Sex Estimation with Patella Measurements from CT Images

Year 2025, Volume: 7 Issue: 3, 609 - 13, 09.09.2025

Murat Dıramalı , Buğra Kaan Yazgı , Erdem Hösükler , Ayşenur Buz Yaşar

Abstract

Aim: This study aimed to investigate sex-based differences in an adult Turkish sample by measuring patellar bone size in an adult Turkish sample.
Material and Method: Patella height, width, and depth were measured in cases who underwent knee computed tomography (CT) at Bolu Abant Izzet Baysal University Training and Research Hospital between 2013 and 2023. A total of 102 cases were evaluated. Patellar dimensions, including the heights, widths, and depths of the cases were measured for each case. Statistical analysis was conducted using SPSS version 26.00.
Results: A total of 102 cases including 62 males and 40 females were analyzed in the study. Patella height, width, and modified depth parameters were found to be significantly higher in males (p<0.001). However, since the depth does not affect the accuracy of sex estimation, only the height and width parameters were used for the analysis. For the male sex prediction, 86.7% sensitivity, 71.1% specificity, and 80.6% accuracy rates were obtained with the analysis using height and width parameters. The following discriminant formula was established: “Sex=1.504xHeight + 1.867xWidth-14.218”. Separate models were also developed using height and width parameters. When using only height parameters, male sex was predicted with 80% sensitivity, 73.7% specificity, and 77.6% accuracy. The discriminant formula was formulated as follows: “Sex=2.925xHeight-11.992”. Ehen using only the width parameters, the male sex was predicted with 88.7% sensitivity, 75% specificity, and 83.3% accuracy. The discriminant formula was established as: “Sex=2.987xWidth-12.900”. The depth parameters provided 85.5% sensitivity, 52.5% specificity, and 72.5% accuracy with male sex. The formula “Sex=2.925xHeight-11.992” was developed.
Conclusion: Our study demonstrated sex dimorphism in the patellar bone within the Turkish population, with males showing significantly larger patellae than females. An accuracy rate of 80.6% was achieved using all patellar measurements. The findings suggest that the patella may serve as a valuable supplementary tool when used alongside other anthropological methods, enhancing the accuracy and reliability in sex estimation.

Keywords

Forensic medicine , forensic anthropology , identification , sex estimation , patellar bone , computed tomography

Ethical Statement

Bolu Abant İzzet Baysal University Clinical Research Ethics Committee with the decision dated 22/09/2023 and numbered 2023/409.

Thanks

We thank the Clinic of Forensic Medicine of Bolu Abant İzzet Baysal University İzzet Baysal Training and Research Hospital staff for their help in collecting the data.

References

• Langley NR, Tersigni-Tarrant MA. Skeletal Individuation and Analyses. In: Langley NR, Tersigni-Tarrant MA, eds, Forensic Anthropology: A Comprehensive Introduction. Boca Raton: CRC Press. 2017;79-125.
• Saukko P, Knight B. The Establishment of Identity of Human Remains. In: Saukko P, Knight B, eds, Knight’s Forensic Pathology. Boca Raton: CRC Press. 2016;95-132.
• Hoşsöz S. Adli Antropolojide Biyolojik Profil Belirleme Yöntemleri. In: Çeker D, Erol AS, Plümer Küçük G, eds, Adli Antropoloji ve Kimliklendirme- Sahada ve Laboratuvarda Popüler Metodlar. Ankara: Nobel Kitap. 2020;142-98.
• Toneva DH, Nikolova SY, Tasheva-Terzieva ED, et al. Sexual dimorphism in shape and size of the neurocranium. Int J Legal Med. 2022;136:1851-63.
• Koç S, Can M. Adli Kimliklendirme. In: Dokgöz H, ed, Adli Tıp & Adli Bilimler. Ankara: Akademisyen Kitabevi. 2020:153-162.
• Rahmani E, Mohammadi S, Babahajian A, et al. Anthropometric characteristics of patella for sex estimation using magnetic resonance images. Forensic Imaging. 2020;23:200412.
• Krishan K, Chatterjee PM, Kanchan T, et al. A review of sex estimation techniques during examination of skeletal remains in forensic anthropology casework. Forensic Sci Int. 2016;261:165.e1-8.
• Peckmann TR, Fisher B. Sex estimation from the patella in an African American population. J Forensic Leg Med. 2018;54:1-7.
• Zhan M jun, Li C lin, Fan F, et al. Estimation of sex based on patella measurements in a contemporary Chinese population using multidetector computed tomography: an automatic measurement method. Leg Med. 2020;47:101778.
• Indra L, Vach W, Desideri J, et al. Testing the validity of population-specific sex estimation equations: an evaluation based on talus and patella measurements. Sci Justice. 2021;61:555-63.
• Bidmos MA, Olateju OI, Latiff S, et al. Machine learning and discriminant function analysis in the formulation of generic models for sex prediction using patella measurements. Int J Legal Med. 2023;137:471-85.
• Introna F, Di Vella G, Campobasso CP. Sex determination by discriminant analysis of patella measurements. Forensic Sci Int. 1998;95;39-45.
• Kemkes-Grottenthaler A. Sex determination by discriminant analysis: an evaluation of the reliability of patella measurements. Forensic Sci Int. 2005;147:129-33.
• Maio C, Cunha E, Navega D. Metric analysis of the patella for sex estimation in a Portuguese sample. Forensic Sci Res. 2024;9:owae015. Erratum in: Forensic Sci Res. 2024;9:owae056.
• Koo TK, Li MY. A Guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155-63. Erratum in: J Chiropr Med. 2017;16:346.
• Akhlaghi M, Sheikhazadi A, Naghsh A, Dorvashi G. Identification of sex in Iranian population using patella dimensions. J Forensic Leg Med. 2010;17:150-5.
• Abdel Moneim WM, Abdel Hady RH, Abdel Maaboud RM, et al. Identification of sex depending on radiological examination of foot and patella. Am J Forensic Med Pathol. 2008;29:136-40.
• Michiue T, Hishmat AM, Oritani S, et al. Virtual computed tomography morphometry of the patella for estimation of sex using postmortem Japanese adult data in forensic identification. Forensic Sci Int. 2018;285:206.e1-6.
• Dorado-Fernández E, Cáceres-Monllor DA, Carrillo-Rodríguez MF, et al. A meta-analytic review for the patella sexual dimorphism assessment. Int J Morphol. 2020:38:933-9.
• Yasar Teke H, Ünlütürk Ö, Günaydin E, et al. Determining gender by taking measurements from magnetic resonance images of the patella. J Forensic Leg Med. 2018;58:87-92.
• Öner S, Turan M, Öner Z. Estimation of gender by using decision tree, a machine learning algorithm, with patellar measurements obtained from MDCT images. Med Records. 2021;3:1-9.
• Peckmann TR, Meek S, Dilkie N, Rozendaal A. Determination of sex from the patella in a contemporary Spanish population. J Forensic Leg Med. 2016;44:84-91.