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Heldring N, Rezaie AR, Larsson A, Gahn R, Zilg B, Camilleri S, Saade A, Wesp P, Palm E, Kvist O. A probability model for estimating age in young individuals relative to key legal thresholds: 15, 18 or 21-year. Int J Legal Med 2024:10.1007/s00414-024-03324-x. [PMID: 39292274 DOI: 10.1007/s00414-024-03324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/29/2024] [Indexed: 09/19/2024]
Abstract
Age estimations are relevant for pre-trial detention, sentencing in criminal cases and as part of the evaluation in asylum processes to protect the rights and privileges of minors. No current method can determine an exact chronological age due to individual variations in biological development. This study seeks to develop a validated statistical model for estimating an age relative to key legal thresholds (15, 18, and 21 years) based on a skeletal (CT-clavicle, radiography-hand/wrist or MR-knee) and tooth (radiography-third molar) developmental stages. The whole model is based on 34 scientific studies, divided into examinations of the hand/wrist (15 studies), clavicle (5 studies), distal femur (4 studies), and third molars (10 studies). In total, data from approximately 27,000 individuals have been incorporated and the model has subsequently been validated with data from 5,000 individuals. The core framework of the model is built upon transition analysis and is further developed by a combination of a type of parametric bootstrapping and Bayesian theory. Validation of the model includes testing the models on independent datasets of individuals with known ages and shows a high precision with separate populations aligning closely with the model's predictions. The practical use of the complex statistical model requires a user-friendly tool to provide probabilities together with the margin of error. The assessment based on the model forms the medical component for the overall evaluation of an individual's age.
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Affiliation(s)
- Nina Heldring
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius Väg 5, 171 65, Stockholm, Sweden.
- Department of Oncology-Pathology, Karolinska Institutet, Retzius V. 3, 171 77, Stockholm, Sweden.
| | - Ali-Reza Rezaie
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius Väg 5, 171 65, Stockholm, Sweden
| | | | - Rebecca Gahn
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius Väg 5, 171 65, Stockholm, Sweden
| | - Brita Zilg
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius Väg 5, 171 65, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Retzius V. 3, 171 77, Stockholm, Sweden
| | - Simon Camilleri
- Faculty of Dentistry, Oral and Craniofacial Sciences, Tower Wing, Guys' Hospital St Thomas Street, London, England
| | - Antoine Saade
- Department of Orthodontics, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Philipp Wesp
- Department of Radiology, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- Munich Center for Machine Learning (MCML), Geschwister‑Scholl‑Platz 1, 80539, Munich, Germany
| | - Elias Palm
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius Väg 5, 171 65, Stockholm, Sweden
| | - Ola Kvist
- Pediatric Radiology Department, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Wittschieber D, Hahnemann ML, Mentzel HJ. Forensic Diagnostics of the Skeletal Age in the Living - Backgrounds and Methodology. ROFO-FORTSCHR RONTG 2024; 196:254-261. [PMID: 37699433 DOI: 10.1055/a-2130-3162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND The expert opinions on forensic age diagnostics requested by state institutions are used to show the exceeding of legally relevant age thresholds, especially the completed 18th year of life. According to the recommendations of the Study Group on Forensic Age Diagnostics (AGFAD), this requires - among other things - a determination of skeletal age. METHOD Considering recent scientific knowledge, the current conditions and established skeletal age diagnostics methods are presented. Additionally, this review article sheds light on the influence of ethnicity and socioeconomic status, questions regarding indication, as well as alternative and future developments. RESULTS AND CONCLUSION In forensic age diagnostics, particularly hand radiography and thin-slice CT of the medial clavicular epiphysis are relevant for determining skeletal age. The Atlas method of Greulich and Pyle (1959) and the clavicular stages by Schmeling et al. (2004) and Kellinghaus et al. (2010) are primarily used for this. This spectrum of methods, which is based on a very solid database, might be supplemented by MRI studies of the knee joint in the near future. KEY POINTS · Determining skeletal age is an essential part of forensic age diagnostics commissioned by state authorities and courts.. · Hand radiography and CT of the medial clavicular epiphysis form the core of the spectrum of methods recommended by the Study Group of Forensic Age Diagnostics (AGFAD).. · Since the radiological studies required for forensic age diagnostics are not medically indicated, it must be ensured that the legal basis is specifically named in each case when commissioning expert opinions.. · MRI studies of the knee joint might increase the spectrum of methods in the near future.. CITATION FORMAT · Wittschieber D, Hahnemann ML, Mentzel H. Forensic Diagnostics of the Skeletal Age in the Living - Backgrounds and Methodology. Fortschr Röntgenstr 2024; 196: 254 - 261.
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Affiliation(s)
| | | | - Hans-Joachim Mentzel
- Institute of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Jena University Hospital, Jena, Germany
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Tiwari PK, Nayak AK, Verma A, Pandey SK, Mishra A, Devadas D, Yadav A, Gupta M. Greulich and Pyle atlas: a non-reliable skeletal maturity assessment method in the North Indian population. Forensic Sci Med Pathol 2024; 20:106-116. [PMID: 37071347 DOI: 10.1007/s12024-023-00607-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/19/2023]
Abstract
Forensic age assessments are crucial in the evaluation of criminal responsibility and preventing false age claims. Of all the methods available, the Greulich and Pyle (GP) atlas is most commonly used for age estimation purposes. Therefore, the current study sought to analyze the reliability and applicability of the GP standard and, additionally, to determine any possible association between the socioeconomic status (SES), food habits, and estimated skeletal maturity in the North Indian population. The study included 627 (334 males and 293 females) healthy children up to 19 years of age with varying SES and food habits. The skeletal age (SA) was estimated by three different evaluators using the GP atlas. The chronological mean age (CA) and SA were compared in different age cohorts. A paired t-test and a Pearson chi-square test were applied to show the difference between CA and estimated SA and the association of skeletal maturity with SES and food habits. The estimated skeletal age in males was retarded by 0.142 years or 1.72 months (p ≤ 0.05), whereas in females, it was retarded by 0.259 years or 3.12 months (p ≤ 0.05). In males, the GP method has significantly underestimated SA in age cohorts 3-4, 4-5, 6-7, 7-8, 8-9, and 12-13, whereas it overestimated in 10-11 and 18-19 years. However, in females, the SA was significantly underestimated in age groups 10-11, 12-13, and 14-15, respectively. Estimated skeletal maturity had no significant association with SES and food habits. The current study concludes that the GP atlas may not be applicable to North India's population. The observed difference in assessed skeletal maturity may be due to geographical region, genetics, hormonal effects, etc., which require further investigation. Hence, population-specific standards are necessary to determine the bone age of Indian children accurately.
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Affiliation(s)
- Praveen Kumar Tiwari
- Department of Forensic Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Amit Kumar Nayak
- Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Ashish Verma
- Department of Radiology and Radio-Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Surendra Kumar Pandey
- Department of Forensic Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Anand Mishra
- Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Deepa Devadas
- Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Ashish Yadav
- Department of Bio-Statistic, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Mayank Gupta
- Department of Forensic Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
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Sariyilmaz K, Abali S, Ziroglu N, Cingoz T, Ozkunt O, Abali ZY, Kalayci CB, Hayretci M, Semiz S. Interdisiplinary and intraobserver reliability of the Greulich-Pyle method among Turkish children. J Pediatr Endocrinol Metab 2023; 36:1181-1185. [PMID: 37844258 DOI: 10.1515/jpem-2023-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES Greulich-Pyle (GP) is one of the most used method for bone age determination (BAD) in various orthopedic, pediatric, radiological, and forensic situations. We aimed to investigate the inter- and intra-observer reliability of the GP method between the most relevant disciplines and its applicability to the Turkish population. METHODS One-hundred and eighty (90 boys, 90 girls) patients with a chronological age younger than 18 (mean 9.33) were included. X-rays mixed by the blinded investigator were evaluated by two orthopedists, two radiologists, and two pediatric endocrinologists to determine skeletal age according to the GP atlas. A month later the process was repeated. As a statistical method, Paired t-test was used for comparison, an Intraclass Correlation Coefficients test was used for reliability and a 95 % confidence interval was determined. Results were classified according to Landis-Koch. RESULTS All results were consistent with chronological age (p<0.001), according to the investigators' evaluations compared with chronological age. At the initial evaluation, the interobserver reliability of the method was 0.999 (excellent); at the second evaluation, the interobserver reliability was 0.997 (excellent). The intra-observer reliability of the method was 'excellent' in all observers. When results were separately evaluated by gender, excellent intraobserver correlation and excellent correlation with chronological age were found among all researchers (>0.9). When X-rays were divided into three groups based on age ranges and evaluated, 'moderate' and 'good' correlations with chronological age were obtained during the peripubertal period. CONCLUSIONS The GP method used in skeletal age determination has excellent inter- and intra-observer reliability. During the peripubertal period, potential discrepancies in bone age assessments should be kept in mind. This method can be used safely and reproducibly by the relevant specialists.
