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Mohammad N, Ahmad R, Gaus MHA, Kurniawan A, Yusof MYPM. Accuracy of automated forensic dental age estimation lab (F-DentEst Lab) on large Malaysian dataset. Forensic Sci Int 2024; 361:112150. [PMID: 39047517 DOI: 10.1016/j.forsciint.2024.112150] [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] [Received: 03/04/2024] [Revised: 06/26/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
When a disaster occurs, the authority must prioritise two things. First, the search and rescue of lives, and second, the identification and management of deceased individuals. However, with thousands of dead bodies to be individually identified in mass disasters, forensic teams face challenges such as long working hours resulting in a delayed identification process and a public health concern caused by the decomposition of the body. Using dental panoramic imaging, teeth have been used in forensics as a physical marker to estimate the age of an individual. Traditionally, dental age estimation has been performed manually by experts. Although the procedure is fairly simple, the large number of victims and the limited amount of time available to complete the assessment during large-scale disasters make forensic work even more challenging. The emergence of artificial intelligence (AI) in the fields of medicine and dentistry has led to the suggestion of automating the current process as an alternative to the conventional method. This study aims to test the accuracy and performance of the developed deep convolutional neural network system for age estimation in large, out-of-sample Malaysian children dataset using digital dental panoramic imaging. Forensic Dental Estimation Lab (F-DentEst Lab) is a computer application developed to perform the dental age estimation digitally. The introduction of this system is to improve the conventional method of age estimation that significantly increase the efficiency of the age estimation process based on the AI approach. A total number of one-thousand-eight-hundred-and-ninety-two digital dental panoramic images were retrospectively collected to test the F-DentEst Lab. Data training, validation, and testing have been conducted in the early stage of the development of F-DentEst Lab, where the allocation involved 80 % training and the remaining 20 % for testing. The methodology was comprised of four major steps: image preprocessing, which adheres to the inclusion criteria for panoramic dental imaging, segmentation, and classification of mandibular premolars using the Dynamic Programming-Active Contour (DP-AC) method and Deep Convolutional Neural Network (DCNN), respectively, and statistical analysis. The suggested DCNN approach underestimated chronological age with a small ME of 0.03 and 0.05 for females and males, respectively.
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Affiliation(s)
- Norhasmira Mohammad
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh, Selangor, Malaysia; Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh, Selangor, Malaysia
| | - Rohana Ahmad
- Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh, Selangor, Malaysia
| | - Mohd Hanif Abdul Gaus
- MAIA Sdn Bhd, Educity Complex 1, Persiaran Graduan, Kota Ilmu, Educity Iskandar, Iskandar Puteri, Johor, Malaysia
| | - Arofi Kurniawan
- Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Mohd Yusmiaidil Putera Mohd Yusof
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh, Selangor, Malaysia; Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh, Selangor, Malaysia
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Liang Y, Chen X, Zheng R, Cheng X, Su Z, Wang X, Du H, Zhu M, Li G, Zhong Y, Cheng S, Yu B, Yang Y, Chen R, Cui L, Yao H, Gu Q, Gong C, Jun Z, Huang X, Liu D, Yan X, Wei H, Li Y, Zhang H, Liu Y, Wang F, Zhang G, Fan X, Dai H, Luo X. Validation of an AI-Powered Automated X-ray Bone Age Analyzer in Chinese Children and Adolescents: A Comparison with the Tanner-Whitehouse 3 Method. Adv Ther 2024:10.1007/s12325-024-02944-4. [PMID: 39085749 DOI: 10.1007/s12325-024-02944-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Automated bone age assessment (BAA) is of growing interest because of its accuracy and time efficiency in daily practice. In this study, we validated the clinical applicability of a commercially available artificial intelligence (AI)-powered X-ray bone age analyzer equipped with a deep learning-based automated BAA system and compared its performance with that of the Tanner-Whitehouse 3 (TW-3) method. METHODS Radiographs prospectively collected from 30 centers across various regions in China, including 900 Chinese children and adolescents, were assessed independently by six doctors (three experts and three residents) and an AI analyzer for TW3 radius, ulna, and short bones (RUS) and TW3 carpal bone age. The experts' mean estimates were accepted as the gold standard. The performance of the AI analyzer was compared with that of each resident. RESULTS For the estimation of TW3-RUS, the AI analyzer had a mean absolute error (MAE) of 0.48 ± 0.42. The percentage of patients with an absolute error of < 1.0 years was 86.78%. The MAE was significantly lower than that of rater 1 (0.54 ± 0.49, P = 0.0068); however, it was not significant for rater 2 (0.48 ± 0.48) or rater 3 (0.49 ± 0.46). For TW3 carpal, the AI analyzer had an MAE of 0.48 ± 0.65. The percentage of patients with an absolute error of < 1.0 years was 88.78%. The MAE was significantly lower than that of rater 2 (0.58 ± 0.67, P = 0.0018) and numerically lower for rater 1 (0.54 ± 0.64) and rater 3 (0.50 ± 0.53). These results were consistent for the subgroups according to sex, and differences between the age groups were observed. CONCLUSION In this comprehensive validation study conducted in China, an AI-powered X-ray bone age analyzer showed accuracies that matched or exceeded those of doctor raters. This method may improve the efficiency of clinical routines by reducing reading time without compromising accuracy.
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Affiliation(s)
- Yan Liang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Pediatric Genetic Metabolic and Endocrine Rare Diseases, Wuhan, 430030, China
| | - Xiaobo Chen
- Department of Endocrinology, Children's Hospital, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Rongxiu Zheng
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xinran Cheng
- Department of Pediatric Endocrine Genetics and Metabolism, Chengdu Women's and Children's Center Hospital, Chengdu, 610074, China
| | - Zhe Su
- Department of Endocrinology, Shenzhen Children's Hospital, No. 7019 Yitian Road, Shenzhen, 518038, China
| | - Xiumin Wang
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Hongwei Du
- Department of Paediatrics, First Hospital of Jilin University, Changchun, 130021, China
| | - Min Zhu
- Department of Endocrinology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Guimei Li
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Yan Zhong
- Department of Child Health Care, Hunan Children's Hospital, Changsha, 410007, China
| | - Shengquan Cheng
- Department of Pediatrics, First Affiliated Hospital of Air Force Medical University, Xi'an, 710032, China
| | - Baosheng Yu
- Department of Pediatrics, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210003, China
| | - Yu Yang
- Department of Endocrinology and Genetics, Jiangxi Provincial Children's Hospital, Affiliated Children's Hospital of Nanchang University, Nanchang, 330006, China
| | - Ruimin Chen
- Department of Endocrinology, Genetics and Metabolism, Fuzhou Children's Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Lanwei Cui
- Department of Pediatric, The First Affiliated Hospital of Harbin Medical University, Harbin, 150007, China
| | - Hui Yao
- Department of Endocrinology and Metabolism, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430015, China
| | - Qiang Gu
- Department of Pediatrics, First Affiliated Hospital of Shihezi University, Shihezi, 832000, China
| | - Chunxiu Gong
- Department of Endocrine and Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, 100045, China
| | - Zhang Jun
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xiaoyan Huang
- Department of Genetics, Metabolism and Endocrinology, Hainan Women and Children's Medical Center, Haikou, 570312, China
| | - Deyun Liu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Xueqin Yan
- Department of Pediatrics, Boai Hospital of Zhongshan, Zhongshan, 528400, China
| | - Haiyan Wei
- Department of Endocrinology and Metabolism, Genetics, Henan Children's Hospital (Children's Hospital Affiliated to Zhengzhou University), Zhengzhou, 450018, China
| | - Yuwen Li
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Huifeng Zhang
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yanjie Liu
- Department of Pediatrics, Inner Mongolia People's Hospital, Hohhot, 010017, China
| | - Fengyun Wang
- Department of Endocrinology, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Gaixiu Zhang
- Department of Endocrine and Genetics and Metabolism, Children's Hospital of Shanxi, Taiyuan, 030006, China
| | - Xin Fan
- Department of Pediatric, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 537406, China
| | - Hongmei Dai
- Department of Pediatric, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Hubei Key Laboratory of Pediatric Genetic Metabolic and Endocrine Rare Diseases, Wuhan, 430030, China.
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Wang L, Zhang X, Chen P, Zhou D. Doctor simulator: Delta-Age-Sex-AdaIn enhancing bone age assessment through AdaIn style transfer. Pediatr Radiol 2024:10.1007/s00247-024-06000-9. [PMID: 39060414 DOI: 10.1007/s00247-024-06000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Bone age assessment assists physicians in evaluating the growth and development of children. However, deep learning methods for bone age estimation do not currently incorporate differential features obtained through comparisons with other bone atlases. OBJECTIVE To propose a more accurate method, Delta-Age-Sex-AdaIn (DASA-net), for bone age assessment, this paper combines age and sex distribution through adaptive instance normalization (AdaIN) and style transfer, simulating the process of visually comparing hand images with a standard bone atlas to determine bone age. MATERIALS AND METHODS The proposed Delta-Age-Sex-AdaIn (DASA-net) consists of four modules: BoneEncoder, Binary code distribution, Delta-Age-Sex-AdaIn, and AgeDecoder. It is compared with state-of-the-art methods on both a public Radiological Society of North America (RSNA) pediatric bone age prediction dataset (14,236 hand radiographs, ranging from 1 to 228 months) and a private bone age prediction dataset from Zigong Fourth People's Hospital (474 hand radiographs, ranging from 12 to 218 months, 268 male). Ablation experiments were designed to demonstrate the necessity of incorporating age distribution and sex distribution. RESULTS The DASA-net model achieved a lower mean absolute deviation (MAD) of 3.52 months on the RSNA dataset, outperforming other methods such as BoneXpert, Deeplasia, BoNet, and other deep learning based methods. On the private dataset, the DASA-net model obtained a MAD of 3.82 months, which is also superior to other methods. CONCLUSION The proposed DASA-net model aided the model's learning of the distinctive characteristics of hand bones of various ages and both sexes by integrating age and sex distribution into style transfer.
