Computed Tomography-based Craniometric Sex Determination in Forensic Anthropology: A Systematic Review

This systematic review evaluates the role of computed tomography (CT)-based craniometric analysis in forensic sex determination by synthesizing evidence published between 2005 and 2025. Sex estimation is a fundamental component of biological profiling in forensic anthropology, and the skull remains one of the most reliable skeletal structures when the pelvis is unavailable or fragmented. The development of CT imaging has enabled accurate three-dimensional craniofacial measurements with high reproducibility and without damaging skeletal remains. A comprehensive literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines using PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar. Studies involving adult populations that reported quantitative CT-based cranial measurements for sex determination were included. Data regarding imaging techniques, cranial parameters, statistical approaches, and classification accuracy were extracted and qualitatively synthesized. A total of 65 studies fulfilled the inclusion criteria. Cranial base length, bizygomatic breadth, and foramen magnum dimensions emerged as the most consistently reported sexually dimorphic variables. Multivariate and stepwise discriminant function analyses generally demonstrated higher classification accuracy than univariate approaches, with reported accuracies ranging from approximately 83% to 95%, and several recent studies exceeding 90%. Overall, the included studies demonstrated a low-to-moderate risk of bias, although methodological heterogeneity, population-specific variation, and limited external validation remain important limitations. Current evidence indicates that CT-based craniometric analysis is a reliable and increasingly robust approach for forensic sex estimation, highlighting the need for standardized measurement protocols and broader population-specific validation to enhance its forensic applicability.