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Affiliation(s)
- Kerim Sariyilmaz
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Türkiye
| | - Saygin Abali
- Department of Pediatric Health and Diseases, Pediatric Endocrinology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Türkiye
| | - Nezih Ziroglu
- Department of Orthopedics and Traumatology, Acibadem Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Tunca Cingoz
- Department of Orthopedics and Traumatology, Acibadem Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Okan Ozkunt
- Department of Physical Medicine and Rehabilitation, Medicine Faculty, Biruni University, Istanbul, Türkiye
| | - Zehra Yavaş Abali
- Department of Pediatric Health and Diseases, Pediatric Endocrinology, Pendik Training and Research Hospital, Marmara University, Istanbul, Türkiye
| | - Cem Burak Kalayci
- Department of Radiology, Acibadem Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Merve Hayretci
- Department of Radiology, Acibadem Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Serap Semiz
- Department of Pediatric Health and Diseases, Pediatric Endocrinology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Türkiye
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Martín Pérez SE, Martín Pérez IM, Vega González JM, Molina Suárez R, León Hernández C, Rodríguez Hernández F, Herrera Perez M. Precision and Accuracy of Radiological Bone Age Assessment in Children among Different Ethnic Groups: A Systematic Review. Diagnostics (Basel) 2023; 13:3124. [PMID: 37835867 PMCID: PMC10572703 DOI: 10.3390/diagnostics13193124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/24/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
AIM The aim was to identify, evaluate, and summarize the findings of relevant individual studies on the precision and accuracy of radiological BA assessment procedures among children from different ethnic groups. MATERIALS AND METHODS A qualitative systematic review was carried out following the MOOSE statement and previously registered in PROSPERO (CRD42023449512). A search was performed in MEDLINE (PubMed) (n = 561), the Cochrane Library (n = 261), CINAHL (n = 103), Web of Science (WOS) (n = 181), and institutional repositories (n = 37) using MeSH and free terms combined with the Booleans "AND" and "OR". NOS and ROBINS-E were used to assess the methodological quality and the risk of bias of the included studies, respectively. RESULTS A total of 51 articles (n = 20,100) on radiological BA assessment procedures were precise in terms of intra-observer and inter-observer reliability for all ethnic groups. In Caucasian and Hispanic children, the Greulich-Pyle Atlas (GPA) was accurate at all ages, but in youths, Tanner-Whitehouse radius-ulna-short bones 3 (TW3-RUS) could be an alternative. In Asian and Arab subjects, GPA and Tanner-Whitehouse 3 (TW3) overestimated the BA in adolescents near adulthood. In African youths, GPA overestimated the BA while TW3 was more accurate. CONCLUSION GPA and TW3 radiological BA assessment procedures are both precise but their accuracy in estimating CA among children of different ethnic groups can be altered by racial bias.
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Affiliation(s)
- Sebastián Eustaquio Martín Pérez
- Departamento de Farmacología y Medicina Física, Área de Radiología y Medicina Física, Sección de Enfermería y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (I.M.M.P.); (F.R.H.)
- Escuela de Doctorado y Estudios de Posgrado, Universidad de La Laguna, San Cristóbal de La Laguna, 38203 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Isidro Miguel Martín Pérez
- Departamento de Farmacología y Medicina Física, Área de Radiología y Medicina Física, Sección de Enfermería y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (I.M.M.P.); (F.R.H.)
- Escuela de Doctorado y Estudios de Posgrado, Universidad de La Laguna, San Cristóbal de La Laguna, 38203 Santa Cruz de Tenerife, Spain
| | - Jesús María Vega González
- Institute of Legal Medicine and Forensic Sciences of Santa Cruz de Tenerife, 38230 San Cristóbal de La Laguna, Spain;
| | - Ruth Molina Suárez
- Pediatric Endocrinology Unit, Pediatric Department, Hospital Universitario de Canarias, San Cristóbal de La Laguna, 38320 Santa Cruz de Tenerife, Spain;
| | - Coromoto León Hernández
- Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna, Apdo. 456, San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, España;
| | - Fidel Rodríguez Hernández
- Departamento de Farmacología y Medicina Física, Área de Radiología y Medicina Física, Sección de Enfermería y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (I.M.M.P.); (F.R.H.)
| | - Mario Herrera Perez
- School of Medicine (Health Sciences), Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain;
- Foot and Ankle Unit, Orthopedic Surgery and Traumatology Department, San Cristóbal de La Laguna, 38320 Santa Cruz de Tenerife, Spain
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Kowo-Nyakoko F, Gregson CL, Madanhire T, Stranix-Chibanda L, Rukuni R, Offiah AC, Micklesfield LK, Cooper C, Ferrand RA, Rehman AM, Ward KA. Evaluation of two methods of bone age assessment in peripubertal children in Zimbabwe. Bone 2023; 170:116725. [PMID: 36871897 DOI: 10.1016/j.bone.2023.116725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES Bone age (BA) measurement in children is used to evaluate skeletal maturity and helps in the diagnosis of growth disorders in children. The two most used methods are Greulich and Pyle (GP), and Tanner and Whitehouse 3 (TW3), both based upon assessment of a hand-wrist radiograph. To our knowledge no study has compared and validated the two methods in sub-Saharan Africa (SSA), and only a few have determined BA despite it being a region where skeletal maturity is often impaired for example by HIV and malnutrition. This study aimed to compare BA as measured by two methods (GP and TW3) against chronological age (CA) and determine which method is most applicable in peripubertal children in Zimbabwe. METHODS We conducted a cross-sectional study of boys and girls who tested negative for HIV. Children and adolescents were recruited by stratified random sampling from six schools in Harare, Zimbabwe. Non-dominant hand-wrist radiographs were taken, and BA assessed manually using both GP and TW3. Paired sample Student t-tests were used to calculate the mean differences between BA and chronological age (CA) in boys and girls. Bland-Altman plots compared CA to BA as determined by both methods, and agreement between GP and TW3 BA. All radiographs were graded by a second radiographer and 20 % of participants of each sex were randomly selected and re-graded by the first observer. Intraclass correlation coefficient assessed intra- and inter-rater reliability and coefficient of variation assessed precision. RESULTS We recruited 252 children (111 [44 %] girls) aged 8.0-16.5 years. The boys and girls were of similar mean ± SD CA (12.2 ± 2.4 and 11.7 ± 1.9 years) and BA whether assessed by GP (11.5 ± 2.8 and 11.5 ± 2.1 years) or TW3 (11.8 ± 2.5 and 11.8 ± 2.1 years). In boys BA was lower than CA by 0.76 years (95 % CI: -0.95, -0.57) when using GP, and by 0.43 years (95 % CI: -0.61, -0.24) when using TW3. Among the girls there was no difference between BA and CA by either GP [-0.19 years (95 % CI: -0.40, 0.03)] or TW3 [0.07 years (95 % CI: -0.16, 0.29)]. In both boys and girls, there were no systematic differences between CA and TW3 BA across age groups whereas agreement improved between CA and GP BA as children got older. Inter-operator precision was 1.5 % for TW3 and 3.7 % for GP (n = 252) and intra-operator precision was 1.5 % for TW3 and 2.4 % for GP (n = 52). CONCLUSION The TW3 BA method had better precision than GP and did not systematically differ from CA, meaning that TW3 is the preferred method of assessment of skeletal maturity in Zimbabwean children and adolescents. TW3 and GP methods do not agree for estimates of BA and therefore cannot be used interchangeably. The systematic differences in GP BA assessments over age means it is not appropriate for use in all age groups or stages of maturity in this population.
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Affiliation(s)
- Farirayi Kowo-Nyakoko
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, SO16 6YD Southampton, UK; Biomedical Research and Training Institute, 10 Seagrave Road, Avondale Harare, Zimbabwe; Department of Medical Physics and Imaging Sciences, University of Zimbabwe- Faculty of Medicine and Health Sciences, Parirenyatwa Group of Hospitals, Mazowe Street, Harare, Zimbabwe.
| | - Celia L Gregson
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol BS10 5NB, UK; SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Tafadzwa Madanhire
- Biomedical Research and Training Institute, 10 Seagrave Road, Avondale Harare, Zimbabwe
| | - Lynda Stranix-Chibanda
- Child and Adolescent Unit, University of Zimbabwe-Faculty of Medicine and Health Sciences, Parirenyatwa Group of Hospitals, Mazowe Street, Harare, Zimbabwe
| | - Ruramayi Rukuni
- Biomedical Research and Training Institute, 10 Seagrave Road, Avondale Harare, Zimbabwe; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Amaka C Offiah
- Department of Oncology & Metabolism, University of Sheffield, Damer Street Building, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield S10 2TH, UK
| | - Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, SO16 6YD Southampton, UK
| | - Rashida A Ferrand
- Biomedical Research and Training Institute, 10 Seagrave Road, Avondale Harare, Zimbabwe; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrea M Rehman
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kate A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, SO16 6YD Southampton, UK; SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Mentzel HJ, Wittschieber D. [Radiological methods for age diagnostics : Clinical and forensic aspects]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:129-140. [PMID: 36656310 DOI: 10.1007/s00117-022-01110-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Age diagnostics play an increasing role in radiology. Medical and forensic questions are indications for the application of age diagnostics. In addition to X‑rays of the hand in childhood, panoramic tomography and computed tomography are currently the standard procedures. Alternative modalities without ionizing radiation (sonography, magnetic resonance imaging) have not (yet) been established. The purpose of this article is to present the indications and methods of age diagnostics in the clinical and forensic contexts and to familiarize you with their advantages and disadvantages as well as the possibility of determining the final length.