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Affiliation(s)
- Liping Wang
- Department of Computer Center, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China.
| | - Xingpeng Zhang
- School of Computer Science and Software Engineering, Southwest Petroleum University, Chengdu, 610500, Sichuan, China
| | | | - Dehao Zhou
- Department of Computer Center, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
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Huart J, Pozzi A, Bleedorn J, Lu TW, Knell S, Park B. Statistical shape modeling of the geometric morphology of the canine femur, tibia, and patella. Front Vet Sci 2024; 11:1366827. [PMID: 39051009 PMCID: PMC11266300 DOI: 10.3389/fvets.2024.1366827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 06/11/2024] [Indexed: 07/27/2024] Open
Abstract
Bone morphometry varies among dogs of different sizes and breeds. Studying these differences may help understand the predisposition of certain breeds for specific orthopedic pathologies. This study aimed to develop a statistical shape model (SSM) of the femur, patella, and tibia of dogs without any clinical orthopeadic abnormalities to analyze and compare morphological variations based on body weight and breed. A total of 97 CT scans were collected from different facilities and divided based on breed and body weight. The 3D models of the bones were obtained and aligned to a coordinate system. The SSM was created using principal component analysis (PCA) to analyze shape variations. The study found that the first few modes of variation accounted for a significant percentage of the total variation, with size/scale being the most prominent factor. The results provide valuable insights into normal anatomical variations and can be used for future research in understanding pathological bone morphologies and developing 3D imaging algorithms in veterinary medicine.
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Affiliation(s)
- Jeremy Huart
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty University of Zurich, Zürich, Switzerland
| | - Antonio Pozzi
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty University of Zurich, Zürich, Switzerland
| | - Jason Bleedorn
- Department of Veterinary Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Sebastian Knell
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty University of Zurich, Zürich, Switzerland
| | - Brian Park
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty University of Zurich, Zürich, Switzerland
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Benediktsson S, Johannsson E, Rygh CB, Gundersen H. Norwegian male U14 soccer players have superior running capacity compared to Icelandic players. Front Sports Act Living 2024; 6:1407842. [PMID: 39011347 PMCID: PMC11246952 DOI: 10.3389/fspor.2024.1407842] [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: 03/27/2024] [Accepted: 06/11/2024] [Indexed: 07/17/2024] Open
Abstract
The organisation and development strategies of youth soccer differ between Norway and Iceland. Whether this affect physical capacity is unknown. Thus, the first aim of the present study is to compare physical capacity between players from Iceland and Norway. Secondary aim is to assess associations between biological maturity and physical capacity in the Icelandic players since an association previously has been shown among the Norwegians. There were 48 U14 players from Iceland included and 103 players from Norway. Bone age (BA), measured with left-wrist x-ray, was used as an indicator of biological maturity. To measure physical capacity, 40 metre (m) linear sprint, standing long jump (SLJ), countermovement jump (CMJ), the Yo-Yo intermittent recovery test (IR1-test) and a maximal oxygen uptake test (VO2max) were used. Training load was assessed by questionnaire. The results showed that the Norwegian players ran faster (5.90 ± 0.38 vs. 6.37 ± 0.44 s, p < .001), had better intermittent endurance capacity (1,235 ± 461 vs. 960 ± 423 m, p < .001) and higher VO2max, (60.3 ± 6.5 vs. 54.8 ± 5.3 ml·kg-1·min-1, p < .001) than the Icelandic players. The players from Norway reported a higher number of weekly organised soccer training hours than the Icelandic. We also found significant correlations between BA and performance on 40 m linear sprint (r = -.566, p < .001), SLJ (r = .380, p = .008) and CMJ (r = .354, p = .014) among the Icelandic players. Moreover, no correlations were found between BA and VO2max or intermittent endurance capacity. In conclusion, the Norwegian players ran faster and had better VO2max and intermittent endurance capacity than the Icelandic players. Biological maturity level was associated with speed and jumping performance in U14 soccer players in Iceland, but not with VO2max or intermittent endurance capacity. Findings indicate that more research is needed to investigate the influence of different organisation and structure of youth soccer between the two countries on physical capacity.
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Affiliation(s)
- Sigurður Benediktsson
- Center of Sport and Health Sciences, School of Education, University of Iceland, Reykjavik, Iceland
| | - Erlingur Johannsson
- Center of Sport and Health Sciences, School of Education, University of Iceland, Reykjavik, Iceland
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Cecilie Brekke Rygh
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Hilde Gundersen
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Pape J, Hirsch FW, Deffaa OJ, DiFranco MD, Rosolowski M, Gräfe D. Applicability and robustness of an artificial intelligence-based assessment for Greulich and Pyle bone age in a German cohort. ROFO-FORTSCHR RONTG 2024; 196:600-606. [PMID: 38065542 DOI: 10.1055/a-2203-2997] [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: 05/24/2024]
Abstract
PURPOSE The determination of bone age (BA) based on the hand and wrist, using the 70-year-old Greulich and Pyle (G&P) atlas, remains a widely employed practice in various institutions today. However, a more recent approach utilizing artificial intelligence (AI) enables automated BA estimation based on the G&P atlas. Nevertheless, AI-based methods encounter limitations when dealing with images that deviate from the standard hand and wrist projections. Generally, the extent to which BA, as determined by the G&P atlas, corresponds to the chronological age (CA) of a contemporary German population remains a subject of continued discourse. This study aims to address two main objectives. Firstly, it seeks to investigate whether the G&P atlas, as applied by the AI software, is still relevant for healthy children in Germany today. Secondly, the study aims to assess the performance of the AI software in handling non-strict posterior-anterior (p. a.) projections of the hand and wrist. MATERIALS AND METHODS The AI software retrospectively estimated the BA in children who had undergone radiographs of a single hand using posterior-anterior and oblique planes. The primary purpose was to rule out any osseous injuries. The prediction error of BA in relation to CA was calculated for each plane and between the two planes. RESULTS A total of 1253 patients (aged 3 to 16 years, median age 10.8 years, 55.7 % male) were included in the study. The average error of BA in posterior-anterior projections compared to CA was 3.0 (± 13.7) months for boys and 1.7 (± 13.7) months for girls. Interestingly, the deviation from CA tended to be even slightly lower in oblique projections than in posterior-anterior projections. The mean error in the posterior-anterior projection plane was 2.5 (± 13.7) months, while in the oblique plane it was 1.8 (± 13.9) months (p = 0.01). CONCLUSION The AI software for BA generally corresponds to the age of the contemporary German population under study, although there is a noticeable prediction error, particularly in younger children. Notably, the software demonstrates robust performance in oblique projections. KEY POINTS · Bone age, as determined by artificial intelligence, aligns with the chronological age of the contemporary German cohort under study.. · As determined by artificial intelligence, bone age is remarkably robust, even when utilizing oblique X-ray projections.. CITATION FORMAT · Pape J, Hirsch F, Deffaa O et al. Applicability and robustness of an artificial intelligence-based assessment for Greulich and Pyle bone age in a German cohort. Fortschr Röntgenstr 2024; 196: 600 - 606.
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Affiliation(s)
- Johanna Pape
- Pediatric Radiology, University Hospital Leipzig, Germany
| | | | | | | | - Maciej Rosolowski
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Daniel Gräfe
- Pediatric Radiology, University Hospital Leipzig, Germany
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Xie LZ, Dou XY, Ge TH, Han XG, Zhang Q, Wang QL, Chen S, He D, Tian W. Deep learning-based identification of spine growth potential on EOS radiographs. Eur Radiol 2024; 34:2849-2860. [PMID: 37848772 DOI: 10.1007/s00330-023-10308-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/21/2023] [Accepted: 08/15/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES To develop an automatic computer-based method that can help clinicians in assessing spine growth potential based on EOS radiographs. METHODS We developed a deep learning-based (DL) algorithm that can mimic the human judgment process to automatically determine spine growth potential and the Risser sign based on full-length spine EOS radiographs. A total of 3383 EOS cases were collected and used for the training and test of the algorithm. Subsequently, the completed DL algorithm underwent clinical validation on an additional 440 cases and was compared to the evaluations of four clinicians. RESULTS Regarding the Risser sign, the weighted kappa value of our DL algorithm was 0.933, while that of the four clinicians ranged from 0.909 to 0.930. In the assessment of spine growth potential, the kappa value of our DL algorithm was 0.944, while the kappa values of the four clinicians were 0.916, 0.934, 0.911, and 0.920, respectively. Furthermore, our DL algorithm obtained a slightly higher accuracy (0.973) and Youden index (0.952) compared to the best values achieved by the four clinicians. In addition, the speed of our DL algorithm was 15.2 ± 0.3 s/40 cases, much faster than the inference speeds of the clinicians, ranging from 177.2 ± 28.0 s/40 cases to 241.2 ± 64.1 s/40 cases. CONCLUSIONS Our algorithm demonstrated comparable or even better performance compared to clinicians in assessing spine growth potential. This stable, efficient, and convenient algorithm seems to be a promising approach to assist doctors in clinical practice and deserves further study. CLINICAL RELEVANCE STATEMENT This method has the ability to quickly ascertain the spine growth potential based on EOS radiographs, and it holds promise to provide assistance to busy doctors in certain clinical scenarios. KEY POINTS • In the clinic, there is no available computer-based method that can automatically assess spine growth potential. • We developed a deep learning-based method that could automatically ascertain spine growth potential. • Compared with the results of the clinicians, our algorithm got comparable results.
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Affiliation(s)
- Lin-Zhen Xie
- Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin-Yu Dou
- Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Teng-Hui Ge
- Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Guang Han
- Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Zhang
- Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi-Long Wang
- Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuo Chen
- Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Da He
- Peking University Fourth School of Clinical Medicine, Beijing, China.
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.
| | - Wei Tian
- Peking University Fourth School of Clinical Medicine, Beijing, China.
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.
