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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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Choukair D, Hückmann A, Mittnacht J, Breil T, Schenk JP, Alrajab A, Uhlmann L, Bettendorf M. Near-Adult Heights and Adult Height Predictions Using Automated and Conventional Greulich-Pyle Bone Age Determinations in Children with Chronic Endocrine Diseases. Indian J Pediatr 2022; 89:692-698. [PMID: 35103904 PMCID: PMC9205833 DOI: 10.1007/s12098-021-04009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To validate adult height predictions (BX) using automated and Greulich-Pyle bone age determinations in children with chronic endocrine diseases. METHODS Heights and near-adult heights were measured in 82 patients (48 females) with chronic endocrinopathies at the age of 10.45 ± 2.12 y and at time of transition to adult care (17.98 ± 3.02 y). Further, bone age (BA) was assessed using the conventional Greulich-Pyle (GP) method by three experts, and by BoneXpert™. PAH were calculated using conventional BP tables and BoneXpert™. RESULTS The conventional and the automated BA determinations revealed a mean difference of 0.25 ± 0.72 y (p = 0.0027). The automated PAH by BoneXpert™ were 156.26 ± 0.86 cm (SDS - 2.01 ± 1.07) in females and 171.75 ± 1.6 cm (SDS - 1.29 ± 1.06) in males, compared to 153.95 ± 1.12 cm (SDS - 2.56 ± 1.5) in females and 169.31 ± 1.6 cm (SDS - 1.66 ± 1.56) in males by conventional BP, respectively and in comparison to near-adult heights 156.38 ± 5.84 cm (SDS - 1.91 ± 1.15) in females and 168.94 ± 8.18 cm (SDS - 1.72 ± 1.22) in males, respectively. CONCLUSION BA ratings and adult height predictions by BoneXpert™ in children with chronic endocrinopathies abolish rater-dependent variability and enhance reproducibility of estimates thereby refining care in growth disorders. Conventional methods may outperform automated analyses in specific cases.
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Affiliation(s)
- Daniela Choukair
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital Heidelberg, Heidelberg, 69120, Germany.
| | - Annette Hückmann
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital Heidelberg, Heidelberg, 69120, Germany
| | - Janna Mittnacht
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital Heidelberg, Heidelberg, 69120, Germany
| | - Thomas Breil
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital Heidelberg, Heidelberg, 69120, Germany
| | | | | | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Markus Bettendorf
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital Heidelberg, Heidelberg, 69120, Germany
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Bakkaloglu SA, Bacchetta J, Lalayiannis AD, Leifheit-Nestler M, Stabouli S, Haarhaus M, Reusz G, Groothoff J, Schmitt CP, Evenepoel P, Shroff R, Haffner D. Bone evaluation in paediatric chronic kidney disease: clinical practice points from the European Society for Paediatric Nephrology CKD-MBD and Dialysis working groups and CKD-MBD working group of the ERA-EDTA. Nephrol Dial Transplant 2021; 36:413-425. [PMID: 33245331 DOI: 10.1093/ndt/gfaa210] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Indexed: 11/13/2022] Open
Abstract
Mineral and bone disorder (MBD) is widely prevalent in children with chronic kidney disease (CKD) and is associated with significant morbidity. CKD may cause disturbances in bone remodelling/modelling, which are more pronounced in the growing skeleton, manifesting as short stature, bone pain and deformities, fractures, slipped epiphyses and ectopic calcifications. Although assessment of bone health is a key element in the clinical care of children with CKD, it remains a major challenge for physicians. On the one hand, bone biopsy with histomorphometry is the gold standard for assessing bone health, but it is expensive, invasive and requires expertise in the interpretation of bone histology. On the other hand, currently available non-invasive measures, including dual-energy X-ray absorptiometry and biomarkers of bone formation/resorption, are affected by growth and pubertal status and have limited sensitivity and specificity in predicting changes in bone turnover and mineralization. In the absence of high-quality evidence, there are wide variations in clinical practice in the diagnosis and management of CKD-MBD in childhood. We present clinical practice points (CPPs) on the assessment of bone disease in children with CKD Stages 2-5 and on dialysis based on the best available evidence and consensus of experts from the CKD-MBD and Dialysis working groups of the European Society for Paediatric Nephrology and the CKD-MBD working group of the European Renal Association-European Dialysis and Transplant Association. These CPPs should be carefully considered by treating physicians and adapted to individual patients' needs as appropriate. Further areas for research are suggested.