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Affiliation(s)
- Hans-Joachim Mentzel
- Sektion Pädiatrische Radiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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Alshamrani K. The Application of Magnetic Resonance Imaging in Skeletal Age Assessment. Appl Bionics Biomech 2022; 2022:9607237. [PMID: 35237346 PMCID: PMC8885254 DOI: 10.1155/2022/9607237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
METHOD The study includes 80 patients identified from an endocrine clinic, two males and two females from each of 5 age groups (<5, 5 to 7, 8 to 10, 11 to 13, and 14 to 16 years). Skeletal age as determined from an open MRI scanner and radiographs performed on the same day was compared for each child. Two observers assess the skeletal age from radiographs and MRI images independently. After a period of at least three weeks, observers determined the skeletal age of all patients independently. All of the images were in different and random orders, on both of the assessment occasions. The agreement was assessed using the interclass correlation coefficient and Bland Altman plots. Problem Statement. The recurrent use of left-hand radiography in children with chronic conditions might result in the patient being exposed to the same image several times throughout the course of their lives. Use of radiation-free methods such as magnetic resonance imaging (MRI) may be able to assist in reducing the risks associated with radiation exposure, if done properly. RESULTS Patients' age ranged from 3 to 16 years, in which the mean of the chronological age was 9.3 years (±2.9) and 9.8 years (±2.7) in girls and boys, respectively. The interrater agreement for skeletal age determination was 0.984 for radiographs and 0.976 for MRI scans. Using the G&P technique, for Observer 1, intraobserver agreement for radiographs and DXA was 0.993 and 0.983, respectively, and 0.995 and 0.994, respectively, for Observer 2. Plotting the rater readings against the line of equality shows no significant differences between readings acquired from radiographs and MRI scans. CONCLUSION For the study contribution, it is possible to employ open compact MRI to determine the skeletal age of a person. Our results showed that left-hand MRI scans were of better quality than the radiographs.
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Affiliation(s)
- Khalaf Alshamrani
- Radiological Sciences Department, College of Applied Medical Science, Najran University, Najran, Saudi Arabia
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Determination of bone age and evaluating the applicability of Greulich-Pyle standards among the Turkish children. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1021045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Birch JG, Makarov MR, Sanders JO, Podeszwa DA, Honcharuk EM, Esparza M, Tran EY, Jo CH, Rodgers JA. Lower-Extremity Segment-Length Prediction Accuracy of the Sanders Multiplier, Paley Multiplier, and White-Menelaus Formula. J Bone Joint Surg Am 2021; 103:1713-1717. [PMID: 34166322 DOI: 10.2106/jbjs.20.01923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several methods are available to estimate leg lengths at maturity to facilitate the determination of timing of epiphysiodesis. We compared the Paley multiplier, Sanders multiplier, and White-Menelaus methods in an epiphysiodesis-aged cohort. We assessed intra- and interrater reliability for Sanders skeletal stages and Greulich and Pyle atlas skeletal age. METHODS Actual growth was recorded in healthy, unoperated femoral and tibial segments from an epiphysiodesis database. The predicted and actual lengths were compared with use of the Paley multiplier and White-Menelaus methods, Greulich and Pyle skeletal age, and the Sanders multiplier using Sanders stages. Intra- and interrater reliability were assessed in a separate group of 76 skeletal age films. RESULTS The cohort included 148 femora and 195 tibiae in 197 patients. Femoral length at maturity was slightly underestimated by the Sanders multiplier and staging, was overestimated by the Paley multiplier and skeletal age, and was most accurately predicted with use of the White-Menelaus formula and skeletal age. All methods overestimated tibial length at maturity. The whole-leg prediction accuracy of the Sanders multiplier and White-Menelaus formula were comparable and were more accurate than that of the Paley multiplier. For Sanders skeletal staging, the interrater reliability varied from 0.86 to 0.88 and the intrarater reliability varied from 0.87 to 0.96. For Greulich and Pyle skeletal age, the interrater reliability varied from 0.87 to 0.89 and the intrarater reliability varied from 0.91 to 0.95. CONCLUSIONS Use of the Sanders multiplier and skeletal stages was more accurate than the Paley multiplier and skeletal age in this cohort. Use of the White-Menelaus formula and skeletal age was slightly more accurate in predicting femoral length and slightly less accurate in predicting tibial length compared with the Sanders multiplier. Intra- and interrater reliability were similar between Sanders skeletal stages and Greulich and Pyle atlas skeletal age. The White-Menelaus formula and skeletal age was the recommended method for predicting lower-extremity segment lengths at maturity and epiphysiodesis effect. Although easier to recall without referencing an atlas and not sex-specific, Sanders skeletal staging does not correspond directly to years of growth remaining, and thus cannot be used with the White-Menelaus formula. CLINICAL RELEVANCE The Greulich and Pyle atlas to determine skeletal age and the White-Menelaus formula to determine growth remaining are reliable predictors of epiphysiodesis effect in the lower extremities.
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Affiliation(s)
- John G Birch
- Texas Scottish Rite Hospital for Children, Dallas, Texas
| | | | | | | | | | | | - Elaine Y Tran
- Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Chan-Hee Jo
- Texas Scottish Rite Hospital for Children, Dallas, Texas
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11
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Houston J, Chiang A, Haleem S, Bernard J, Bishop T, Lui DF. Reproducibility and reliability analysis of the Luk Distal Radius and Ulna Classification for European patients with adolescent idiopathic scoliosis. J Child Orthop 2021; 15:166-170. [PMID: 34040663 PMCID: PMC8138788 DOI: 10.1302/1863-2548.15.200251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Current clinical and radiological methods of predicting a patient's growth potential are limited in terms of practicality, accuracy and known to differ in different races. This information influences optimal timing of bracing and surgical intervention in adolescent idiopathic scoliosis (AIS). The Luk classification was developed to mitigate limitations of existing tools. Few reliability studies are available and are limited to certain geographical regions with varying results. This study was performed to analyze reproducibility and reliability of the Luk Distal Radius and Ulna Classification in European patients. METHODS This is a radiological study of 50 randomly selected left hand and wrist radiographs of patients with AIS referred to a tertiary referral centre. They were assessed for bone maturity using the Luk Distal Radius and Ulna Classification. Assessment was performed twice by four examiners at an interval of one month. Statistical analysis was performed using the intraclass correlation (ICC) method to determine the reliabilities within and between the examiners. RESULTS In total, 50 radiographs (M:F = 13:37) with a mean age of 13.7 years (10 to 18) were assessed for reliability. The inter-rater ICC value was 0.918 for radius assessment and 0.939 for ulna assessment. The intra-rater ICC values for radius assessment ranged between 0.897 and 0.769 and between 0.948 and 0.786 for ulna assessment. There was near perfect correlation for both assessments. CONCLUSION This study provides independent evidence that the Luk Distal Radius and Ulna Classification is a reliable tool for assessment of skeletal maturity for European patients. Minimal clinical experience is required to reliably utilize it. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- James Houston
- St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Amy Chiang
- St George’s Hospital Medical School, University of London, London, UK
| | - Shahnawaz Haleem
- Royal Orthopaedic Hospital, The Woodlands, Bristol Rd South, Birmingham, UK,Correspondence should be sent to Shahnawaz Haleem, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK. E-mail:
| | - Jason Bernard
- St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Timothy Bishop
- St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Darren F. Lui
- St Georges University Hospitals NHS Foundation Trust, London, UK
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12
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Age estimation in the living: A scoping review of population data for skeletal and dental methods. Forensic Sci Int 2021; 320:110689. [PMID: 33561788 DOI: 10.1016/j.forsciint.2021.110689] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 11/22/2022]
Abstract
Age estimation of living individuals has become a crucial part of the forensic practice, especially due to the global increase in cross-border migration. The low rate of birth registration in many countries, hence of identification documents of migrants, especially in Africa and Asia, highlights the importance of reliable methods for age estimation of living individuals. Despite the fact that a number of skeletal and dental methods for age estimation have been developed, their main limitation is that they are based on specific reference samples and there is still no consensus among researchers on whether these methods can be applied to all populations. Though this issue remains still unsolved, population information at a glance could be useful for forensic practitioners dealing with such issues. This study aims at presenting a scoping review and mapping of the current situation concerning population data for skeletal (hand-wrist and clavicle) and dental methods (teeth eruption and third molar formation) for age estimation in the living. Two hundred studies on the rate of skeletal maturation and four hundred thirty-nine on the rate of dental maturation were found, covering the period from 1952 and 2020 for a total of ninety-eight countries. For most of the western and central African countries there are currently no data on the rate of skeletal and dental maturation. The same applies to the countries of the Middle East, as well as the eastern European countries, especially as regard the skeletal development.
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13
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Reinehr T, Hoffmann E, Rothermel J, Lehrian TJ, Brämswig J, Binder G. A New Model of Adult Height Prediction Validated in Boys with Constitutional Delay of Growth and Puberty. Horm Res Paediatr 2019; 91:186-194. [PMID: 31048583 DOI: 10.1159/000499712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND For children with retarded bone ages such as in constitutional delay of growth and puberty (CDGP) there are no specific methods to predict adult height based on bone age. Widely used methods such as Bayley-Pinneau (BP) tend to overestimate adult height in CDGP. OBJECTIVE We aimed to develop a specific adult height prediction model for teenage boys with retarded bone ages >1 year. METHODS Based on the adult heights of 68 males (median age 22.5 years) a new height prediction model was calculated based on 105 height measurements and bone age determinations at a median age of 14.0 years. The new model was adapted for the degree of bone age retardation and validated in an independent cohort of 32 boys with CDGP. RESULTS The BP method overestimated adult height (median +1.2 cm; p = 0.282), especially in boys with a bone age retardation ≥2 years (median +1.6 cm; p = 0.027). In the validation study, there was no significant difference between adult height and predicted adult height based on the new model (p = 0.196), while the BP model led to a significant overestimation of predicted adult height (median +4.1 cm; p = 0.009). CONCLUSIONS The new model to predict adult height in boys with CDGP provides novel indices for height predictions in bone ages >13 years and is adapted to different degrees of bone age retardation. The new prediction model has a good predictive capability and overcomes some of the shortcomings of the BP model.