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Bajjad AA, Gupta S, Agarwal S, Pawar RA, Kothawade MU, Singh G. Use of artificial intelligence in determination of bone age of the healthy individuals: A scoping review. J World Fed Orthod 2024; 13:95-102. [PMID: 37968159 DOI: 10.1016/j.ejwf.2023.10.001] [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] [Received: 08/24/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Bone age assessment, as an indicator of biological age, is widely used in orthodontics and pediatric endocrinology. Owing to significant subject variations in the manual method of assessment, artificial intelligence (AI), machine learning (ML), and deep learning (DL) play a significant role in this aspect. A scoping review was conducted to search the existing literature on the role of AI, ML, and DL in skeletal age or bone age assessment in healthy individuals. METHODS A literature search was conducted in PubMed, Scopus, and Web of Science from January 2012 to December 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute guidelines. Grey literature was searched using Google Scholar and OpenGrey. Hand-searching of the articles in all the reputed orthodontic journals and the references of the included articles were also searched for relevant articles for the present scoping review. RESULTS Nineteen articles that fulfilled the inclusion criteria were included. Ten studies used skeletal maturity indicators based on hand and wrist radiographs, two studies used magnetic resonance imaging and seven studies used cervical vertebrae maturity indicators based on lateral cephalograms to assess the skeletal age of the individuals. Most of these studies were published in non-orthodontic medical journals. BoneXpert automated software was the most commonly used software, followed by DL models, and ML models in the studies for assessment of bone age. The automated method was found to be as reliable as the manual method for assessment. CONCLUSIONS This scoping review validated the use of AI, ML, or DL in bone age assessment of individuals. A more uniform distribution of sufficient samples in different stages of maturation, use of three-dimensional inputs such as magnetic resonance imaging, and cone beam computed tomography is required for better training of the models to generalize the outputs for use in the target population.
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Affiliation(s)
- Adeel Ahmed Bajjad
- Department of Orthodontics, Kothiwal Dental College and Research Centre, Moradabad, India
| | - Seema Gupta
- Department of Orthodontics, Kothiwal Dental College and Research Centre, Moradabad, India.
| | - Soumitra Agarwal
- Department of Orthodontics, Kothiwal Dental College and Research Centre, Moradabad, India
| | - Rakesh A Pawar
- Department of Orthodontics, JMF ACPM Dental College, Dhule, India
| | | | - Gul Singh
- Department of Orthodontics, Kothiwal Dental College and Research Centre, Moradabad, India
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Gitto S, Serpi F, Albano D, Risoleo G, Fusco S, Messina C, Sconfienza LM. AI applications in musculoskeletal imaging: a narrative review. Eur Radiol Exp 2024; 8:22. [PMID: 38355767 PMCID: PMC10866817 DOI: 10.1186/s41747-024-00422-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/29/2023] [Indexed: 02/16/2024] Open
Abstract
This narrative review focuses on clinical applications of artificial intelligence (AI) in musculoskeletal imaging. A range of musculoskeletal disorders are discussed using a clinical-based approach, including trauma, bone age estimation, osteoarthritis, bone and soft-tissue tumors, and orthopedic implant-related pathology. Several AI algorithms have been applied to fracture detection and classification, which are potentially helpful tools for radiologists and clinicians. In bone age assessment, AI methods have been applied to assist radiologists by automatizing workflow, thus reducing workload and inter-observer variability. AI may potentially aid radiologists in identifying and grading abnormal findings of osteoarthritis as well as predicting the onset or progression of this disease. Either alone or combined with radiomics, AI algorithms may potentially improve diagnosis and outcome prediction of bone and soft-tissue tumors. Finally, information regarding appropriate positioning of orthopedic implants and related complications may be obtained using AI algorithms. In conclusion, rather than replacing radiologists, the use of AI should instead help them to optimize workflow, augment diagnostic performance, and keep up with ever-increasing workload.Relevance statement This narrative review provides an overview of AI applications in musculoskeletal imaging. As the number of AI technologies continues to increase, it will be crucial for radiologists to play a role in their selection and application as well as to fully understand their potential value in clinical practice. Key points • AI may potentially assist musculoskeletal radiologists in several interpretative tasks.• AI applications to trauma, age estimation, osteoarthritis, tumors, and orthopedic implants are discussed.• AI should help radiologists to optimize workflow and augment diagnostic performance.
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Affiliation(s)
- Salvatore Gitto
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Cristina Belgioioso 173, Milan, 20157, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Francesca Serpi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Cristina Belgioioso 173, Milan, 20157, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Risoleo
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Stefano Fusco
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Cristina Belgioioso 173, Milan, 20157, Italy
| | - Carmelo Messina
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Cristina Belgioioso 173, Milan, 20157, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Cristina Belgioioso 173, Milan, 20157, Italy.
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
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Gonca M, Sert MF, Gunacar DN, Kose TE, Beser B. Determination of growth and developmental stages in hand-wrist radiographs : Can fractal analysis in combination with artificial intelligence be used? J Orofac Orthop 2024:10.1007/s00056-023-00510-1. [PMID: 38252312 DOI: 10.1007/s00056-023-00510-1] [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: 06/03/2023] [Accepted: 12/01/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE The goal of this work was to assess the classification of maturation stage using artificial intelligence (AI) classifiers. METHODS Hand-wrist radiographs (HWRs) from 1067 individuals aged between 7 and 18 years were included. Fifteen regions of interest were selected for fractal dimension (FD) analysis. Five predictive models with different inputs were created (model 1: only FD; model 2: FD and Chapman sesamoid stage; model 3: FD, age, and sex; model 4: FD, Chapman sesamoid stage, age, and sex; model 5: Chapman sesamoid stage, age, and sex). The target diagnoses were accelerating growth velocity, very high growth velocity, and decreasing growth velocity. Four AI algorithms were applied: multilayer perceptron (MLP), support vector machine (SVM), gradient boosting machine (GBM) and C 5.0 decision tree classifier. RESULTS All AI algorithms except for C 5.0 yielded similar overall predictive accuracies for the five models. In order from lowest to highest, the predictive accuracies of the models were as follows: model 1 < model 3 < model 2 < model 5 < model 4. The highest overall F1 score, which was used instead of accuracy especially for models with unbalanced data, was obtained for models 1, 2, and 3 based on SVM, for model 4 based on MLP, and for model 5 based on C 5.0. Adding Chapman sesamoid stage, chronologic age, and sex as additional inputs to the FD values significantly increased the F1 score. CONCLUSION Applying FD analysis to HWRs is not sufficient to predict maturation stage in growing patients but can be considered a growth rate prediction method if combined with the Chapman sesamoid stage, age, and sex.
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Affiliation(s)
- Merve Gonca
- Faculty of Dentistry, Department of Orthodontics, Recep Tayyip Erdoğan University, Menderes Boulevard No 612, 53020, Rize, Turkey.
| | - Mehmet Fatih Sert
- Department of Business Administration (Quantitative Methods), Gaziantep University, Gaziantep, Turkey
| | - Dilara Nil Gunacar
- Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Taha Emre Kose
- Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Busra Beser
- Faculty of Dentistry, Department of Orthodontics, Recep Tayyip Erdoğan University, Menderes Boulevard No 612, 53020, Rize, Turkey
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Chávez-Vázquez AG, Klünder-Klünder M, Garibay-Nieto NG, López-González D, Sánchez-Curiel Loyo M, Miranda-Lora AL. Evaluation of height prediction models: from traditional methods to artificial intelligence. Pediatr Res 2024; 95:308-315. [PMID: 37735232 DOI: 10.1038/s41390-023-02821-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/17/2023] [Accepted: 09/02/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Traditional methods for predicting adult height (AHP) rely on manual readings of bone age (BA). However, the incorporation of artificial intelligence has recently improved the accuracy of BA readings and their incorporation into AHP models. METHODS This study aimed to identify the AHP model that fits the current average height for adults in Mexico. Using a cross-sectional design, the study included 1173 participants (5-18 yr). BA readings were done by two experts (manually) and with an automated method (BoneXpert®). AHP was carried out using both traditional and automated methods. The best AHP model was the one that was closest to the population mean. RESULTS All models overestimated the population mean (males: 0.7-6.7 cm, females: 0.9-3.7 cm). The AHP models with the smallest difference were BoneXpert for males and Bayley & Pinneau for females. However, the manual readings of BA showed significant interobserver variability (up to 43% of predictions between observers exceeded 5 cm using the Bayley & Pinneau method). CONCLUSION Traditional AHP models relying on manual BA readings have high interobserver variability. Therefore, BoneXpert is the most reliable option, reducing such variability and providing AHP models that remain close to the mean population height. IMPACT Traditional models for predicting adult height often result in overestimated height predictions. The manual reading of bone age is prone to interobserver variability, which can introduce significant biases in the prediction of adult height. The BoneXpert method minimizes the variability associated with traditional methods and demonstrates consistent results in relation to the average height of the population. This study is the first to assess adult height prediction models specifically in the current generations of Mexican children.
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Affiliation(s)
- Ana G Chávez-Vázquez
- Unit of Epidemiological Research in Endocrinology and Nutrition, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Miguel Klünder-Klünder
- Research Subdirectorate, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Nayely G Garibay-Nieto
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México "Dr. Eduardo Liceaga" and Hospital Ángeles del Pedregal, Mexico City, Mexico
| | - Desirée López-González
- Research Unit in Clinical Epidemiology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - América L Miranda-Lora
- Unit of Epidemiological Research in Endocrinology and Nutrition, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
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Oza C, Antani M, Mondkar SA, Kajale N, Ojha V, Goel P, Khadilkar V, Khadilkar AV. BoneXpert-derived bone health index reference curves constructed on healthy Indian children and adolescents. Pediatr Radiol 2024; 54:127-135. [PMID: 38099931 DOI: 10.1007/s00247-023-05824-1] [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: 08/31/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Artificial intelligence (AI)-based applications for the assessment of the paediatric musculoskeletal system like BoneXpert are not only useful to assess bone age (BA) but also to provide a bone health index (BHI) and a standard deviation score (SDS) for both. This allows comparison of the BHI with age- and sex-matched healthy Caucasian children. OBJECTIVE We conducted this study with the objective of generating BHI curves using BoneXpert in healthy Indian children with BA between 2 and 17 years. METHOD We retrospectively reviewed anthropometric parameters, BHI, and BHI SDS data of digitalized left-hand radiographs (joint photographic experts group [jpg] format) of a cohort of 788 paediatric patients from a previous study to which they were recruited to compare various methods of BA assessment. The recruited children represented all age groups for both sexes. The corrected BHI for jpg images was calculated using the formula corrected BHI=BHI*(stature/(avL*50))^0.33333 where stature is height of subject and avL is average length of metacarpal bones. The reference Indian BHI curves and centiles were generated using the Lambda-Mu-Sigma method. RESULT The mean BHI and BHI SDS of the study group were 4.02±0.57 and -1.73±1.09, respectively. The average increase in median BHI from each age group was between 2.5% and 3% in both sexes up to age of 14 years after which it increased to 4.5% to 5%. The mean BHI of Indian children was lower than that of Caucasian children with maximum differences noted in boys at 16 years (21.7%) and girls at 14 years (16%). We report 8.4% SD of BHI for our study sample. Reference percentile curves for BHI according to BA were derived separately for boys and girls. CONCLUSION Reference data has been provided for the screening of bone health status of Indian children and adolescents.
