Near-Adult Heights and Adult Height Predictions Using Automated and Conventional Greulich–Pyle Bone Age Determinations in Children with Chronic Endocrine Diseases

Objectives To validate adult height predictions (BX) using automated and Greulich–Pyle bone age determinations in children with chronic endocrine diseases. Methods Heights and near-adult heights were measured in 82 patients (48 females) with chronic endocrinopathies at the age of 10.45±2.12 y and at time of transition to adult care (17.98±3.02 y). Further, bone age (BA) was assessed using the conventional Greulich–Pyle (GP) method by three experts, and by BoneXpert™. PAH were calculated using conventional BP tables and BoneXpert™. Results The conventional and the automated BA determinations revealed a mean diference of 0.25±0.72 y (p=0.0027). The automated PAH by BoneXpert™ were 156.26 ± 0.86 cm (SDS ? 2.01 ± 1.07) in females and 171.75 ± 1.6 cm (SDS ? 1.29 ± 1.06) in males, compared to 153.95 ± 1.12 cm (SDS ? 2.56 ± 1.5) in females and 169.31 ± 1.6 cm (SDS?1.66±1.56) in males by conventional BP, respectively and in comparison to near-adult heights 156.38±5.84 cm (SDS?1.91±1.15) in females and 168.94±8.18 cm (SDS?1.72±1.22) in males, respectively. Conclusion BA ratings and adult height predictions by BoneXpert™ in children with chronic endocrinopathies abolish rater-dependent variability and enhance reproducibility of estimates thereby refning care in growth disorders. Conventional methods may outperform automated analyses in specifc cases.

Assessment of Bone Age in Prepubertal Healthy Korean Children: Comparison among the Korean Standard Bone Age Chart, Greulich-Pyle Method, and Tanner-Whitehouse Method

OBJECTIVE: To compare the reliability of the Greulich-Pyle (GP) method, Tanner-Whitehouse 3 (TW3) method and Korean standard bone age chart (KS) in the evaluation of bone age of prepubertal healthy Korean children. MATERIALS AND METHODS: Left hand-wrist radiographs of 212 prepubertal healthy Korean children aged 7 to 12 years, obtained for the evaluation of the traumatic injury in emergency department, were analyzed by two observers. Bone age was estimated using the GP method, TW3 method and KS, and was calculated in months. The correlation between bone age measured by each method and chronological age of each child was analyzed using Pearson correlation coefficient, scatterplot. The three methods were compared using one-way analysis of variance. RESULTS: Significant correlations were found between chronological age and bone age estimated by all three methods in whole group and in each gender (R2 ranged from 0.87 to 0.9, p 0.01). CONCLUSION: The KS, GP, and TW3 methods show good reliability in the evaluation of bone age of prepubertal healthy Korean children without significant difference between them. Any are useful for evaluation of bone age in prepubertal healthy Korean children.

Applicability study of the automatic bone age assessment of BoneXpert software in children and adolescent of China (Shanghai) / 中华实用儿科临床杂志

Objective To explore the application of the automatic bone age assessment of BoneXpert software in Children and adolescent of China (Shanghai).Methods Left hand and wrist radiographs of 434 cases of children from trauma (264 boys and 170 girls) were obtained from Jan.2010 to Dec.2013.Bone age was assessed by BoneXpert software and 40 radiographs were randomly chosen and re-evaluated after a week.Results Seven images were rejected by BoneXpert,so the efficiency of the software was 98.4％ and it takes only 14.5 s for every image.Sample assessments by two times are exactly the same.As to BoneXpert software,there were statistical differences between bone age and chronological age in 8 groups:7,8,9,11 years old boys and 2,3,9,11 years old girls(P ＜ 0.05) out of 26 groups,and the average difference was about 1 s.The following modifications suggested that 0.57,0.79,0.93,-0.38 and-0.22,0.30,0.37,0.59 years could be added respectively for the groups of boys aged 7,8,9,11 and girls aged 2,3,9,11 years old according to their average differences between the bone age and the chronological age.Conclusions The BoneXpert method for automated determination of skeletal maturity which evaluates bone age objectively and quickly can be applied clinically after slight adjustment in some age groups.BoneXpert software is 100 percent automatic and could eliminate the subjective evaluation inaccuracy.

Correlación entre los niveles plasmáticos de hormona luteinizante (LH) y hormona folículo-estimulante (FSH) y el estadio de maduración esquelética en un grupo de niños de Medellín, Colombia / Correlation between plasma levels of luteinizing (LH) and folliclestimulating hormones (FSH) and the state of skeletal maturation in a group of children from Medellin, Colombia

Con el fin de evaluar la asociación entre la madurez ósea y los cambios en los niveles de las gonadotrofinas durante las etapas iniciales de la pubertad, se correlacionaron los niveles séricos de las hormonas luteinizante (LH) y folículo-estimulante (FSH) con el estado de maduración esquelética (evaluado por el método de Greulich y Pyle), la edad, el peso, la talla y la madurez sexual (según la clasificación de Tanner y con el empleo del orquidómetro de Prader) en una población sana de la ciudad de Medellín, Colombia.El estudio de tipo prospectivo observacional, conformado por 16 varones y 15 niñas, entre 8 y 12 años de edad, evaluó seis veces a la misma cohorte durante un período de 30 meses empleando muestras sanguíneas para los niveles hormonales y radiografías de las estructuras óseas carpofalángicas; se incluyeron quienes completaron seis muestras sanguíneas y seis estudios radiológicos.Una vez registradas las diferencias clínicas de los estados Tanner de madurez sexual, los varones con ganancia progresiva de peso mostraron tendencia hacia mayores concentraciones de FSH y discreto avance de la edad esquelética, en tanto que, para los dos sexos, el cambio en los valores de LH se correlacionó mejor con la progresión de la edad esquelética independientemente de otras variables.

