ABSTRACT
The assessment of skeletal maturity is crucial for the analysis of growth disorders and plays an important role in paediatrics. For this reason, several methods have been developed for estimating skeletal maturity. Among them, the Tanner and Whitehouse method (TW2), which is based on the analysis of hand radiographs, is usually considered the most accurate and reliable. Nevertheless, TW2 is applied only in a small fraction of cases, due to its complexity and long examination times. Thus, the development of automated systems which reliably implement this method is highly desirable. However, major difficulties have been found in the development of computer-based systems for the assessment of skeletal maturity. In particular the extraction of the bones of interest has proved to be extremely challenging. In this paper, we propose a system architecture for the implementation of the TW2 method, which is based on artificial neural networks. For each bone considered, the maturation stage is determined by means of a two-step process which first locates the position of the bone in the radiograph and then analyzes the bone shape. Experimental results obtained with our implementation of the carpal version of TW2 are in good agreement with those provided by trained observers.
Subject(s)
Age Determination by Skeleton/methods , Hand/diagnostic imaging , Neural Networks, Computer , Adolescent , Algorithms , Automation , Carpal Bones/diagnostic imaging , Child , Expert Systems , Growth , Humans , Image Processing, Computer-Assisted , Osteogenesis , Pattern Recognition, Automated , Reproducibility of ResultsABSTRACT
It may be possible to recognize different forms of precocious puberty at the first evaluation. In a group of 26 sexually precocious girls we used Bayley-Pinneau predicted adult height (P.A.H.) to discriminate patients with 'poor' or 'good' height prognosis. Patients with evidence of impaired height prognosis (P.A.H. < -1 SDS) (Group 1) were immediately treated with LH-RH analogs, while patients with unimpaired height prognosis (P.A.H. > -1 SDS) (Group 2) were followed without therapy. Two yr of treatment significantly improved P.A.H. in Group 1 patients, from a mean of -1.68 +/- 0.4 to a mean of -0.57 +/- 0.6 (SDS) (p < 0.01). After the 2 yr observation period, Group 2 patients showed no significant variation of P.A.H. (from a mean of 0.45 +/- 0.8 to a mean of 0.33 +/- 0.6). The retrospective analysis of the growth pattern changes in the two Groups seems to indicate that LH-RH agonist treatment improves height potential in girls with initial poor height prognosis and that girls with initial good height prognosis maintain an unimpaired growth potential.
Subject(s)
Puberty, Precocious/diagnosis , Age Factors , Body Height/drug effects , Breast/growth & development , Child , Female , Follicle Stimulating Hormone/blood , Follow-Up Studies , Gonadotropin-Releasing Hormone/analogs & derivatives , Gonadotropin-Releasing Hormone/pharmacology , Humans , Luteinizing Hormone/blood , Luteinizing Hormone/drug effects , Prognosis , Prospective Studies , Puberty, Precocious/drug therapyABSTRACT
In order to evaluate the effects of low-dosage, 6-12 months course of oxandrolone treatment in constitutional delay of growth, we compared the growth responses on treatment, the pattern of sexual development and pubertal growth events, up to final stature of 11 prepubertal boys, aged 10.6-14.1 yr, with those of 11 prepubertal, age-matched untreated controls. Treatment caused a significant increase of height velocity, from 4 to 9 cm/yr, and a significant acceleration of bone maturation, without affecting the timing of onset of puberty, the progression of sexual development or the onset of pubertal growth spurt. On the other hand, oxandrolone induced an earlier skeletal growth arrest but did not affect the expected final height. Treated boys showed an adult stature not significantly different from that of control subjects. Our data suggest that 6 months-1 year, low dosage oxandrolone treatment in constitutionally delayed growth has no significant effect on the pattern of pubertal growth, nor on the rate of sexual maturation or on final height.
Subject(s)
Body Height , Growth Disorders/drug therapy , Oxandrolone/therapeutic use , Adolescent , Bone Development/drug effects , Child , Humans , Male , Oxandrolone/pharmacology , Puberty/physiologySubject(s)
Age Determination by Skeleton , Adolescent , Child , Child, Preschool , Female , Humans , Male , MethodsABSTRACT
A new method is presented for the evaluation of skeletal growth; it is a simplification of an already known too time-consuming method. A single left wrist-and-hand X-ray is required; examining the morphology of five hand and wrist bones (different according to age) the examined subject can be judged either normal, or requiring a more thorough examination. The results shown were achieved comparing, on 286 roentgenograms, the new simplified method with the already standardized ones. The use of the new method is not only advised because of its simplicity but because of its lack of false negatives as well in the authors' experience.