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Affiliation(s)
- Chirantap Oza
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India
- Endogrow Paediatric and Adolescent Endocrine Centre, Ahmedabad, India
- Department of Paediatrics, Narendra Modi Medical College, Ahmedabad, India
| | - Misha Antani
- Department of Pathology, B. J. Medical College, Ahmedabad, India
| | - Shruti A Mondkar
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India
| | - Neha Kajale
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India
| | - Vikas Ojha
- Department of Radiology, Jehangir Hospital, Pune, India
| | - Pranay Goel
- Department of Biology, Indian Institute of Science Education and Research, Pune, India
| | - Vaman Khadilkar
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India
- Jehangir Hospital, Pune, India
| | - Anuradha V Khadilkar
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India.
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India.
- Jehangir Hospital, Pune, India.
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Rassmann S, Keller A, Skaf K, Hustinx A, Gausche R, Ibarra-Arrelano MA, Hsieh TC, Madajieu YED, Nöthen MM, Pfäffle R, Attenberger UI, Born M, Mohnike K, Krawitz PM, Javanmardi B. Deeplasia: deep learning for bone age assessment validated on skeletal dysplasias. Pediatr Radiol 2024; 54:82-95. [PMID: 37953411 PMCID: PMC10776485 DOI: 10.1007/s00247-023-05789-1] [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: 03/22/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Skeletal dysplasias collectively affect a large number of patients worldwide. Most of these disorders cause growth anomalies. Hence, evaluating skeletal maturity via the determination of bone age (BA) is a useful tool. Moreover, consecutive BA measurements are crucial for monitoring the growth of patients with such disorders, especially for timing hormonal treatment or orthopedic interventions. However, manual BA assessment is time-consuming and suffers from high intra- and inter-rater variability. This is further exacerbated by genetic disorders causing severe skeletal malformations. While numerous approaches to automate BA assessment have been proposed, few are validated for BA assessment on children with skeletal dysplasias. OBJECTIVE We present Deeplasia, an open-source prior-free deep-learning approach designed for BA assessment specifically validated on patients with skeletal dysplasias. MATERIALS AND METHODS We trained multiple convolutional neural network models under various conditions and selected three to build a precise model ensemble. We utilized the public BA dataset from the Radiological Society of North America (RSNA) consisting of training, validation, and test subsets containing 12,611, 1,425, and 200 hand and wrist radiographs, respectively. For testing the performance of our model ensemble on dysplastic hands, we retrospectively collected 568 radiographs from 189 patients with molecularly confirmed diagnoses of seven different genetic bone disorders including achondroplasia and hypochondroplasia. A subset of the dysplastic cohort (149 images) was used to estimate the test-retest precision of our model ensemble on longitudinal data. RESULTS The mean absolute difference of Deeplasia for the RSNA test set (based on the average of six different reference ratings) and dysplastic set (based on the average of two different reference ratings) were 3.87 and 5.84 months, respectively. The test-retest precision of Deeplasia on longitudinal data (2.74 months) is estimated to be similar to a human expert. CONCLUSION We demonstrated that Deeplasia is competent in assessing the age and monitoring the development of both normal and dysplastic bones.
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Affiliation(s)
- Sebastian Rassmann
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Venusberg-Campus 1 Building 11, 2nd Floor, 53127, Bonn, Germany
| | | | - Kyra Skaf
- Medical Faculty, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Alexander Hustinx
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Venusberg-Campus 1 Building 11, 2nd Floor, 53127, Bonn, Germany
| | - Ruth Gausche
- CrescNet - Wachstumsnetzwerk, Medical Faculty, University Hospital Leipzig, Leipzig, Germany
| | - Miguel A Ibarra-Arrelano
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Venusberg-Campus 1 Building 11, 2nd Floor, 53127, Bonn, Germany
| | - Tzung-Chien Hsieh
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Venusberg-Campus 1 Building 11, 2nd Floor, 53127, Bonn, Germany
| | | | - Markus M Nöthen
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Roland Pfäffle
- Department for Pediatrics, University Hospital Leipzig, Leipzig, Germany
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Mark Born
- Division of Paediatric Radiology, Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Klaus Mohnike
- Medical Faculty, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Peter M Krawitz
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Venusberg-Campus 1 Building 11, 2nd Floor, 53127, Bonn, Germany
| | - Behnam Javanmardi
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Venusberg-Campus 1 Building 11, 2nd Floor, 53127, Bonn, Germany.
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Coreelman H, Hillewig E, Verstraete KL, de Haas MB, Thevissen PW, De Tobel J. Skeletal age estimation of living adolescents and young adults: A pilot study on conventional radiography versus magnetic resonance imaging and staging technique versus atlas method. Leg Med (Tokyo) 2023; 65:102313. [PMID: 37633179 DOI: 10.1016/j.legalmed.2023.102313] [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] [Received: 04/10/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE To compare conventional radiography (CR) and magnetic resonance imaging (MRI) of the left hand/wrist and both clavicles for forensic age estimation of adolescents and young adults. MATERIALS AND METHODS CR and MRI were prospectively conducted in 108 healthy Caucasian volunteers (52 males, 56 females) aged 16 to 21 years. Skeletal development was assessed by allocating stages (wrist, clavicles) and atlas standards (hand/wrist). Inter- and intra-observer agreements were quantified using linear weighted Cohen's kappa, and descriptive statistics regarding within-stage/standard age distributions were reported. RESULTS Inter- and intra-observer agreements for hand/wrist CR (staging technique: 0.840-0.871 and 0.877-0.897, respectively; atlas method: 0.636-0.947 and 0.853-0.987, respectively) and MRI (staging technique: 0.890-0.932 and 0.897-0.952, respectively; atlas method: 0.854-0.941 and 0.775-0.978, respectively) were rather similar. The CR atlas method was less reproducible than the staging technique. Inter- and intra-observer agreements for clavicle CR (0.590-0.643 and 0.656-0.770, respectively) were lower than those for MRI (0.844-0.852 and 0.866-0.931, respectively). Furthermore, although shifted, wrist CR and MRI within-stage age distribution spread were similar, as were those between staging techniques and atlas methods. The possibility to apply (profound) substages to clavicle MRI rendered a more gradual increase of age distributions with increasing stages, compared to CR. CONCLUSIONS For age estimation based on the left hand/wrist and both clavicles, reference data should be considered anatomical structure- and imaging modality-specific. Moreover, CR is adequate for hand/wrist evaluation and a wrist staging technique seems to be more useful than an atlas method. By contrast, MRI is of added value for clavicle evaluation.
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Affiliation(s)
- Heleen Coreelman
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Elke Hillewig
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Koenraad Luc Verstraete
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Michiel Bart de Haas
- Division of Special Services and Expertise - Forensic Anthropology, Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB The Hague, The Netherlands
| | - Patrick Werner Thevissen
- Department of Imaging and Pathology - Forensic Odontology, KU Leuven, Kapucijnenvoer 7 blok a bus 7001, 3000 Leuven, Belgium
| | - Jannick De Tobel
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Surgery - Oral and Maxillofacial Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
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Granild-Jensen JB, Møller-Madsen B, Rackauskaite G, Farholt S, Søndergaard C, Sørensen TH, Vestergaard ET, Langdahl BL. Zoledronate Increases Bone Mineral Density in Nonambulant Children With Cerebral Palsy: A Randomized Controlled Trial. J Clin Endocrinol Metab 2023; 108:2840-2851. [PMID: 37235798 DOI: 10.1210/clinem/dgad299] [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: 01/19/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023]
Abstract
CONTEXT Zoledronate appears to reduce fracture rates in children with cerebral palsy (CP), but no previous randomized, controlled trial has been performed to compare the effect of zoledronate to placebo in children with CP. OBJECTIVE To investigate the effect of zoledronate on bone mineral density (BMD) Z-scores in children with nonambulant CP in a randomized, controlled, double-blind trial. METHODS Nonambulant children with CP (5 to 16 years of age) were randomized 1:1 to receive 2 doses of zoledronate or placebo at a 6-month interval. BMD Z-score changes at the lumbar spine and the lateral distal femur (LDF) were calculated from dual-energy x-ray absorptiometry scans. Monitoring included weight, bone age, pubertal staging, knee-heel length, adverse events, biochemical markers, and questionnaires. RESULTS Twenty-four participants were randomized and all completed the study. Fourteen were assigned to zoledronate. The mean lumbar spine BMD Z-score increased 0.8 SD (95% CI: 0.4; 1.2) in the zoledronate group, which was significant when compared to 0.0 SD (95% CI: -0.3; 0.3) in the placebo group. Similarly, the LDF BMD Z-scores increased more in the zoledronate group. Severe acute phase symptoms affected 50% of the patients in the zoledronate group but were reported exclusively after the first dose. Growth parameters were similar in both groups. CONCLUSION Zoledronate for 12 months increased BMD Z-scores significantly without affecting growth, but first-dose side effects were common and considerable. Studies into lower first doses and long-term outcomes are needed.
