.3 150.4 136.9 163.8
Female 44 155.8 152.8 139.3 166.2
Female 51 158.2 162.2 148.7 175.6
Female 52 157.2 156.7 143.2 170.1

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Male 51 171.4 157.6 162.4 176.6
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Male 48 169.3 155.7 160.4 174.7
Male 60 167.5 156.3 161.0 175.3
Male 59 169.9 158.0 162.8 177.0
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Male 50 168.8 157.8 162.5 176.8

Male 51 167.0 157.0 161.8 176.0
Male 56 170.1 160.3 165.0 179.3
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Male 39 163.5 154.4 159.2 173.4

Male 35 168.0 157.2 161.9 176.2
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Male 45 170.2 159.6 164.3 178.6

Male 43 165.2 156.8 161.6 175.8
Male 42 170.2 158.7 163.5 177.7
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Male 53 171.0 160.1 164.8 179.1

Male 43 165.7 156.2 160.9 175.2
Male 44 171.2 157.9 162.6 176.9
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Male 51 165.1 155.9 160.6 174.9

Male 35 167.5 153.9 158.7 172.9
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Male 57 164.2 156.6 161.3 175.6

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Figure 1 Linear measurements (black lines) from 3D-VRT images used to calculate the
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combined length of manubrium and mesosternum: manubrium length (M) and

mesosternum length (B).
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Acknowledgement

This work was supported by the National Natural Science Foundation of China

(No.81373252) and the Applied Basic Research Programs of Science and Technology

Commission Foundation of Sichuan Province (No. 2013JY0148).

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·The present investigation used the CT-VRT method.

·We generated linear regression models on the basis of sternum length.

·The derived regression equations may be used for stature estimation.

·The CT-VRT method may be a practical method for stature estimation.

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