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Affiliation(s)
- Sevcan A Bakkaloglu
- Department of Paediatric Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Justine Bacchetta
- Department of Paediatric Nephrology, Rheumatology and Dermatology, University Children's Hospital, Lyon, France
| | - Alexander D Lalayiannis
- Renal Unit, UCL Great Ormond Street Hospital for Children Institute of Child Health, London, UK
| | - Maren Leifheit-Nestler
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School Children's Hospital, Hannover, Germany
| | - Stella Stabouli
- First Department of Paediatrics, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Mathias Haarhaus
- Division of Renal Medicine and Baxter Novum, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Diaverum AB, Stockholm, Sweden
| | - George Reusz
- First Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Jaap Groothoff
- Department of Paediatric Nephrology, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Claus Peter Schmitt
- Division of Paediatric Nephrology, Center for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Pieter Evenepoel
- Department of Microbiology and Immunology, Laboratory of Nephrology, KU Leuven, Leuven, Belgium.,Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital for Children Institute of Child Health, London, UK
| | - Dieter Haffner
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School Children's Hospital, Hannover, Germany
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Diete V, Wabitsch M, Denzer C, Jäger H, Hauth E, Beer M, Vogele D. Applicability of Magnetic Resonance Imaging for Bone Age Estimation in the Context of Medical Issues. ROFO-FORTSCHR RONTG 2020; 193:692-700. [PMID: 33336355 DOI: 10.1055/a-1313-7664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The determination of bone age is a method for analyzing biological age and structural maturity. Bone age estimation is predominantly used in the context of medical issues, for example in endocrine diseases or growth disturbance. As a rule, conventional X-ray images of the left wrist and hand are used for this purpose. The aim of the present study is to investigate the extent to which MRI can be used as a radiation-free alternative for bone age assessment. METHODS In 50 patients, 19 females and 31 males, in addition to conventional left wrist and hand radiographs, MRI was performed with T1-VIBE (n = 50) and T1-TSE (n = 34). The average age was 11.87 years (5.08 to 17.50 years). Bone age assessment was performed by two experienced investigators blinded for chronological age according to the most widely used standard of Greulich and Pyle. This method relies on a subjective comparison of hand radiographs with gender-specific reference images from Caucasian children and adolescents. In addition to interobserver and intraobserver variability, the correlation between conventional radiographs and MRI was determined using the Pearson correlation coefficient. RESULTS Between the bone age determined from the MRI data and the results of the conventional X-ray images, a very good correlation was found for both T1-VIBE with r = 0.986 and T1-TSE with r = 0.982. Gender differences did not arise. The match for the interobserver variability was very good: r = 0.985 (CR), 0.966 (T1-VIBE) and 0.971 (T1-TSE) as well as the match for the intraobserver variability for investigator A (CR = 0.994, T1-VIBE = 0.995, T1-TSE = 0.998) and for investigator B (CR = 0.994, T1-VIBE = 0.993, T1-TSE = 0.994). CONCLUSION The present study shows that MRI of the left wrist and hand can be used as a possible radiation-free alternative to conventional X-ray imaging for bone age estimation in the context of medical issues. KEY POINTS · MRI and X-ray show a very good correlation for bone age determination in medical issues.. · With short examination times, T1 VIBE shows slight advantages over T1 TSE.. · Both investigators show high intra- and interobserver variability.. CITATION FORMAT · Diete V, Wabitsch M, Denzer C et al. Applicability of Magnetic Resonance Imaging for Bone Age Estimation in the Context of Medical Issues. Fortschr Röntgenstr 2021; 193: 692 - 700.