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Affiliation(s)
- Jakob Bie Granild-Jensen
- Department of Child and Youth, Randers Regional Hospital, 8930 Randers, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Bjarne Møller-Madsen
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
- Department of Children's Orthopedics (www.dpor.dk), Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Gija Rackauskaite
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Stense Farholt
- Centre for Rare Diseases - Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Charlotte Søndergaard
- Department of Pediatrics and Adolescent Medicine, Gødstrup Regional Hospital, 7400 Herning, Denmark
| | - Tine Høg Sørensen
- Department of Pediatrics and Adolescent Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Esben Thyssen Vestergaard
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Bente Lomholt Langdahl
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
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Holzapfel L, Choukair D, Schenk JP, Bettendorf M. Longitudinal assessment of bone health index as a measure of bone health in short-statured children before and during treatment with recombinant growth hormone. J Pediatr Endocrinol Metab 2023; 36:824-831. [PMID: 37531076 DOI: 10.1515/jpem-2023-0084] [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: 02/27/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES The aim of our study was the longitudinal assessment of bone health index (BHI) in short-statured children during growth hormone (GH) treatment to estimate changes in their bone health. METHODS 256 short-statured children (isolated GH deficiency (IGHD) n=121, multiple pituitary hormone deficiency (MPHD) n=49, intrauterine growth retardation (small for gestational age (SGA)) n=52, SHOX (short stature homeobox gene) deficiency n=9, Ullrich Turner syndrome (UTS) n=25) who started with GH between 2010 and 2018 were included. Annual bone ages (Greulich and Pyle, GP) and BHI were, retrospectively, analysed in consecutive radiographs of the left hand (BoneXpert software) from GH therapy start (T0) up to 10 years (T10) thereafter, with T max indicating the individual time point of the last available radiograph. The results are presented as the median (25 %/75 % interquartile ranges, IQR) and statistical analyses were performed using non-parametric tests as appropriate. RESULTS The BHI standard deviation scores (SDS) were reduced (-0.97, -1.8/-0.3) as bone ages were retarded (-1.6 years, -2.31/-0.97) in all patients before start of GH and were significantly lower in patients with growth hormone deficiency (GHD) (-1.04, -1.85/-0.56; n=170) compared to non-GHD patients (-0.79, -1.56/-0.01; n=86; p=0.022). BHI SDS increased to -0.17 (-1/0.58) after 1 year of GH (T1, 0.5-1.49, p<0.001) and to -0.20 (-1/-0.50, p<0.001) after 5.3 years (T max, 3.45/7.25). CONCLUSIONS BHI SDS are reduced in treatment-naive short-statured children regardless of their GH status, increase initially with GH treatment while plateauing thereafter, suggesting sustained improved bone health.
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Affiliation(s)
- Lukas Holzapfel
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniela Choukair
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Jens-Peter Schenk
- Division of Paediatric Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Bettendorf
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
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den Hollander B, Brands MM, de Boer L, Haaxma CA, Lengyel A, van Essen P, Peters G, Kwast HJT, Klein WM, Coene KLM, Lefeber DJ, van Karnebeek CDM. Oral sialic acid supplementation in NANS-CDG: Results of a single center, open-label, observational pilot study. J Inherit Metab Dis 2023; 46:956-971. [PMID: 37340906 DOI: 10.1002/jimd.12643] [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: 05/03/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/22/2023]
Abstract
NANS-CDG is a congenital disorder of glycosylation (CDG) caused by biallelic variants in NANS, encoding an essential enzyme in de novo sialic acid synthesis. It presents with intellectual developmental disorder (IDD), skeletal dysplasia, neurologic impairment, and gastrointestinal dysfunction. Some patients suffer progressive intellectual neurologic deterioration (PIND), emphasizing the need for a therapy. In a previous study, sialic acid supplementation in knockout nansa zebrafish partially rescued skeletal abnormalities. Here, we performed the first in-human pre- and postnatal sialic-acid study in NANS-CDG. In this open-label observational study, 5 patients with NANS-CDG (range 0-28 years) were treated with oral sialic acid for 15 months. The primary outcome was safety. Secondary outcomes were psychomotor/cognitive testing, height and weight, seizure control, bone health, gastrointestinal symptoms, and biochemical and hematological parameters. Sialic acid was well tolerated. In postnatally treated patients, there was no significant improvement. For the prenatally treated patient, psychomotor and neurologic development was better than two other genotypically identical patients (one treated postnatally, one untreated). The effect of sialic acid treatment may depend on the timing, with prenatal treatment potentially benefiting neurodevelopmental outcomes. Evidence is limited, however, and longer-term follow-up in a larger number of prenatally treated patients is required.
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Affiliation(s)
- Bibiche den Hollander
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- United for Metabolic Diseases, Amsterdam, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam Reproduction and Development, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marion M Brands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- United for Metabolic Diseases, Amsterdam, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam Reproduction and Development, Amsterdam UMC, Amsterdam, The Netherlands
| | - Lonneke de Boer
- United for Metabolic Diseases, Amsterdam, The Netherlands
- Radboud University Medical Center, Department of Pediatric Neurology, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Charlotte A Haaxma
- Radboud University Medical Center, Department of Pediatric Neurology, Amalia Children's Hospital, Nijmegen, The Netherlands
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Anna Lengyel
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Peter van Essen
- Radboud University Medical Center, Department of Pediatric Neurology, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Gera Peters
- Department of Rehabilitation Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke J T Kwast
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willemijn M Klein
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karlien L M Coene
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Dirk J Lefeber
- United for Metabolic Diseases, Amsterdam, The Netherlands
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Clara D M van Karnebeek
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- United for Metabolic Diseases, Amsterdam, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam Reproduction and Development, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Human Genetics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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18
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Debs P, Fayad LM. The promise and limitations of artificial intelligence in musculoskeletal imaging. FRONTIERS IN RADIOLOGY 2023; 3:1242902. [PMID: 37609456 PMCID: PMC10440743 DOI: 10.3389/fradi.2023.1242902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023]
Abstract
With the recent developments in deep learning and the rapid growth of convolutional neural networks, artificial intelligence has shown promise as a tool that can transform several aspects of the musculoskeletal imaging cycle. Its applications can involve both interpretive and non-interpretive tasks such as the ordering of imaging, scheduling, protocoling, image acquisition, report generation and communication of findings. However, artificial intelligence tools still face a number of challenges that can hinder effective implementation into clinical practice. The purpose of this review is to explore both the successes and limitations of artificial intelligence applications throughout the muscuskeletal imaging cycle and to highlight how these applications can help enhance the service radiologists deliver to their patients, resulting in increased efficiency as well as improved patient and provider satisfaction.
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Affiliation(s)
- Patrick Debs
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Laura M. Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, MD, United States
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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19
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Fava D, Pepino C, Tosto V, Gastaldi R, Pepe A, Paoloni D, Strati MF, Angelelli A, Calandrino A, Tedesco C, Camia T, Allegri AEM, Patti G, Casalini E, Bassi M, Calevo MG, Napoli F, Maghnie M. Precocious Puberty Diagnoses Spike, COVID-19 Pandemic, and Body Mass Index: Findings From a 4-year Study. J Endocr Soc 2023; 7:bvad094. [PMID: 37873499 PMCID: PMC10590639 DOI: 10.1210/jendso/bvad094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Indexed: 10/25/2023] Open
Abstract
Context Since the COVID-19 outbreak, the number of girls with suspected precocious puberty has increased. Objective To compare the incidence of idiopathic central precocious puberty (ICPP) during COVID-19 with that of the previous 4 years. Methods Anthropometric, biochemical, and radiological parameters were collected between January 2016 and June 2021 from 133 girls who met the Rapidly Progressive ICPP criteria (RP-ICPP). Results We found a higher incidence of RP-ICPP between March 2020 and June 2021 (group 2) compared with January 2016 through March 2020 (group 1) (53.5% vs 41.1%); 2021 showed the highest annual incidence (P < .05). Group 1 and group 2 differed in age at diagnosis (7.96 ± 0.71 vs 7.61 ± 0.94; P < .05), mean Tanner stage (2.86 ± 0.51 vs 2.64 ± 0; P < .05), and in the time between the appearance of thelarche and diagnosis (0.93 ± 0.75 vs 0.71 ± 0.62 years, P < .05). There was an increase in the number of girls aged <8 years in group 2 and a significantly higher number of girls aged >8 years was found in group 1 (42 in group 1 vs 20 in group 2, P < 0.05). Overall body mass index SD score showed higher values in group 2 (1.01 ± 1.23 vs 0.69 ± 1.15; P = .18), which spent an average of 1.94 ± 1.81 hours per day using electronic devices; 88.5% of this group stopped any physical activity. Conclusions A spike in new diagnoses of idiopathic (1.79-fold higher) and RP-CPP coincided with the COVID-19 pandemic. The incidence of RP-ICPP was 1.3-fold higher during COVID-19 with a trend toward an increase in body mass index SD score. The expanding use of digital devices and the reduction of daily physical activity represent possible risk factors.
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Affiliation(s)
- Daniela Fava
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Carlotta Pepino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Valentina Tosto
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Medicine and Surgery, University of Perugia, 06100 Perugia, Italy
| | - Roberto Gastaldi
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessia Pepe
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Dalila Paoloni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Marina Francesca Strati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Alessia Angelelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Andrea Calandrino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Caterina Tedesco
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Tiziana Camia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Anna Elsa Maria Allegri
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Giuseppa Patti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Emilio Casalini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Maria Grazia Calevo
- Scientific Direction, Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Flavia Napoli
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
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Breen AB, Steen H, Pripp A, Hvid I, Horn J. Comparison of Different Bone Age Methods and Chronological Age in Prediction of Remaining Growth Around the Knee. J Pediatr Orthop 2023; 43:386-391. [PMID: 36941111 DOI: 10.1097/bpo.0000000000002397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Bone age (BA) has been shown to be superior to chronological age (CA) when predicting remaining growth. However, it is not known whether the calculations are more accurate when BA is assessed by the Greulich and Pyle (GP) or the Sauvegrain (SG) methods. The aim of our study was to identify the method which gives an estimate closest to actual growth in the lower extremities. METHODS Leg length radiographs, hand radiographs, and elbow radiographs were simultaneously obtained during the adolescent growth spurt (10 to 16 years) in 52 children treated for LLD, with radiographic follow-up of segmental length (femur, tibia, and foot) until skeletal maturity, were randomly selected from a local institutional register. BA, according to GP and SG, were manually rated, and BA based on the GP method was additionally assessed by the automated BoneXpert (BX) method. The remaining growth was calculated based on the White-Menelaus method for both BA methods (GP, SG), the combination of the 2 methods, GP by BX, CA, and the combination of CA and GP by BX. Estimated growth was compared with the actual growth in the distal femur and proximal tibia from the time of BA determination until skeletal maturity. RESULTS For all included methods, the average calculated remaining growth was higher compared with the actual growth. The mean absolute difference between calculated remaining growth and actual growth in the femur and tibia was lowest using GP by BX [0.66 cm (SD 0.51 cm) and 0.43 cm (SD 0.34 cm)] and highest using CA [1.02 (SD 0.72) and 0.67 (SD 0.46)]. It was a significant association between calculated growth and the difference between actual and calculated growth for the SG method ( P =<0.001). CONCLUSION During the adolescent growth spurt, the GP method compared with the SG method and CA gives the most accurate estimate of remaining growth around the knee according to our results. CLINICAL RELEVANCE In calculations of remaining growth around the knee, BA assessment by the GP atlas or BX method should be used as the parameter of biological maturity.