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Affiliation(s)
- Thomas Reinehr
- Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Children's Hospital, University of Witten/Herdecke, Datteln, Germany,
| | - Elisa Hoffmann
- Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Children's Hospital, University of Witten/Herdecke, Datteln, Germany
| | - Juliane Rothermel
- Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Children's Hospital, University of Witten/Herdecke, Datteln, Germany
| | | | - Jürgen Brämswig
- University Children's Hospital, Pediatric Endocrinology, Münster, Germany
| | - Gerhard Binder
- University Children's Hospital, Pediatric Endocrinology, Tübingen, Germany
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14
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Alshamrani K, Messina F, Offiah AC. Is the Greulich and Pyle atlas applicable to all ethnicities? A systematic review and meta-analysis. Eur Radiol 2019; 29:2910-2923. [PMID: 30617474 PMCID: PMC6510872 DOI: 10.1007/s00330-018-5792-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/06/2018] [Accepted: 09/21/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether the Greulich and Pyle (G&P) atlas is applicable when applied to populations of different ethnicity. METHODS A systematic review of studies published between 1959 and 15th February 2017 identified from the Embase, MEDLINE and Cochrane databases was undertaken. Quality of the studies was assessed using the National Institute for Health and Care Excellence tool. Meta-analysis used mean differences and standard deviations as summary statistics for the difference between bone age (BA) and chronological age (CA). RESULTS A total of 49 studies were included of which 27 (55%) were related to Caucasian populations. Of the 49 eligible studies, 35 were appropriate for further meta-analysis. In African females, meta-analysis showed a significant mean difference between BA and CA of 0.37 years (95% CI 0.04, 0.69). In Asian males, meta-analysis showed significant differences between BA and CA of -1.08, -1.35, -1.07, -0.80 and 0.50 years for chronological ages of 6, 7, 8, 9 and 17 years, respectively. Meta-analysis showed no significant differences between BA and CA in African males, Asian females, Caucasians and Hispanics. CONCLUSIONS The G&P standard is imprecise and should be used with caution when applied to Asian male and African female populations, particularly when aiming to determine chronological age for forensic/legal purposes. KEY POINTS • In African females, bone age is significantly advanced when compared to the G&P standard. • In Asian males, bone age is significantly delayed between 6 and 9 years old inclusive and significantly advanced at 17 years old when compared to the G&P standard. • The G&P atlas should be used with caution when applied to Asian and African populations, particularly when aiming to determine chronological age for forensic/legal purposes.
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Affiliation(s)
- Khalaf Alshamrani
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK.
- College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia.
- Academic Unit of Child Health, Damer Street Building, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK.
| | - Fabrizio Messina
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amaka C Offiah
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
- Academic Unit of Child Health, Damer Street Building, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK
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15
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Lee DM, Chung IH. Morning basal luteinizing hormone, a good screening tool for diagnosing central precocious puberty. Ann Pediatr Endocrinol Metab 2019; 24:27-33. [PMID: 30943677 PMCID: PMC6449618 DOI: 10.6065/apem.2019.24.1.27] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/21/2018] [Indexed: 01/30/2023] Open
Abstract
PURPOSE The standard method used to diagnose central precocious puberty (CPP) is the gonadotropin releasing hormone stimulation test (GnRHST). However, this test is inconvenient for children because it is time-consuming and requires multiple samples. This study aimed to determine the reliability of morning unstimulated luteinizing hormone (mLH) level when screening for CPP, with an emphasis on the influence of diurnal variation. METHODS This study included 160 girls with signs of early puberty (SMR 2) under 8 years of age. They were classified as CPP or non-CPP based on their standard GnRHST. The auxological, biochemical, and hormonal characteristics of subjects were retrospectively evaluated. The prognostic value of single morning unstimulated gonadotropin level was examined for use in CPP screening. RESULTS Of 160 patients, 121 (75.6%) presented with CPP, and 39 (24.4%) were determined to be prepubertal. The mLH/mFSH (morning unstimulated follicular stimulating hormone) ratio showed significant differences between the 2 groups (P<0.001). The mLH was correlated with GnRHST variables (r=0.532, P<0.001). The mLH cutoff point when screening for CPP was 0.22 IU/L, which had sensitivity and specificity of 69.4% and 82.1%, respectively. In regression analysis, bone age (BA) (odds ratio [OR], 1.018; 95% confidence interval [CI], 0.967-1.071; P=0.506) and body mass index (BMI) (OR, 0.874; 95% CI, 0.583-1.310; P=0.515) were not significant predictors. The mLH≥0.22 IU/L group (OR, 9.596; 95% CI, 3.853-23.900; P<0.001) was highly suggestive of CPP. CONCLUSION In this study, single morning unstimulated luteinizing hormone had clinical efficacy for CPP screening, but BA advanced over chronological age and BMI was not useful for CPP screening.
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Affiliation(s)
- Dong-Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea,Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - In-Hyuk Chung
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea,Address for correspondence: In-Hyuk Chung, MD, PhD Department of Pediatrics, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea Tel: +82-31-900-0520 Fax: +82-31-900-0343 E-mail:
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16
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Bleka Ø, Rolseth V, Dahlberg PS, Saadé A, Saadé M, Bachs L. BioAlder: a tool for assessing chronological age based on two radiological methods. Int J Legal Med 2018; 133:1177-1189. [DOI: 10.1007/s00414-018-1959-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/23/2018] [Indexed: 11/27/2022]
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17
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Dahlberg PS, Mosdøl A, Ding Y, Bleka Ø, Rolseth V, Straumann GH, Skjerven-Martinsen M, Delaveris GJM, Vist GE. A systematic review of the agreement between chronological age and skeletal age based on the Greulich and Pyle atlas. Eur Radiol 2018; 29:2936-2948. [DOI: 10.1007/s00330-018-5718-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/04/2018] [Accepted: 08/14/2018] [Indexed: 01/07/2023]
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18
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Tsehay B, Afework M, Mesifin M. Assessment of Reliability of Greulich and Pyle (GP) Method for Determination of Age of Children at Debre Markos Referral Hospital, East Gojjam Zone. Ethiop J Health Sci 2018; 27:631-640. [PMID: 29487472 PMCID: PMC5811942 DOI: 10.4314/ejhs.v27i6.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Greulich and Pyle standards are the most widely used age estimation standards all over the world. The applicability of the Greulich and Pyle standards to populations which differ from their reference population is often questioned. This study aimed to assess the reliability of Greulich and Pyle (GP) method for determination of age of children at Debre Markos Referral Hospital, East Gojjam Zone, Ethiopia. Subjects and Methods Hospital based cross sectional study design was applied to children who came to Debre Markos Referral Hospital from May to October 2015 and fulfilled the inclusion criteria of the study. The data was analyzed using SPSS version 20 and medcalc version 15 softwares. Significance was set at α = 0.05. Results A total of 108 radiographs were analyzed. Chronological age in most of the children was under estimated. The mean under-estimation was 11.8 months in the female sample and 8.7 months in the male sample. Greulich and Pyle method became inapplicable for the sample at 16 years for females and 16.5 years for males and later. Delay in skeletal maturation was observed in both sexes, but the females in the sample matured earlier than the males. Conclusion The findings of this study suggest against the applicability of GP atlas which were not directly applicable to an East Gojjam Zone population. Large scale studies should be planned and nationwide guideline, and atlas which can easily be used throughout the country should be developed.
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Affiliation(s)
- Binalfew Tsehay
- Department of Biomedical Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mekbeb Afework
- Department of Anatomy, Addiss Ababa University, Addiss Ababa, Ethiopia
| | - Metasebia Mesifin
- Department of Biomedical Sciences, Debre Markos University, Debre Markos, Ethiopia.,Department of Anatomy, Addiss Ababa University, Addiss Ababa, Ethiopia.,Department of Radiology, Debre Markos Referal Hospital, Debre Markos, Ethiopia
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19
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Govender D, Goodier M. Bone of contention: The applicability of the Greulich-Pyle method for skeletal age assessment in South Africa. SA J Radiol 2018; 22:1348. [PMID: 31754503 PMCID: PMC6837818 DOI: 10.4102/sajr.v22i1.1348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/15/2018] [Indexed: 11/18/2022] Open
Abstract
Background The Greulich–Pyle (GP) method is one of the most commonly used radiographic techniques for skeletal age (SA) determination. The applicability of this method for populations outside of the United States has been questioned and this has been investigated in several recent studies around the world. Only limited data are available on the accuracy of the GP method for a South African population. Objective To determine the accuracy and reliability of the GP method in a population from KwaZulu-Natal, South Africa. Method A retrospective study was performed using a digital database consisting of 102 hand-wrist radiographs. The SA was estimated by two readers with different levels of experience, using the GP method. Differences between estimated SA and chronological age (CA) were analysed. Results Skeletal age determined with the GP method was found to significantly differ from CA. For the population as a whole, the GP method underestimated age. The greatest mean underestimation between SA and CA was 11.5 ± 17 months and 7.4 ± 13.2 months for the 10.1 to 15 year age groups in male and female patients, respectively. The method was found to have excellent inter- and intra-observer reliability. Conclusion The GP method generally significantly underestimates age for both genders. Overestimation is also possible with individuals as young as 16 years old found by the method to be skeletally mature. Until new SA assessment tools are developed for South Africa, use of supplementary means of determination of SA should be considered, especially in medico-legal cases.