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Affiliation(s)
- Vera Diete
- Department for Diagnostic and Interventional Radiology, University Ulm Medical Centre, Ulm, Germany
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, University Ulm Medical Centre, Ulm, Germany
| | - Christian Denzer
- Division of Pediatric Endocrinology and Diabetes, University Ulm Medical Centre, Ulm, Germany
| | | | | | - Meinrad Beer
- Department for Diagnostic and Interventional Radiology, University Ulm Medical Centre, Ulm, Germany
| | - Daniel Vogele
- Department for Diagnostic and Interventional Radiology, University Ulm Medical Centre, Ulm, Germany
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Saida K, Silva S, Solar B, Fujita A, Hamanaka K, Mitsuhashi S, Koshimizu E, Mizuguchi T, Miyatake S, Takata A, Miyake N, Matsumoto N. SOFT syndrome in a patient from Chile. Am J Med Genet A 2018; 179:338-340. [PMID: 30569574 DOI: 10.1002/ajmg.a.61015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/15/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022]
Abstract
SOFT syndrome (MIM614813) is an extremely rare primordial dwarfism caused by biallelic mutations in the POC1A gene. It is characterized by prenatal short stature, onychodysplasia, facial dysmorphism, hypotrichosis, and variable skeletal abnormalities including hypoplastic pelvis and sacrum, small hands, and cone-shaped epiphyses, as well as delayed bone age. To the best of our knowledge, only eight POC1A mutations have been reported in humans to date. We report a 7-year-old Chilean girl with SOFT syndrome arising from a novel POC1A mutation c. 649C>T, p.Arg217Trp. Although her clinical features were largely compatible with SOFT syndrome, hand X-ray examinations at 3.5 and 6 years unexpectedly showed normal bone age. Automated bone age determination was performed using image analysis software, BoneXpert. This case highlights the importance of the accumulation of patients with POC1A mutations to further elucidate the detailed clinical features of SOFT syndrome.
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Affiliation(s)
- Ken Saida
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Sebastian Silva
- Servicio de Neurología Infantil, Hospital de Puerto Montt, Puerto Montt, Chile
| | - Benjamin Solar
- Servicio de Neurología Infantil, Hospital de Puerto Montt, Puerto Montt, Chile
| | - Atsushi Fujita
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kohei Hamanaka
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Satomi Mitsuhashi
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Eriko Koshimizu
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takeshi Mizuguchi
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Atsushi Takata
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Noriko Miyake
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Zhang J, Lin F, Ding X. Automatic Determination of the Greulich-Pyle Bone Age as an Alternative Approach for Chinese Children with Discordant Bone Age. Horm Res Paediatr 2017; 86:83-89. [PMID: 27414678 DOI: 10.1159/000446434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 04/26/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Automated bone age (BA) rating using BoneXpert is being adopted worldwide. This study investigated whether manual matching of hand radiographs could be replaced by BoneXpert for BA ratings of Chinese children with delayed or advanced BA. METHODS 482 left-hand radiographs from 482 children (aged 2-16 years) with discordant BA were evaluated by BoneXpert and manually by 4 radiology residents using the Greulich and Pyle atlas. Radiographs whose BoneXpert BA deviated by >1 year from manual assessment were rerated by 2 attending radiologists in a blinded manner. RESULTS Among all 482 radiographs, 46 (9.5%) radiographs were rerated and no radiographs were rejected. Differences between BoneXpert and manual rating of 28 (5.8%) cases were >1 year. The manual BAs of the 28 radiographs were all >10 years and greater than the BoneXpert BAs. The root mean square deviation between the residents and BoneXpert was 0.56 for these children (95% CI 0.53-0.61). CONCLUSION BoneXpert agreed with manual BA rating in 94.2% of the images. Therefore, BoneXpert could be used as an alternative for the radiology residents to make an initial BA estimation. Modification of BoneXpert should provide greater accuracy for the estimation of BA in children aged >10 years with discordant BA.