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Affiliation(s)
- Anne Berg Breen
- Division of Orthopedic Surgery, Oslo University Hospital
- Institute of Clinical Medicine
| | - Harald Steen
- Division of Orthopedic Surgery, Oslo University Hospital
| | - Are Pripp
- Oslo Centre of Biostatistics and Epidemiology, University of Oslo, Norway
| | - Ivan Hvid
- Division of Orthopedic Surgery, Oslo University Hospital
| | - Joachim Horn
- Division of Orthopedic Surgery, Oslo University Hospital
- Institute of Clinical Medicine
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21
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Klein KO, Mauras N, Nayak S, Sunil B, Martinez-Placencia BM, Dragnic S, Ballina M, Zhou Q, Kansra AR. Efficacy and Safety of Leuprolide Acetate 6-Month Depot for the Treatment of Central Precocious Puberty: A Phase 3 Study. J Endocr Soc 2023; 7:bvad071. [PMID: 37334213 PMCID: PMC10274571 DOI: 10.1210/jendso/bvad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Indexed: 06/20/2023] Open
Abstract
Context Treatment options for central precocious puberty (CPP) are important for individualization of therapy. Objective We evaluated the efficacy and safety of 6-month 45-mg leuprolide acetate (LA) depot with intramuscular administration. Methods LA depot was administered at weeks 0 and 24 to treatment-naïve (n = 27) or previously treated (n = 18) children with CPP in a phase 3, multicenter, single-arm, open-label study (NCT03695237). Week 24 peak-stimulated luteinizing hormone (LH) suppression (<4 mIU/mL) was the primary outcome. Secondary/other outcomes included basal sex hormone suppression (girls, estradiol <20 pg/mL; boys, testosterone <30 ng/dL), suppression of physical signs, height velocity, bone age, patient/parent-reported outcomes, and adverse events. Results All patients (age, 7.8 ± 1.27 years) received both scheduled study doses. At 24 weeks, 39/45 patients (86.7%) had LH suppressed. Six were counted as unsuppressed; 2 because of missing data, 3 with LH of 4.35-5.30 mIU/mL and 1 with LH of 21.07 mIU/mL. Through 48 weeks, LH, estradiol, and testosterone suppression was achieved in ≥86.7%, ≥97.4%, and 100%, respectively (as early as week 4 for LH and estradiol and week 12 for testosterone). Physical signs were suppressed at week 48 (girls, 90.2%; boys, 75.0%). Mean height velocity ranged 5.0 to 5.3 cm/year post-baseline in previously treated patients and declined from 10.1 to 6.5 cm/year at week 20 in treatment-naïve patients. Mean bone age advanced slower than chronological age. Patient/parent-reported outcomes remained stable. No new safety signals were identified. No adverse event led to treatment discontinuation. Conclusion Six-month intramuscular LA depot demonstrated 48-week efficacy with a safety profile consistent with other GnRH agonist formulations.
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Affiliation(s)
- Karen O Klein
- University of California, San Diego, and Rady Children's Hospital San Diego, San Diego, CA 92121, USA
| | - Nelly Mauras
- Nemours Children's Health, Jacksonville, FL 32207, USA
| | - Sunil Nayak
- Pediatric Endocrine Associates, Greenwood Village, CO 80111, USA
| | - Bhuvana Sunil
- Mary Bridge Children's Hospital, Tacoma, WA 98403, USA
| | | | | | | | - Qing Zhou
- AbbVie, Inc., North Chicago, IL 60064, USA
| | - Alvina R Kansra
- Correspondence: Alvina R. Kansra, MD, Associate Medical Director, TAMD, Therapeutic Area, AbbVie, Inc., 1 North Waukegan Road, Bldg. AP31, North Chicago, IL 60064, USA.
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22
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Zhang D, Liu B, Huang Y, Yan Y, Li S, He J, Zhang S, Zhang J, Xia N. An Automated TW3-RUS Bone Age Assessment Method with Ordinal Regression-Based Determination of Skeletal Maturity. J Digit Imaging 2023; 36:1001-1015. [PMID: 36813977 PMCID: PMC10287613 DOI: 10.1007/s10278-023-00794-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
The assessment of bone age is important for evaluating child development, optimizing the treatment for endocrine diseases, etc. And the well-known Tanner-Whitehouse (TW) clinical method improves the quantitative description of skeletal development based on setting up a series of distinguishable stages for each bone individually. However, the assessment is affected by rater variability, which makes the assessment result not reliable enough in clinical practice. The main goal of this work is to achieve a reliable and accurate skeletal maturity determination by proposing an automated bone age assessment method called PEARLS, which is based on the TW3-RUS system (analysis of the radius, ulna, phalanges, and metacarpal bones). The proposed method comprises the point estimation of anchor (PEA) module for accurately localizing specific bones, the ranking learning (RL) module for producing a continuous stage representation of each bone by encoding the ordinal relationship between stage labels into the learning process, and the scoring (S) module for outputting the bone age directly based on two standard transform curves. The development of each module in PEARLS is based on different datasets. Finally, corresponding results are presented to evaluate the system performance in localizing specific bones, determining the skeletal maturity stage, and assessing the bone age. The mean average precision of point estimation is 86.29%, the average stage determination precision is 97.33% overall bones, and the average bone age assessment accuracy is 96.8% within 1 year for the female and male cohorts.
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Affiliation(s)
- Dongxu Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361000, China.
| | - Bowen Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361000, China
| | - Yulin Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361000, China
| | - Yang Yan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361000, China
| | - Shaowei Li
- Department of Pediatrics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, 363000, China
| | - Jinshui He
- Department of Pediatrics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, 363000, China
| | - Shuyun Zhang
- Department of Pediatrics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, 363000, China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361000, China
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361000, China
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23
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Mao X, Hui Q, Zhu S, Du W, Qiu C, Ouyang X, Kong D. Automated Skeletal Bone Age Assessment with Two-Stage Convolutional Transformer Network Based on X-ray Images. Diagnostics (Basel) 2023; 13:diagnostics13111837. [PMID: 37296689 DOI: 10.3390/diagnostics13111837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
Human skeletal development is continuous and staged, and different stages have various morphological characteristics. Therefore, bone age assessment (BAA) can accurately reflect the individual's growth and development level and maturity. Clinical BAA is time consuming, highly subjective, and lacks consistency. Deep learning has made considerable progress in BAA in recent years by effectively extracting deep features. Most studies use neural networks to extract global information from input images. However, clinical radiologists are highly concerned about the ossification degree in some specific regions of the hand bones. This paper proposes a two-stage convolutional transformer network to improve the accuracy of BAA. Combined with object detection and transformer, the first stage mimics the bone age reading process of the pediatrician, extracts the hand bone region of interest (ROI) in real time using YOLOv5, and proposes hand bone posture alignment. In addition, the previous information encoding of biological sex is integrated into the feature map to replace the position token in the transformer. The second stage extracts features within the ROI by window attention, interacts between different ROIs by shifting the window attention to extract hidden feature information, and penalizes the evaluation results using a hybrid loss function to ensure its stability and accuracy. The proposed method is evaluated on the data from the Pediatric Bone Age Challenge organized by the Radiological Society of North America (RSNA). The experimental results show that the proposed method achieves a mean absolute error (MAE) of 6.22 and 4.585 months on the validation and testing sets, respectively, and the cumulative accuracy within 6 and 12 months reach 71% and 96%, respectively, which is comparable to the state of the art, markedly reducing the clinical workload and realizing rapid, automatic, and high-precision assessment.
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Affiliation(s)
- Xiongwei Mao
- Department of Radiology, Zhejiang University Hospital, Zhejiang University, Hangzhou 310027, China
- Department of Radiology, Zhejiang University Hospital District, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Qinglei Hui
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310027, China
| | - Siyu Zhu
- Zhejiang Qiushi Institute for Mathematical Medicine, Hangzhou 311121, China
| | - Wending Du
- Zhejiang Qiushi Institute for Mathematical Medicine, Hangzhou 311121, China
| | - Chenhui Qiu
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310027, China
| | - Xiaoping Ouyang
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Dexing Kong
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310027, China
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24
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He B, Xu Z, Zhou D, Chen Y. Multi-Branch Attention Learning for Bone Age Assessment with Ambiguous Label. SENSORS (BASEL, SWITZERLAND) 2023; 23:4834. [PMID: 37430748 DOI: 10.3390/s23104834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 07/12/2023]
Abstract
Bone age assessment (BAA) is a typical clinical technique for diagnosing endocrine and metabolic diseases in children's development. Existing deep learning-based automatic BAA models are trained on the Radiological Society of North America dataset (RSNA) from Western populations. However, due to the difference in developmental process and BAA standards between Eastern and Western children, these models cannot be applied to bone age prediction in Eastern populations. To address this issue, this paper collects a bone age dataset based on the East Asian populations for model training. Nevertheless, it is laborious and difficult to obtain enough X-ray images with accurate labels. In this paper, we employ ambiguous labels from radiology reports and transform them into Gaussian distribution labels of different amplitudes. Furthermore, we propose multi-branch attention learning with ambiguous labels network (MAAL-Net). MAAL-Net consists of a hand object location module and an attention part extraction module to discover the informative regions of interest (ROIs) based only on image-level labels. Extensive experiments on both the RSNA dataset and the China Bone Age (CNBA) dataset demonstrate that our method achieves competitive results with the state-of-the-arts, and performs on par with experienced physicians in children's BAA tasks.