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Affiliation(s)
- Dashnee Govender
- Department of Radiology, Grey's Hospital, University of KwaZulu-Natal, South Africa
| | - Matthew Goodier
- Department of Radiology, Grey's Hospital, University of KwaZulu-Natal, South Africa
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20
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Nicholson AD, Sanders JO, Liu RW, Cooperman DR. Binary and analogue markers of skeletal maturity: clinical utility of the thenar and plantar sesamoids. J Child Orthop 2018; 12:76-83. [PMID: 29456758 PMCID: PMC5813129 DOI: 10.1302/1863-2548.12.170192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We investigate the thenar and plantar sesamoids as markers of skeletal maturity, and grade appearance using two scales, a binary system (absent or present), and an analogue system that relies upon judging regular changes in morphological appearance. METHODS We studied 94 healthy children (49 female and 45 male patients) between ages three and 18 years who had approximately 700 serially acquired sets of radiographs and physical examinations. The children had at least annual radiographs taken of the left hand and left foot. Velocity of growth was calculated and curves were fit to a cubic spline model to determine age of maximum height velocity, or peak height velocity (PHV). Appearance of the plantar and thenar sesamoids was recorded using a binary system classifying the sesamoids as absent or present and an analogue system classifying the sesamoid as absent, present as a small ossification centre or larger than a small ossification centre. RESULTS The plantar sesamoids appear 1.67 years before PHV and reach mature size 1.02 years after PHV. The thenar sesamoids appear 0.32 years before PHV and reach mature size 2.25 years after PHV. The plantar sesamoids are present and thenar sesamoids are absent at a mean 1.5 years prior to PHV. No patients had the thenar sesamoids present while the plantar sesamoids were absent. CONCLUSION As binary markers, when the plantar and thenar sesamoids are considered together it is possible to localize maturity. As analogue markers, they offer more information. The sesamoids also allow clarification of the calcaneal and Sanders stages. LEVEL OF EVIDENCE Not Applicable.
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Affiliation(s)
- A. D. Nicholson
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA,Correspondence should be sent to A. D. Nicholson, 123 York St., Apt.4G, New Haven, Connecticut, 06511, United States. E-mail:
| | - J. O. Sanders
- Department of Orthopaedics, University of Rochester School of Medicine, Rochester, New York, USA
| | - R. W. Liu
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - D. R. Cooperman
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
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Alcina M, Lucea A, Salicrú M, Turbón D. Reliability of the Greulich and Pyle method for chronological age estimation and age majority prediction in a Spanish sample. Int J Legal Med 2017; 132:1139-1149. [DOI: 10.1007/s00414-017-1760-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
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Bunch PM, Altes TA, McIlhenny J, Patrie J, Gaskin CM. Skeletal development of the hand and wrist: digital bone age companion-a suitable alternative to the Greulich and Pyle atlas for bone age assessment? Skeletal Radiol 2017; 46:785-793. [PMID: 28343328 PMCID: PMC5393285 DOI: 10.1007/s00256-017-2616-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 01/25/2017] [Accepted: 02/28/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess reader performance and subjective workflow experience when reporting bone age studies with a digital bone age reference as compared to the Greulich and Pyle atlas (G&P). We hypothesized that pediatric radiologists would achieve equivalent results with each method while digital workflow would improve speed, experience, and reporting quality. MATERIALS AND METHODS IRB approval was obtained for this HIPAA-compliant study. Two pediatric radiologists performed research interpretations of bone age studies randomized to either the digital (Digital Bone Age Companion, Oxford University Press) or G&P method, generating reports to mimic clinical workflow. Bone age standard selection, interpretation-reporting time, and user preferences were recorded. Reports were reviewed for typographical or speech recognition errors. Comparisons of agreement were conducted by way of Fisher's exact tests. Interpretation-reporting times were analyzed on the natural logarithmic scale via a linear mixed model and transformed to the geometric mean. Subjective workflow experience was compared with an exact binomial test. Report errors were compared via a paired random permutation test. RESULTS There was no difference in bone age determination between atlases (p = 0.495). The interpretation-reporting time (p < 0.001) was significantly faster with the digital method. The faculty indicated preference for the digital atlas (p < 0.001). Signed reports had fewer errors with the digital atlas (p < 0.001). CONCLUSIONS Bone age study interpretations performed with the digital method were similar to those performed with the Greulich and Pyle atlas. The digital atlas saved time, improved workflow experience, and reduced reporting errors relative to the Greulich and Pyle atlas when integrated into electronic workflow.
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Affiliation(s)
- Paul M. Bunch
- grid.32224.35Department of Radiology, Massachusetts General Hospital, 55 Francis Street, Boston, MA 02114 USA
| | - Talissa A. Altes
- grid.134936.aDepartment of Radiology, University of Missouri, One Hospital Drive, Columbia, MO 65212 USA
| | - Joan McIlhenny
- grid.412587.dDepartment of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, 1215 Lee Street, Charlottesville, VA 22908 USA
| | - James Patrie
- grid.412587.dDepartment of Health Evaluation Sciences, University of Virginia Health System, PO Box 800717, Charlottesville, VA 22908 USA
| | - Cree M. Gaskin
- grid.412587.dDepartment of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, 1215 Lee Street, Charlottesville, VA 22908 USA
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Metsäniitty M, Varkkola O, Waltimo-Sirén J, Ranta H. Forensic age assessment of asylum seekers in Finland. Int J Legal Med 2016; 131:243-250. [DOI: 10.1007/s00414-016-1498-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
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Forensic use of the Greulich and Pyle atlas: prediction intervals and relevance. Eur Radiol 2016; 27:1032-1043. [DOI: 10.1007/s00330-016-4466-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 04/05/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
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25
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Hajalioghli P, Tarzamni MK, Arami S, Fouladi DF, Ghojazadeh M. The utility of ultrasonographic bone age determination in detecting growth disturbances; a comparative study with the conventional radiographic technique. Skeletal Radiol 2015; 44:1351-6. [PMID: 26025121 DOI: 10.1007/s00256-015-2175-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/10/2015] [Accepted: 05/18/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test whether the conventional radiographic technique in determining bone age abnormalities can be replaced by ultrasonography. MATERIALS AND METHODS A total of 54 Caucasian subjects up to 7 years of age with clinically suspected growth problems underwent left hand and wrist radiographic and ultrasonographic bone age estimations with the use of the Greulich-Pyle atlas. The ultrasonographic scans targeted the ossification centers in the radius and ulna distal epiphysis, carpal bones, epiphyses of the first and third metacarpals, and epiphysis of the middle phalanx, as described in previous reports. The degree of agreement between the two sets of data, as well as the accuracy of the ultrasonographic method in detecting radiographically suggested bone age abnormities, was examined. RESULTS The mean chronological age, radiographic bone age, and ultrasonographic bone age (all in months) were 41.96 ± 22.25, 26.68 ± 14.08, and 26.71 ± 13.50 in 28 boys and 43.62 ± 24.63, 30.12 ± 17.69, and 31.27 ± 18.06 in 26 girls, respectively. According to the Bland-Altman plot there was high agreement between the results of the two methods with only three outliers. The deviations in bone age from the chronological age taken by the two techniques had the same sign in all patients. Supposing radiography to be the method of reference, the sensitivity, specificity, positive predictive value, and negative predictive value of sonography in detecting growth abnormalities were all 100% in males and 90.9, 100, 100, and 93.8%, respectively, in females. CONCLUSION The conventional radiographic technique for determining bone age abnormalities could be replaced by ultrasonography.
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Affiliation(s)
- Parisa Hajalioghli
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Mohammed RB, Rao DS, Goud AS, Sailaja S, Thetay AAR, Gopalakrishnan M. Is Greulich and Pyle standards of skeletal maturation applicable for age estimation in South Indian Andhra children? J Pharm Bioallied Sci 2015; 7:218-25. [PMID: 26229357 PMCID: PMC4517325 DOI: 10.4103/0975-7406.160031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/20/2015] [Accepted: 02/05/2015] [Indexed: 11/12/2022] Open
Abstract
Introduction: Now-a-day age determination has gained importance for various forensic and legal reasons. Skeletal age (SA) of a test population can be estimated by comparing with established standards of Greulich and Pyle (G-P). As this atlas has been prepared using data from upper-class children born between 1917 and 1942 in the USA and the applicability of these standards to contemporary populations has yet to be tested on Andhra children living in India. Hence, this study was aimed to assess the reliability of bone age calculated by G-P atlas in estimation of age in selected population. Materials and Methods: A total of 660 children (330 girls, 330 boys) between ages 9 and 20 years were randomly selected from outpatient Department of Oral Medicine in GITAM Dental College, Andhra Pradesh. Digital hand-wrist radiographs were obtained and assessed for SA using G-P atlas and the difference between estimated SA and chronological age (CA) were compared with paired t-test and Wilcoxon signed rank test. Results: G-P method underestimated the SA by 0.23 ± 1.53 years for boys and overestimated SA by 0.02 ± 2 years in girls and mild underestimation was noted in the total sample of about 0.1 ± 1.78 years. Spearman rank test showed significant correlation between SA and CA (r = 0.86; P < 0.001). Conclusion: This study concluded that G-P standards were reliable in assessing age in South Indian Andhra children of age 9–20 years with unknown CA.