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Affiliation(s)
- Ji Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Schündeln MM, Marschke L, Bauer JJ, Hauffa PK, Schweiger B, Führer-Sakel D, Lahner H, Poeppel TD, Kiewert C, Hauffa BP, Grasemann C. A Piece of the Puzzle: The Bone Health Index of the BoneXpert Software Reflects Cortical Bone Mineral Density in Pediatric and Adolescent Patients. PLoS One 2016; 11:e0151936. [PMID: 27014874 PMCID: PMC4807844 DOI: 10.1371/journal.pone.0151936] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/07/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Suspected osteopathology in chronically ill children often necessitates the assessment of bone mineral density. The most frequently used methods are dual-energy X-ray-absorption (DXA) and peripheral quantitative computed tomography (pQCT). The BoneXpert software provides an automated radiogrammatic method to assess skeletal age from digitalized X-rays of the left hand. Furthermore, the program calculates the Bone Health Index (BHI), a measure of cortical thickness and mineralization, which is obtained from indices of three metacarpal bones. In our study, we analyzed the manner in which BHI information provided by BoneXpert compares with DXA or pQCT measurements in youths. STUDY DESIGN The BHI was retrospectively obtained using digitalized X-rays of the left hand and compared with the results of 203 corresponding DXA readings (Lunar Prodigy, GE Healthcare) of the lumbar vertebrae and femur as well as 117 pQCT readings (XCT 900, Stratec) of the distal radius. RESULTS The BHI values showed a strong positive correlation with the DXA readings at each and all lumbar vertebrae (L1 -L4: r = 0.73; P < 0.0001). The age-adjusted Z-score of L1 -L4 and the height-adjusted score showed a positive correlation with the BHI-SDS (standard deviation score, r = 0.23; P < 0.002 and r = 0.27; P < 0.001, respectively). Total bone mineral density, as assessed via pQCT, also positively correlated with the BHI (r = 0.39; P < 0.0001), but the trabecular values displayed only a weak correlation. CONCLUSIONS The BHI obtained using BoneXpert can be a useful parameter in the assessment of bone health in children in most cases. This technique provides observer-independent information on cortical thickness and mineralization based on X-ray imaging of the hands.
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Affiliation(s)
- Michael M. Schündeln
- Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Laura Marschke
- Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Jens J. Bauer
- Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
- Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Pia K. Hauffa
- Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Bernd Schweiger
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Dagmar Führer-Sakel
- Department of Endocrinology and Metabolism, Medical Center, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Harald Lahner
- Department of Endocrinology and Metabolism, Medical Center, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Thorsten D. Poeppel
- Clinik for Nuclear Medicine, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Cordula Kiewert
- Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Berthold P. Hauffa
- Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Corinna Grasemann
- Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
- * E-mail:
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Ranabothu S, Kaskel FJ. Validation of automated Greulich-Pyle bone age determination in children with chronic renal failure? Pediatr Nephrol 2015; 30:1051-2. [PMID: 25862023 DOI: 10.1007/s00467-015-3103-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 11/29/2022]
Abstract
Growth failure is a common problem in children with chronic kidney disease (CKD). The causes are multifactorial and are associated with increased mortality and morbidity. Standard deviations of bone age versus chronological age in children with CKD have not been developed to date. Accurate and early treatment of bone age is an important component of determining the utility of GH therapy. Improvements in bone age assessments are being evaluated to optimize the understanding of growth delay in CKD.
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Affiliation(s)
- Saritha Ranabothu
- Department of Pediatrics, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
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