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Affiliation(s)
- Bishi He
- School of Automation (School of Artificial Intelligence), Hangzhou Dianzi University, Hangzhou 310018, China
| | - Zhe Xu
- School of Automation (School of Artificial Intelligence), Hangzhou Dianzi University, Hangzhou 310018, China
| | - Dong Zhou
- School of Automation (School of Artificial Intelligence), Hangzhou Dianzi University, Hangzhou 310018, China
| | - Yuanjiao Chen
- School of Automation (School of Artificial Intelligence), Hangzhou Dianzi University, Hangzhou 310018, China
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25
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Nguyen T, Hermann AL, Ventre J, Ducarouge A, Pourchot A, Marty V, Regnard NE, Guermazi A. High performance for bone age estimation with an artificial intelligence solution. Diagn Interv Imaging 2023:S2211-5684(23)00075-X. [PMID: 37095034 DOI: 10.1016/j.diii.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The purpose of this study was to compare the performance of an artificial intelligence (AI) solution to that of a senior general radiologist for bone age assessment. MATERIAL AND METHODS Anteroposterior hand radiographs of eight boys and eight girls from each age interval between five and 17 year-old from four different radiology departments were retrospectively collected. Two board-certified pediatric radiologists with knowledge of the sex and chronological age of the patients independently estimated the Greulich and Pyle bone age to determine the standard of reference. A senior general radiologist not specialized in pediatric radiology (further referred to as "the reader") then determined the bone age with knowledge of the sex and chronological age. The results of the reader were then compared to those of the AI solution using mean absolute error (MAE) in age estimation. RESULTS The study dataset included a total of 206 patients (102 boys of mean chronological age of 10.9 ± 3.7 [SD] years, 104 girls of mean chronological age of 11 ± 3.7 [SD] years). For both sexes, the AI algorithm showed a significantly lower MAE than the reader (P < 0.007). In boys, the MAE was 0.488 years (95% confidence interval [CI]: 0.28-0.44; r2 = 0.978) for the AI algorithm and 0.771 years (95% CI: 0.64-0.90; r2 = 0.94) for the reader. In girls, the MAE was 0.494 years (95% CI: 0.41-0.56; r2 = 0.973) for the AI algorithm and 0.673 years (95% CI: 0.54-0.81; r2 = 0.934) for the reader. CONCLUSION The AI solution better estimates the Greulich and Pyle bone age than a general radiologist does.
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Affiliation(s)
- Toan Nguyen
- Department of Pediatric Radiology, Hôpital Armand Trousseau AP-HP, 75012 Paris, France; Gleamer, 75010 Paris, France.
| | - Anne-Laure Hermann
- Department of Pediatric Radiology, Hôpital Armand Trousseau AP-HP, 75012 Paris, France
| | | | | | | | | | - Nor-Eddine Regnard
- Gleamer, 75010 Paris, France; Réseau Imagerie Sud Francilien, 77127 Lieusaint, France
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, VA Boston Healthcare System, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132, United States of America
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Obuchowicz R, Nurzynska K, Pierzchala M, Piorkowski A, Strzelecki M. Texture Analysis for the Bone Age Assessment from MRI Images of Adolescent Wrists in Boys. J Clin Med 2023; 12:jcm12082762. [PMID: 37109098 PMCID: PMC10141677 DOI: 10.3390/jcm12082762] [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: 03/12/2023] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Currently, bone age is assessed by X-rays. It enables the evaluation of the child's development and is an important diagnostic factor. However, it is not sufficient to diagnose a specific disease because the diagnoses and prognoses may arise depending on how much the given case differs from the norms of bone age. BACKGROUND The use of magnetic resonance images (MRI) to assess the age of the patient would extend diagnostic possibilities. The bone age test could then become a routine screening test. Changing the method of determining the bone age would also prevent the patient from taking a dose of ionizing radiation, making the test less invasive. METHODS The regions of interest containing the wrist area and the epiphyses of the radius are marked on the magnetic resonance imaging of the non-dominant hand of boys aged 9 to 17 years. Textural features are computed for these regions, as it is assumed that the texture of the wrist image contains information about bone age. RESULTS The regression analysis revealed that there is a high correlation between the bone age of a patient and the MRI-derived textural features derived from MRI. For DICOM T1-weighted data, the best scores reached 0.94 R2, 0.46 RMSE, 0.21 MSE, and 0.33 MAE. CONCLUSIONS The experiments performed have shown that using the MRI images gives reliable results in the assessment of bone age while not exposing the patient to ionizing radiation.
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Affiliation(s)
- Rafal Obuchowicz
- Department of Diagnostic Imaging, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Karolina Nurzynska
- Department of Algorithmics and Software, Silesian University of Technology, 44-100 Gliwice, Poland
| | | | - Adam Piorkowski
- Department of Biocybernetics and Biomedical Engineering, AGH University of Science and Technology, 30-059 Krakow, Poland
| | - Michal Strzelecki
- Institute of Electronics, Lodz University of Technology, 93-590 Lodz, Poland
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Li Z, Chen W, Ju Y, Chen Y, Hou Z, Li X, Jiang Y. Bone age assessment based on deep neural networks with annotation-free cascaded critical bone region extraction. Front Artif Intell 2023; 6:1142895. [PMID: 36937708 PMCID: PMC10017763 DOI: 10.3389/frai.2023.1142895] [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: 01/12/2023] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Bone age assessment (BAA) from hand radiographs is crucial for diagnosing endocrinology disorders in adolescents and supplying therapeutic investigation. In practice, due to the conventional clinical assessment being a subjective estimation, the accuracy of BAA relies highly on the pediatrician's professionalism and experience. Recently, many deep learning methods have been proposed for the automatic estimation of bone age and had good results. However, these methods do not exploit sufficient discriminative information or require additional manual annotations of critical bone regions that are important biological identifiers in skeletal maturity, which may restrict the clinical application of these approaches. In this research, we propose a novel two-stage deep learning method for BAA without any manual region annotation, which consists of a cascaded critical bone region extraction network and a gender-assisted bone age estimation network. First, the cascaded critical bone region extraction network automatically and sequentially locates two discriminative bone regions via the visual heat maps. Second, in order to obtain an accurate BAA, the extracted critical bone regions are fed into the gender-assisted bone age estimation network. The results showed that the proposed method achieved a mean absolute error (MAE) of 5.45 months on the public dataset Radiological Society of North America (RSNA) and 3.34 months on our private dataset.
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Affiliation(s)
- Zhangyong Li
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Wang Chen
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Yang Ju
- Department of Mechanical Science and Engineering, Graduate School of Engineering, Nagoya University, Nagoya, Japan
| | - Yong Chen
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Zhengjun Hou
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Xinwei Li
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Yuhao Jiang
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
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Galante N, Cotroneo R, Furci D, Lodetti G, Casali MB. Applications of artificial intelligence in forensic sciences: Current potential benefits, limitations and perspectives. Int J Legal Med 2023; 137:445-458. [PMID: 36507961 DOI: 10.1007/s00414-022-02928-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
In recent years, new studies based on artificial intelligence (AI) have been conducted in the forensic field, posing new challenges and demonstrating the advantages and disadvantages of using AI methodologies to solve forensic well-known problems. Specifically, AI technology has tried to overcome the human subjective bias limitations of the traditional approach of the forensic sciences, which include sex prediction and age estimation from morphometric measurements in forensic anthropology or evaluating the third molar stage of development in forensic odontology. Likewise, AI has been studied as an assisting tool in forensic pathology for a quick and easy identification of the taxonomy of diatoms. The present systematic review follows the PRISMA 2020 statements and aims to explore an emerging topic that has been poorly analyzed in the forensic literature. Benefits, limitations, and forensic implications concerning AI are therefore highlighted, by providing an extensive critical review of its current applications on forensic sciences as well as its future directions. Results are divided into 5 subsections which included forensic anthropology, forensic odontology, forensic pathology, forensic genetics, and other forensic branches. The discussion offers a useful instrument to investigate the potential benefits of AI in the forensic fields as well as to point out the existing open questions and issues concerning its application on real-life scenarios. Procedural notes and technical aspects are also provided to the readers.
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Affiliation(s)
- Nicola Galante
- Healthcare Accountability Lab, Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy.
- Department of Biomedical Sciences for Health, Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy.
| | - Rosy Cotroneo
- Healthcare Accountability Lab, Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
- Department of Biomedical Sciences for Health, Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - Domenico Furci
- Healthcare Accountability Lab, Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
- Department of Biomedical Sciences for Health, Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - Giorgia Lodetti
- Healthcare Accountability Lab, Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
- Department of Biomedical Sciences for Health, Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - Michelangelo Bruno Casali
- Healthcare Accountability Lab, Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
- Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
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Liu ZQ, Hu ZJ, Wu TQ, Ye GX, Tang YL, Zeng ZH, Ouyang ZM, Li YZ. Bone age recognition based on mask R-CNN using xception regression model. Front Physiol 2023; 14:1062034. [PMID: 36866173 PMCID: PMC9971911 DOI: 10.3389/fphys.2023.1062034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Background and Objective: Bone age detection plays an important role in medical care, sports, judicial expertise and other fields. Traditional bone age identification and detection is according to manual interpretation of X-ray images of hand bone by doctors. This method is subjective and requires experience, and has certain errors. Computer-aided detection can effectually enhance the validity of medical diagnosis, especially with the fast development of machine learning and neural network, the method of bone age recognition using machine learning has gradually become the focus of research, which has the advantages of simple data pretreatment, good robustness and high recognition accuracy. Methods: In this paper, the hand bone segmentation network based on Mask R-CNN was proposed to segment the hand bone area, and the segmented hand bone region was directly input into the regression network for bone age evaluation. The regression network is using an enhancd network Xception of InceptionV3. After the output of Xception, the convolutional block attention module is connected to refine the feature mapping from channel and space to obtain more effective features. Results: According to the experimental results, the hand bone segmentation network model based on Mask R-CNN can segment the hand bone region and eliminate the interference of redundant background information. The average Dice coefficient on the verification set is 0.976. The mean absolute error of predicting bone age on our data set was only 4.97 months, which exceeded the accuracy of most other bone age assessment methods. Conclusion: Experiments show that the accuracy of bone age assessment can be enhancd by using the Mask R-CNN-based hand bone segmentation network and the Xception bone age regression network to form a model, which can be well applied to actual clinical bone age assessment.