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Affiliation(s)
- Rezwana Begum Mohammed
- Department of Oral Medicine and Radiology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Dola Srinivasa Rao
- Department of Periodontics, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Alampur Srinivas Goud
- Department of Periodontics, Bhabha College of Dental Sciences, Bhopal, Madhya Pradesh, India
| | - S Sailaja
- Department of Oral Medicine and Radiology, Government Dental College, Hyderabad, Telangana, India
| | - Anshuj Ajay Rao Thetay
- Department of Orthodontics and Dentofacial Orthopaedics, RKDF Dental College and Research Centre, Bhopal, Madhya Pradesh, India
| | - Meera Gopalakrishnan
- Department of Endodontics and Conservative Dentistry, Indira Gandhi Institute of Dental Sciences, Ernakulam, Kerala, India
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Accuracy of MRI skeletal age estimation for subjects 12–19. Potential use for subjects of unknown age. Int J Legal Med 2015; 129:609-17. [DOI: 10.1007/s00414-015-1161-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
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Lottering N, MacGregor DM, Alston CL, Gregory LS. Ontogeny of the spheno-occipital synchondrosis in a modern Queensland, Australian population using computed tomography. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2014; 157:42-57. [DOI: 10.1002/ajpa.22687] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/17/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Nicolene Lottering
- Skeletal Biology and Forensic Anthropology Research Laboratory; School of Biomedical Sciences, Queensland University of Technology; Brisbane QLD 4001 Australia
| | - Donna M. MacGregor
- Skeletal Biology and Forensic Anthropology Research Laboratory; School of Biomedical Sciences, Queensland University of Technology; Brisbane QLD 4001 Australia
| | - Clair L. Alston
- School of Mathematical Sciences, Science and Engineering Faculty, Queensland University of Technology
| | - Laura S. Gregory
- Skeletal Biology and Forensic Anthropology Research Laboratory; School of Biomedical Sciences, Queensland University of Technology; Brisbane QLD 4001 Australia
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Tomei E, Sartori A, Nissman D, Al Ansari N, Battisti S, Rubini A, Stagnitti A, Martino M, Marini M, Barbato E, Semelka RC. Value of MRI of the hand and the wrist in evaluation of bone age: Preliminary results. J Magn Reson Imaging 2013; 39:1198-205. [DOI: 10.1002/jmri.24286] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ernesto Tomei
- Dipartimento di Scienze Radiologiche Oncologiche e Anatomo-patologiche; Università di Roma Sapienza; Rome Italy
| | - Alessandro Sartori
- Dipartimento di Scienze Radiologiche Oncologiche e Anatomo-patologiche; Università di Roma Sapienza; Rome Italy
| | - Daniel Nissman
- Department of Radiology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina USA
| | - Najwa Al Ansari
- Dipartimento di Scienze Radiologiche Oncologiche e Anatomo-patologiche; Università di Roma Sapienza; Rome Italy
| | - Sofia Battisti
- Dipartimento di Scienze Radiologiche; Universita' Campus Bio-Medico; Rome Italy
| | - Antonello Rubini
- Dipartimento di Scienze Radiologiche Oncologiche e Anatomo-patologiche; Università di Roma Sapienza; Rome Italy
| | - Andrea Stagnitti
- Dipartimento di Scienze Radiologiche Oncologiche e Anatomo-patologiche; Università di Roma Sapienza; Rome Italy
| | - Milvia Martino
- Dipartimento di Scienze Radiologiche Oncologiche e Anatomo-patologiche; Università di Roma Sapienza; Rome Italy
| | - Mario Marini
- Dipartimento di Scienze Radiologiche Oncologiche e Anatomo-patologiche; Università di Roma Sapienza; Rome Italy
| | - Ersilia Barbato
- Dipartimento di Scienze Odontostomatologiche; Università di Roma Sapienza; Rome Italy
| | - Richard C. Semelka
- Department of Radiology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina USA
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Chariot P, Denis C. Commentary on:Hackman L, Black S. The reliability of the Greulich and Pyle atlas when applied to a modern Scottish population. J Forensic Sci 2013;58(1):114-9. J Forensic Sci 2013; 58:1106. [DOI: 10.1111/1556-4029.12182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Céline Denis
- Department of Forensic Medicine; Hôpital Jean-Verdier (AP-HP); Bondy; France
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Hackman L, Black S. Age Estimation from Radiographic Images of the Knee. J Forensic Sci 2013; 58:732-7. [DOI: 10.1111/1556-4029.12077] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 03/13/2012] [Accepted: 03/18/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Lucina Hackman
- Centre for Anatomy and Human Identification; University of Dundee; Dundee; Scotland; U.K
| | - Sue Black
- Centre for Anatomy and Human Identification; University of Dundee; Dundee; Scotland; U.K
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Suri S, Prasad C, Tompson B, Lou W. Longitudinal comparison of skeletal age determined by the Greulich and Pyle method and chronologic age in normally growing children, and clinical interpretations for orthodontics. Am J Orthod Dentofacial Orthop 2013; 143:50-60. [PMID: 23273360 DOI: 10.1016/j.ajodo.2012.08.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 08/01/2012] [Accepted: 08/01/2012] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Coinciding treatment with periods of accelerated skeletal growth and maturation might be advantageous in clinical practice. Better understanding of the concordance between skeletal and chronologic ages during the period that children frequently receive orthodontic treatment is needed. The literature on skeletal age determination from hand-wrist radiographs lacks reports based on longitudinal data, creating lacunae in the understanding of the magnitudes and variations of differences between skeletal and chronologic ages. The aims of this research were to comprehensively analyze the concordance between skeletal and chronologic ages determined by using the Greulich and Pyle method at different ages in the preadolescent and adolescent periods, and to determine any age- and sex-related differences in the concordance. METHODS By using the Greulich and Pyle method, skeletal age determinations were made from 572 hand-wrist radiographs of 68 white children with normal facial growth, selected from the records of the Burlington Growth Centre, spanning the growth period from 9 to 18 years. Skeletal age and chronologic age differences for each sex were analyzed by using paired t tests and Wilcoxon signed rank tests at yearly intervals. Differences over the longitudinal duration were examined by using the mixed model approach. The limits of agreement were determined by using the Bland-Altman method. In each yearly chronologic age group, differences were clinically categorized based on the proximity of the skeletal and chronologic ages. RESULTS Overall, a slightly greater proportion of the total skeletal age determinations made in girls (41.9%) were within 0.5 year of their chronologic age, compared with 38% in boys. The largest proportions of subjects having skeletal age-chronologic age differences within 0.5 year were in the 10-year age group in girls (64.5%) and the 13-year age group in boys (64.7%). Mean skeletal age-chronologic age differences were significantly larger in the 13- to 16-year age groups in girls and in the 16- and 17-year age groups in boys, but the differences were not statistically significant at other ages. Several patterns of variations were identified in the direction of differences when individual plots were examined. CONCLUSIONS This longitudinal analysis of differences between skeletal and chronologic ages showed wide ranges and distributions of differences at each yearly age group during the growth period from 9 to 18 years, even when mean differences were small. Variations in the magnitude and direction of differences observed at different ages highlighted the variability in skeletal maturation among normally growing young people. Overall, the differences in skeletal and chronologic ages were positively related to age, with little effect of sex or its interaction with age.
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Affiliation(s)
- Sunjay Suri
- Associate professor, Discipline of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
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Hackman L, Black S. The reliability of the Greulich and Pyle atlas when applied to a modern Scottish population. J Forensic Sci 2012; 58:114-9. [PMID: 23061975 PMCID: PMC3781705 DOI: 10.1111/j.1556-4029.2012.02294.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 11/17/2011] [Accepted: 12/04/2011] [Indexed: 11/27/2022]
Abstract
This study examines the reliability of age estimation utilizing the Greulich and Pyle atlas in relation to a modern Scottish population. A total of 406 left-hand/wrist radiographs (157 females and 249 males) were age-assessed using the Greulich and Pyle atlas. Analysis showed that there was a strong correlation between chronological age and estimated age (females R(2) = 0.939, males R(2) = 0.940). When age groups were broken down into year cohorts, the atlas over-aged females from birth until 13 years of age. The pattern for males showed that the atlas under-estimated age until 13 years of age after which point it consistently over-aged boys between 13 and 17 years of age. This study showed that the Greulich and Pyle atlas can be applied to a modern population but would recommend that any analysis takes into account the potential for over- and under-aging shown in this study.
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Affiliation(s)
- Lucina Hackman
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK.
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DAVIS LUKEM, THEOBALD BARRYJOHN, LINES JASON, TOMS ANDONI, BAGNALL ANTHONY. ON THE SEGMENTATION AND CLASSIFICATION OF HAND RADIOGRAPHS. Int J Neural Syst 2012; 22:1250020. [DOI: 10.1142/s0129065712500207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This research is part of a wider project to build predictive models of bone age using hand radiograph images. We examine ways of finding the outline of a hand from an X-ray as the first stage in segmenting the image into constituent bones. We assess a variety of algorithms including contouring, which has not previously been used in this context. We introduce a novel ensemble algorithm for combining outlines using two voting schemes, a likelihood ratio test and dynamic time warping (DTW). Our goal is to minimize the human intervention required, hence we investigate alternative ways of training a classifier to determine whether an outline is in fact correct or not. We evaluate outlining and classification on a set of 1370 images. We conclude that ensembling with DTW improves performance of all outlining algorithms, that the contouring algorithm used with the DTW ensemble performs the best of those assessed, and that the most effective classifier of hand outlines assessed is a random forest applied to outlines transformed into principal components.