In order to analyze the association between skeletal maturation and the changes in the levels of gonadotrophinsduring the initial stages of puberty, serum levels of luteinizing (LH) and follicle-stimulating hormones (FSH) were correlated with the state of skeletal maturation (determined by the method of Greulich and Pyle), and with the age, weight, height and sexual maturity (according to the classification of Tanner and using Prader´s orchidometer) in a healthy population of Medellin, Colombia. Our report includes 16 boys and 15 girls, ranging in age from 8 to 12 years, who completed a total of six blood specimens for hormone levels determination, and six radiographic studies of the carpo-phalangeal bone structures. The study lasted 30 months. Boys with progressive weight gain showed a trend towards higher concentrations of FSH and a discrete advance in skeletal age. On the other hand, in both girls and boys, changes in the LH values were betterassociated with the progression of skeletal age with no influence of other variables.

Comparison of the Greulich-Pyle and Tanner Whitehouse (TW3) Methods in Bone Age Assessment / 대한소아내분비학회지

PURPOSE: The determination of skeletal age is important for the analysis of growth and growth disorders in children. The aim of this study is to investigate the difference of bone age comparing Greulich-Pyle (GP) and Tanner Whitehouse (TW3) methods. We also evaluated the reproducibility of results of each method by different observers (interobserver variation) and by same observer (intraobserver variation). METHODS: Bone ages were assessed from left hand-wrist radiographs of 200 children (108 males and 92 females) aged 7 to 15 years by GP and TW3 methods. To evaluate the reproducibility of each method, 102 radiographs were assessed independently by three observers and 100 radiographs were reassessed by one same observer using both methods. RESULTS: The average bone age by GP and TW3 were 10.65+/-2.24 years and 10.48+/-2.18 years, respectively (P<0.01). There is significant correlation between GP and TW3 methods (R(2)=0.94, P<0.01). The interobserver variation of GP and TW3 was not different significantly (0.51+/-0.44 years by GP vs 0.54+/-0.42 years by TW3). The intraobserver variation also was not different significantly (0.48+/-0.44 years by GP vs 0.45+/-0.37 years by TW3). CONCLUSION: Our data indicate that bone age by TW3 method was slightly younger than that by GP method but similar, and the reproducibility of both methods were not different. Therefore, both GP and TW3 methods are useful for estimation of bone age in Korea children.

Assessment of Bone Age: A comparison of the Greulich Pyle Method to the Tanner Whitehouse Method / 대한내분비학회지

BACKGROUND: Bone age measurements have clinical significance in estimation of growth status and prediction of final adult height. Mostly used methods of bone age measurements are Tanner Whitehouse method(TW2) and Greulich-Pyle method(OP). TW2 is known to be more accurate method in determining the bone age, compared to GP. But GP is being used more widely despite some shortcomings, because TW2 is time consuming and need special training. In this study, we observed the correlation between GP and TW2 to evaluate which bone age among three portions of hand and wrist[metacarpals and phalanges(GP1), carpal bones(GP2), distai radius and ulna (GP3)], measured by GP, was more correlated with the bone age, measured by TW2. METHODS: Left hand/wrist radiographs were taken from 100 prepubertal children with normal growth. These radiogrphs were reviewed by two pediatric endocrinologists independently. Bone ages using TW2 were measured at first, and then GP1, GP2, and GP3 were measured. These bone ages had been compared with TW2, using SAS computer program. RESULTS: The mean chronological age of 100 children was 10.0+/-2.5 years(5 years to 14.7 years range, 63 males and 37 females). The bone age by TW2 was 9.0+/- 2.6 years(2.3 to 13.6 years). The bone age by GP1, GP2, and GP3 were 8.8+/-2.5 years, 8.7+/-2.9 years, and 8.3+/-2.8 years, respectively. Bone ages by TW2 were significantly closer to the chronological age than those by GP. The Pea~rson correlation coefficients of GP1, GP2, and GP3 in eomparison to TW2 were 0,87(p=0.0001), 0.94(p=0.0001), and 0.91(p=0.0001), respectively, There are significant correlatkm between bone ages by TW2 and GP. Bone ages by GP2 and GP3 were statistically significantly different from those by TW2(P<0.01). Bone ages by GP1 has no statistical difference with that by TW2(P=0.64). CONCLUSION: TW2 method is more accurate than GP method in determining the bone age, but it needs time-consuming and laborious efforts. We suggest that the use of GP method for the metacarpals and phalanges can result in a considerable saving of time with no significant loss of accuracy and reproducibility.