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Affiliation(s)
- LUKE M. DAVIS
- School of Computing Sciences, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, United Kingdom
| | - BARRY-JOHN THEOBALD
- School of Computing Sciences, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, United Kingdom
| | - JASON LINES
- School of Computing Sciences, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, United Kingdom
| | - ANDONI TOMS
- Norwich Radiology Academy, Norfolk and Norwich University Hospital, Norwich, Norfolk, NR4 7UB, United Kingdom
| | - ANTHONY BAGNALL
- School of Computing Sciences, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, United Kingdom
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Moradi M, Sirous M, Morovatti P. The reliability of skeletal age determination in an Iranian sample using Greulich and Pyle method. Forensic Sci Int 2012; 223:372.e1-4. [PMID: 22986219 DOI: 10.1016/j.forsciint.2012.08.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 06/06/2012] [Accepted: 08/22/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Since introduction of Greulich and Pyle (GP) method for bone age determination, several studies have been performed for evaluation of applicability of this method in different geographic and ethnic groups. In this study we investigated the accuracy of this method in Iranian population. MATERIALS AND METHODS 425 (303 male and 122 female) healthy children aged between 6 and 18 years old, without genetic, metabolic, endocrine, growth or nutritional disorders who had plain hand and wrist radiographs were enrolled. All radiographs were taken for an indication of trauma from January 2009 to August 2010. Both sexes were divided into three subgroups (6-10, 10-14, 14-18 years old). Skeletal age (SA) was determined according to GP atlas by a radiologist who was blind to chronological age (CA). Mean CA was compared with mean SA in whole population, each sex group and in each age subgroup. Difference score (DS) was calculated by subtracting SA from CA and determined for whole population, each sex group and also for each age subgroup. Statistical analysis was performed using t-test and ANNOVA correlation test. RESULTS Considering whole study population, mean SA was 12.15±4.16 years and mean CA was 12.4±4.09 years and mean difference score (CA-SA) was 0.25±0.95 years. In male subjects mean SA was 12.68±4.07 years and mean CA was 13.04±3.93 years and mean difference score was 0.37±0.98 years (equal to 4.5 months). In female subjects mean SA was 10.84±4.11 and mean CA was 10.81±4.06 and mean difference score of girls was -0.04±0.78 years (equal to -0.5 month). DS shows no significant difference among three age subgroups in either male (P(value)=0.63) and female (P(value)=0.59) group. CONCLUSION According to this study skeletal age of boys was 4.5 months less than chronological age, but in girls skeletal age was 0.5 month more than it. Considering the possibility of few months difference, GP atlas could be applicable in Iranian children with acceptable accuracy.
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Affiliation(s)
- Maryam Moradi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Applicability of Greulich and Pyle and Demirijan aging methods to a sample of Italian population. Forensic Sci Int 2012; 221:153.e1-5. [PMID: 22565117 DOI: 10.1016/j.forsciint.2012.04.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 03/12/2012] [Accepted: 04/12/2012] [Indexed: 11/23/2022]
Abstract
Age estimation in forensics is essential in cases involving both living and dead subjects. For living subjects, age estimation may be used to establish an individual's status as a minor in cases involving adoption, criminal responsibility, child pornography, and those seeking asylum. Criteria for age estimation in the living have recently been put forth by The Study Group on Forensic Age Diagnostics. The group has proposed guidelines with a three-step procedure: a physical examination and anthropometrical analysis; dental analysis by orthopantomogram (OPG); and X-ray study of the left hand and wrist. The board of FASE highlighted advantages and limits of each method, and suggested practical solutions concerning the age estimation process for adults and subadults. The aim of this study was to verify the applicability of the Greulich and Pyle, and Demirjian techniques on a sample group of Italians, whose ages were known, in determining the skeletal and dental age, in addition to evaluating the reliability of these techniques. 535 subjects between the ages of 7 and 15years were examined, each one undergoing both an orthopantomography (OPG) and radiography of the left wrist and hand. The data obtained underwent statistical analysis. The analyses have shown that a correlation exists between skeletal and dental age, and real age. Age estimation carried out using the Greulich and Pyle method has shown itself to be especially accurate on the Italian sample, particularly in the age ranges of 7-9years and 10.4-11.5years. The Greulich and Pyle method has shown itself to be reliable for the sample analyzed notwithstanding the ethnic differences between the original sample of reference and those analyzed in this study. Application of the Demirjian technique resulted in an overestimation of dental age. This difference is shown to be more highly significant in the higher age ranges. The combination of the Greulich and Pyle, and Demirjian methods have revealed a difference regarding real age, which turns out to be more modest in the younger age ranges and more significant in older subjects.
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Hackman L, Black S. Does mirror imaging a radiograph affect reliability of age assessment using the Greulich and Pyle atlas? J Forensic Sci 2012; 57:1276-80. [PMID: 22509947 PMCID: PMC3781704 DOI: 10.1111/j.1556-4029.2012.02150.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Age estimation is routinely undertaken by comparing radiographs of the individual in question to published reference samples of individuals of known age. This study examines the reliability of age estimation utilizing the Greulich and Pyle atlas in relation to both left- and right-hand/wrist radiographs and explores whether reversing right-hand/wrist radiographs, so that they are in the same anatomical orientation as those images used in the atlas affects reliability. A total of 403 left-hand/wrist radiographs and 415 right-hand/wrist radiographs were age assessed using the Greulich and Pyle atlas. Analysis showed that there is no significant loss in reliability when radiographs of the right hand (women R2 = 0.887 and men R2 = 0.907) are utilized instead of the left (women R2 = 0.939 and men R2 = 0.940) or when they are assessed as mirror images to those printed in the reference atlas (reversed female left hand R2 = 0.929 and reversed male left hand R2 = 0.931).
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Affiliation(s)
- Lucina Hackman
- Centre for Anatomy and Human Identification, University of Dundee, MSI/WTB/JBC Complex, Dundee, UK
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Soudack M, Ben-Shlush A, Jacobson J, Raviv-Zilka L, Eshed I, Hamiel O. Bone age in the 21st century: is Greulich and Pyle's atlas accurate for Israeli children? Pediatr Radiol 2012; 42:343-8. [PMID: 22237478 DOI: 10.1007/s00247-011-2302-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 06/24/2011] [Accepted: 07/03/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND The applicability today of Greulich and Pyle's Radiographic Atlas of Skeletal Development of the Hand and Wrist (G&P) is uncertain. OBJECTIVE The purpose of this study was to determine whether G&P is accurate in Israeli children today. MATERIALS AND METHODS Left-hand radiographs of 679 children (375 boys) ranging in age from 1 day to 18 years old were obtained for trauma in the period 2001-2009 and were evaluated for bone age according to G&P. Individual bone age was plotted against calendar age and smoothed to obtain the association between calendar age and bone age. Any difference was assessed with Wilcoxon signed-rank test. RESULTS In girls, there was no significant difference between bone age and calendar age (P = 0.188). G&P underestimated bone age in boys <15 years old (median difference, 2.3 months; P < 0.0001) and overestimated bone age in boys ≥15 years old (median difference, 2.9 months; P = 0.0043). The largest median difference (5.4 months; P = 0.0003) was seen in boys 6-10 years old. CONCLUSION The differences between calendar age and bone age according to G&P were relatively small compared with normal variance and are unlikely to be of clinical importance.
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Affiliation(s)
- Michalle Soudack
- Pediatric Imaging, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
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Cantekin K, Celikoglu M, Miloglu O, Dane A, Erdem A. Bone age assessment: the applicability of the Greulich-Pyle method in eastern Turkish children. J Forensic Sci 2011; 57:679-82. [PMID: 22211856 DOI: 10.1111/j.1556-4029.2011.02035.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate whether or not the Greulich-Pyle (GP) method is adequate for Turkish children. A group of 767 individuals (425 girls and 342 boys) between 7 and 17 years were studied. Bone age (BA) from plain radiographs of left hands and wrists by GP standards was estimated. The total mean differences between BA and chronological age (CA) for girls and boys were found to be 0.20 and -0.13 years, respectively. There were significant differences between BA and CA in age groups 7-, 8-, 10-, 11-, 12-, 13-, 15-, and 16-year-olds for girls and 7-, 10-, and 12-year-olds for boys. The results of this study suggest that the mean differences between BA and CA are low enough to be of no practical significance, and thus, for the time being unless any other methods will be proved more useful, this method could be used in all age groups.
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Affiliation(s)
- Kenan Cantekin
- Department of Pedodontics, Erciyes University, Kayseri, Turkey
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Comparison of height for age and height for bone age with and without adjustment for target height in pediatric patients with CF. J Cyst Fibros 2011; 10:272-7. [DOI: 10.1016/j.jcf.2011.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 03/07/2011] [Accepted: 03/07/2011] [Indexed: 11/20/2022]
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Heppe DHM, Taal HR, Ernst GDS, Van Den Akker ELT, Lequin MMH, Hokken-Koelega ACS, Geelhoed JJM, Jaddoe VWV. Bone age assessment by dual-energy X-ray absorptiometry in children: an alternative for X-ray? Br J Radiol 2011; 85:114-20. [PMID: 21586503 DOI: 10.1259/bjr/23858213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of the study was to validate dual-energy X-ray absorptiometry (DXA) as a method to assess bone age in children. METHODS Paired dual-energy X-ray absorptiometry (DXA) scans and X-rays of the left hand were performed in 95 children who attended the paediatric endocrinology outpatient clinic of University Hospital Rotterdam, the Netherlands. We compared bone age assessments by DXA scan with those performed by X-ray. Bone age assessment was performed by two blinded observers according to the reference method of Greulich and Pyle. Intra-observer and interobserver reproducibility were investigated using the intraclass correlation coefficient (ICC), and agreement was tested using Bland and Altman plots. RESULTS The intra-observer ICCs for both observers were 0.997 and 0.991 for X-ray and 0.993 and 0.987 for DXA assessments. The interobserver ICC was 0.993 and 0.991 for X-ray and DXA assessments, respectively. The mean difference between bone age assessed by X-ray and DXA was 0.11 years. The limits of agreement ranged from -0.82 to 1.05 years, which means that 95% of all differences between the methods were covered by this range. CONCLUSIONS Results of bone age assessment by DXA scan are similar to those obtained by X-ray. The DXA method seems to be an alternative for assessing bone age in a paediatric hospital-based population.
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Affiliation(s)
- D H M Heppe
- The Generation R Study Group, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
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Serinelli S, Panetta V, Pasqualetti P, Marchetti D. Accuracy of three age determination X-ray methods on the left hand-wrist: a systematic review and meta-analysis. Leg Med (Tokyo) 2011; 13:120-33. [PMID: 21377398 DOI: 10.1016/j.legalmed.2011.01.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 01/04/2011] [Accepted: 01/24/2011] [Indexed: 12/19/2022]
Abstract
Age estimation of living individuals often represents a forensic challenge with important legal and social implications. In an effort to better understand the accuracy of the methods of Greulich and Pyle (GP), Tanner-Whitehouse (TW) and Fels, a systematic review and a meta-analysis of articles published from 1956 to 20 December 2009 in the Medline and Trip databases were conducted. We only selected articles on healthy people. The meta-analysis showed that GP is not as accurate a method as TW2 or TW3 for both Caucasian people and Mongoloids, even if it is the one most often used. However, due to the very wide age estimation range, in line with what has already been established by several authors, our systematic review and meta-analysis confirmed that age estimation in living individuals cannot be considered accurate when only X-ray methods on the left hand-wrist are used, but exhaustive combinations of various procedures (i.e. physical examination, dental and skeletal methods) must also be used, as proposed and already applied by the International Study Group on Forensic Age Estimation.
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Affiliation(s)
- S Serinelli
- Institute of Forensic Medicine, Università Cattolica del Sacro Cuore, Largo F. Vito, 1-00168 Rome, Italy
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Varkkola O, Ranta H, Metsäniitty M, Sajantila A. Age assessment by the Greulich and Pyle method compared to other skeletal X-ray and dental methods in data from Finnish child victims of the Southeast Asian Tsunami. Forensic Sci Med Pathol 2011; 7:311-6. [DOI: 10.1007/s12024-010-9173-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2010] [Indexed: 10/18/2022]
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Tisè M, Mazzarini L, Fabrizzi G, Ferrante L, Giorgetti R, Tagliabracci A. Applicability of Greulich and Pyle method for age assessment in forensic practice on an Italian sample. Int J Legal Med 2011; 125:411-6. [PMID: 21221985 DOI: 10.1007/s00414-010-0541-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 12/15/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND The main importance in age estimation lies in the assessment of criminal liability and protection of unaccompanied minor immigrants, when their age is unknown. Under Italian law, persons are not criminally responsible before they reach the age of 14. The age of 18 is important when deciding whether juvenile or adult law must be applied. In the case of unaccompanied minors, it is important to assess age in order to establish special protective measures, and correct age estimation may prevent a person over 18 from benefiting from measures reserved for minors. OBJECTIVE Since the Greulich and Pyle method is one of the most frequently used in age estimation, the aim of this study was to assess the reproducibility and accuracy of the method on a large Italian sample of teenagers, to ascertain the applicability of the Atlas at the critical age thresholds of 14 and 18 years. MATERIALS AND METHODS This retrospective study examined posteroanterior X-ray projections of hand and wrist from 484 Italian-Caucasian young people (125 females, 359 males) between 11 and 19 years old. All radiographic images were taken from trauma patients hospitalized in the Azienda Ospedaliero Universitaria Ospedali Riuniti of Ancona (Italy) between 2006 and 2007. Two physicians analyzed all radiographic images separately. The blind method was used. RESULTS In the case of an estimated age of 14 years old, the true age ranged from 12.2 to 15.9 years (median, 14.3 years, interquartile range, 1.0 years) for males, and 12.6 to 15.7 years (median, 14.2 years, interquartile range, 1.7 years) for females. In the case of an estimated age of 18 years, the true age ranged from 15.6 to 19.7 years (median, 17.7 years, interquartile range, 1.4 years) for males, and from 16.2 to 20.0 years (median, 18.7 years, interquartile range, 1.8 years) for females. CONCLUSION Our study shows that although the GPM is a reproducible and repeatable method, there is a wide margin of error in the estimation of chronological age, mainly in the critical estimated ages of 14 and 18 years old in both males and females.
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Affiliation(s)
- Marco Tisè
- Institute of Legal Medicine, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy
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Calfee RP, Sutter M, Steffen JA, Goldfarb CA. Skeletal and chronological ages in American adolescents: current findings in skeletal maturation. J Child Orthop 2010; 4:467-70. [PMID: 21966312 PMCID: PMC2946530 DOI: 10.1007/s11832-010-0289-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 08/19/2010] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study was designed to assess the relationship between skeletal and chronological ages among current American adolescents using the Greulich and Pyle atlas for skeletal age determination. MATERIALS AND METHODS We used the Greulich and Pyle atlas to prospectively determine skeletal age in a group of 138 otherwise healthy American adolescents from 12 to 18 years of age. 62 males and 76 females were enrolled in this cohort. Paired Student t-tests were used to statistically compare the skeletal and chronological ages in this population. Subgroup analysis examined the effect of gender on differences between chronologic age and skeletal age. RESULTS For the entire cohort, mean skeletal age was significantly greater than chronological age (mean 0.80 years, P < 0.01). In 29 cases (21%) the skeletal age was at least 2 years greater than the chronologic age. Among females, such cases with marked discrepancy occurred exclusively in those chronologically between 12 and 15 years of age (P < 0.01). Males demonstrated a 2-year or greater discrepancy more commonly than females (26 vs. 17%). In males, 2-year discrepancies were equally likely across chronologic ages (P = 0.82). CONCLUSIONS Current American adolescents are significantly more mature by skeletal age, as determined by the Greulich and Pyle method, than their chronological age would suggest. The skeletal ages of females are most likely to markedly exceed chronologic age between the ages of 12-15 years.
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Affiliation(s)
- Ryan P. Calfee
- Department of Orthopaedic Surgery, Shriners Hospital for Children, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110 USA
| | - Melanie Sutter
- Department of Orthopaedic Surgery, Shriners Hospital for Children, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110 USA
| | - Jennifer A. Steffen
- Department of Orthopaedic Surgery, Shriners Hospital for Children, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110 USA
| | - Charles A. Goldfarb
- Department of Orthopaedic Surgery, Shriners Hospital for Children, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110 USA
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Dost A, Rohrer T, Fussenegger J, Vogel C, Schenk B, Wabitsch M, Karges B, Vilser C, Holl RW. Bone maturation in 1788 children and adolescents with diabetes mellitus type 1. J Pediatr Endocrinol Metab 2010; 23:891-8. [PMID: 21175088 DOI: 10.1515/jpem.2010.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetes mellitus type 1 might interfere with pubertal development. Particularly, long-term metabolic control and intensity of insulin treatment have been reported to contribute to a delay in pubertal onset. Data on somatic development in diabetic children are conflicting; therefore we studied bone age in 1788 children from Germany and Austria with type 1 diabetes. Bone age was retarded by -0.27 +/- 1.1 years in the whole group, but particularly in the adolescents at the end of puberty (>16 years; -0.76 +/- 1.29y). Bone age delay was more pronounced in boys, and in children with long-term median HbAlc levels of 7.5 - 9.0%. No associations were found with current HbAlc levels or the intensity of insulin treatment. Bone age determinations in diabetic children should only be performed when clinical signs of impaired somatic development are present. In addition, the potential influence of diabetes on bone development needs to be considered in the interpretation of carpograms.
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Affiliation(s)
- Axel Dost
- Department of Pediatrics, University of Jena, Germany.
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The problem of aging human remains and living individuals: A review. Forensic Sci Int 2009; 193:1-13. [DOI: 10.1016/j.forsciint.2009.09.008] [Citation(s) in RCA: 384] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 09/08/2009] [Accepted: 09/14/2009] [Indexed: 11/17/2022]
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Automatic determination of Greulich and Pyle bone age in healthy Dutch children. Pediatr Radiol 2009; 39:591-7. [PMID: 19125243 DOI: 10.1007/s00247-008-1090-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 09/15/2008] [Accepted: 09/21/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Bone age (BA) assessment is a routine procedure in paediatric radiology, for which the Greulich and Pyle (GP) atlas is mostly used. There is rater variability, but the advent of automatic BA determination eliminates this. OBJECTIVE To validate the BoneXpert method for automatic determination of skeletal maturity of healthy children against manual GP BA ratings. MATERIALS AND METHODS Two observers determined GP BA with knowledge of the chronological age (CA). A total of 226 boys with a BA of 3-17 years and 179 girls with a BA of 3-15 years were included in the study. BoneXpert's estimate of GP BA was calibrated to agree on average with the manual ratings based on several studies, including the present study. RESULTS Seven subjects showed a deviation between manual and automatic BA in excess of 1.9 years. They were re-rated blindly by two raters. After correcting these seven ratings, the root mean square error between manual and automatic rating in the 405 subjects was 0.71 years (range 0.66-0.76 years, 95% CI). BoneXpert's GP BA is on average 0.28 and 0.20 years behind the CA for boys and girls, respectively. CONCLUSION BoneXpert is a robust method for automatic determination of BA.
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Abstract
OBJECTIVE To our knowledge, only two controversial articles have reported the study of bone age at diagnosis in diabetic children. The aim of this study was to compare chronological age with bone age and to evaluate the impact of A1C on bone age in children at diagnosis of type 1 diabetes. RESEARCH DESIGN AND METHODS In 496 diabetic children, height was measured at diagnosis and height SD score was calculated using the British 1990 growth reference. Bone age was determined according to the Greulich and Pyle method, and A1C levels were measured. RESULTS Participants' height was normal for age and sex. No significant differences were found between chronological age and bone age, and there was no correlation between Delta (bone age - chronological age) and A1C. CONCLUSIONS This study showed that height and bone maturation among diabetic children are normal for age and sex and independent of A1C at diagnosis of type 1 diabetes.
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Affiliation(s)
- Anissa Messaaoui
- Diabetology Clinic, University Children's Hospital Queen Fabiola, Brussels, Belgium
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