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Affiliation(s)
- Zhi-Qiang Liu
- Department of Radiology, Guangzhou Twelfth People’s Hospital, Guangzhou, China
| | - Zi-Jian Hu
- Department of Radiology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tian-Qiong Wu
- Department of Radiology, Guangzhou Twelfth People’s Hospital, Guangzhou, China
| | - Geng-Xin Ye
- Department of Radiology, Guangzhou Twelfth People’s Hospital, Guangzhou, China
| | - Yu-Liang Tang
- Department of Radiology, Guangzhou Twelfth People’s Hospital, Guangzhou, China
| | - Zi-Hua Zeng
- Department of Radiology, Guangzhou Twelfth People’s Hospital, Guangzhou, China
| | - Zhong-Min Ouyang
- Department of Radiology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,*Correspondence: Yuan-Zhe Li, ; Zhong-Min Ouyang,
| | - Yuan-Zhe Li
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China,*Correspondence: Yuan-Zhe Li, ; Zhong-Min Ouyang,
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Maratova K, Zemkova D, Sedlak P, Pavlikova M, Amaratunga SA, Krasnicanova H, Soucek O, Sumnik Z. A comprehensive validation study of the latest version of BoneXpert on a large cohort of Caucasian children and adolescents. Front Endocrinol (Lausanne) 2023; 14:1130580. [PMID: 37033216 PMCID: PMC10079872 DOI: 10.3389/fendo.2023.1130580] [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: 12/23/2022] [Accepted: 02/16/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION Automated bone age assessment has recently become increasingly popular. The aim of this study was to assess the agreement between automated and manual evaluation of bone age using the method according to Tanner-Whitehouse (TW3) and Greulich-Pyle (GP). METHODS We evaluated 1285 bone age scans from 1202 children (657 scans from 612 boys) by using both manual and automated (TW3 as well as GP) bone age assessment. BoneXpert software versions 2.4.5.1. (BX2) and 3.2.1. (BX3) (Visiana, Holte, Denmark) were compared with manual evaluation using root mean squared error (RMSE) analysis. RESULTS RMSE for BX2 was 0.57 and 0.55 years in boys and 0.72 and 0.59 years in girls, respectively for TW3 and GP. For BX3, RMSE was 0.51 and 0.68 years in boys and 0.49 and 0.52 years in girls, respectively for TW3 and GP. Sex- and age-specific analysis for BX2 identified the largest differences between manual and automated TW3 evaluation in girls between 6-7, 12-13, 13-14 and 14-15 years, with RMSE 0.88, 0.81, 0.92 and 0.84 years, respectively. The BX3 version showed better agreement with manual TW3 evaluation (RMSE 0.64, 0.45, 0.46 and 0.57). CONCLUSION The latest version of the BoneXpert software provides improved and clinically sufficient agreement with manual bone age evaluation in children of both sexes compared to the previous version and may be used for routine bone age evaluation in non-selected cases in pediatric endocrinology care.
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Affiliation(s)
- Klara Maratova
- Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Dana Zemkova
- Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Petr Sedlak
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Prague, Czechia
| | - Marketa Pavlikova
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physic, Charles University, Prague, Czechia
| | - Shenali Anne Amaratunga
- Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Hana Krasnicanova
- Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Ondrej Soucek
- Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Zdenek Sumnik
- Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
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Yang Z, Cong C, Pagnucco M, Song Y. Multi-scale multi-reception attention network for bone age assessment in X-ray images. Neural Netw 2023; 158:249-257. [PMID: 36473292 DOI: 10.1016/j.neunet.2022.11.002] [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: 02/13/2022] [Revised: 10/18/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
Bone age assessment plays a significant role in estimating bone maturity. However, radiograph/X-ray images of hand bones contain a large amount of redundant information. Some detection or segmentation based methods have recently been proposed to solve this issue. These network structures are often of high complexity and might require extra annotations, which make them less applicable in practice. In this paper, we present a Multi-scale Multi-reception Attention Net (MMANet), which combines a novel Multi-scale Multi-reception Complement Attention (MMCA) network and a graph attention module with a ResNet backbone to enhance the feature representation of key regions and suppress the influence of background regions to achieve significant performance improvement. Experimental results show our MMANet is able to accurately detect key regions and achieves 3.88 mean absolute error (MAE) on the RSNA 2017 Paediatric Bone Age Challenge dataset. Our method, without explicit modelling of anatomical information, outperforms the current state-of-the-art method (MAE=3.91) by 0.03 (months) which requires extra annotations. Code is available at https://github.com/yzc1122333/BoneAgeAss.
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Affiliation(s)
- Zhichao Yang
- School of Computer Science and Engineering, University of New South Wales, Australia
| | - Cong Cong
- School of Computer Science and Engineering, University of New South Wales, Australia.
| | - Maurice Pagnucco
- School of Computer Science and Engineering, University of New South Wales, Australia
| | - Yang Song
- School of Computer Science and Engineering, University of New South Wales, Australia
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Neuroimaging in 205 consecutive Children Diagnosed with Central Precocious Puberty in Denmark. Pediatr Res 2023; 93:125-130. [PMID: 35365758 DOI: 10.1038/s41390-022-02047-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/01/2022] [Accepted: 03/13/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION A brain magnetic resonance image (MRI) is considered part of routine evaluation in children diagnosed with central precocious puberty (CPP) to rule out intracranial pathology. We evaluated the occurrence of pathological findings on neuroimaging among children diagnosed with CPP. METHODS A retrospective study based on an evaluation of 1544 children referred with early signs of puberty from 2009-2019. Of these, 205 children (29 boys) with confirmed CPP had a brain MRI performed, and we report MRI results, pubertal stage, bone age, and hormonal analyses. All abnormal MRI results were re-evaluated by a trained neuroradiologist. RESULTS A new intracranial pathology was found by brain MRI in 6 out of 205 patients aged 1.5 to 6.1 years. The occurrence of intracranial pathology was 3/162 (1.8%) and 3/24 (12.5 %) in girls and boys respectively. CONCLUSION Organic causes of precocious puberty are more frequent in boys with CPP than in girls. No cases of organic CPP were seen above age 6.1 years of age. The age cut off value for routine brain MRI could be lowered to seven or perhaps even six years of age for girls, except in rapidly progressing puberty or presence of neurological symptoms. IMPACT In our study of children with central precocious puberty (CPP), intracranial pathology is a rare cause and occurs only in younger children. It supports the general trend, that younger children are at higher risk of having organic causes to CPP and supports the clinical practice, that only high-risk patients with CPP should undergo routine brain MRI.
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Wang C, Wu Y, Wang C, Zhou X, Niu Y, Zhu Y, Gao X, Wang C, Yu Y. Attention-based multiple-instance learning for Pediatric bone age assessment with efficient and interpretable. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ieki H, Ito K, Saji M, Kawakami R, Nagatomo Y, Takada K, Kariyasu T, Machida H, Koyama S, Yoshida H, Kurosawa R, Matsunaga H, Miyazawa K, Ozaki K, Onouchi Y, Katsushika S, Matsuoka R, Shinohara H, Yamaguchi T, Kodera S, Higashikuni Y, Fujiu K, Akazawa H, Iguchi N, Isobe M, Yoshikawa T, Komuro I. Deep learning-based age estimation from chest X-rays indicates cardiovascular prognosis. COMMUNICATIONS MEDICINE 2022; 2:159. [PMID: 36494479 PMCID: PMC9734197 DOI: 10.1038/s43856-022-00220-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In recent years, there has been considerable research on the use of artificial intelligence to estimate age and disease status from medical images. However, age estimation from chest X-ray (CXR) images has not been well studied and the clinical significance of estimated age has not been fully determined. METHODS To address this, we trained a deep neural network (DNN) model using more than 100,000 CXRs to estimate the patients' age solely from CXRs. We applied our DNN to CXRs of 1562 consecutive hospitalized heart failure patients, and 3586 patients admitted to the intensive care unit with cardiovascular disease. RESULTS The DNN's estimated age (X-ray age) showed a strong significant correlation with chronological age on the hold-out test data and independent test data. Elevated X-ray age is associated with worse clinical outcomes (heart failure readmission and all-cause death) for heart failure. Additionally, elevated X-ray age was associated with a worse prognosis in 3586 patients admitted to the intensive care unit with cardiovascular disease. CONCLUSIONS Our results suggest that X-ray age can serve as a useful indicator of cardiovascular abnormalities, which will help clinicians to predict, prevent and manage cardiovascular diseases.
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Affiliation(s)
- Hirotaka Ieki
- grid.509459.40000 0004 0472 0267Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ,grid.413411.2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kaoru Ito
- grid.509459.40000 0004 0472 0267Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Mike Saji
- grid.413411.2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Rei Kawakami
- grid.32197.3e0000 0001 2179 2105Department of Computer Science, School of Computing, Tokyo Institute of Technology, Tokyo, Japan
| | - Yuji Nagatomo
- grid.413411.2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan ,grid.416614.00000 0004 0374 0880Department of Cardiology, National Defense Medical College, Tokorozawa, Japan
| | - Kaori Takada
- grid.413411.2Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Toshiya Kariyasu
- grid.413411.2Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan ,grid.413376.40000 0004 1761 1035Department of Radiology, Tokyo Women’s Medical University, Medical Center East, Tokyo, Japan
| | - Haruhiko Machida
- grid.413411.2Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan ,grid.413376.40000 0004 1761 1035Department of Radiology, Tokyo Women’s Medical University, Medical Center East, Tokyo, Japan
| | - Satoshi Koyama
- grid.509459.40000 0004 0472 0267Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Hiroki Yoshida
- grid.509459.40000 0004 0472 0267Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Kurosawa
- grid.509459.40000 0004 0472 0267Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Hiroshi Matsunaga
- grid.509459.40000 0004 0472 0267Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuo Miyazawa
- grid.509459.40000 0004 0472 0267Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Kouichi Ozaki
- grid.509459.40000 0004 0472 0267Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan ,grid.419257.c0000 0004 1791 9005Division for Genomic Medicine, Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yoshihiro Onouchi
- grid.509459.40000 0004 0472 0267Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan ,grid.136304.30000 0004 0370 1101Department of Public Health, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Susumu Katsushika
- grid.26999.3d0000 0001 2151 536XDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Matsuoka
- grid.26999.3d0000 0001 2151 536XDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Shinohara
- grid.26999.3d0000 0001 2151 536XDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshihiro Yamaguchi
- grid.26999.3d0000 0001 2151 536XDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ,grid.412708.80000 0004 1764 7572Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Kodera
- grid.26999.3d0000 0001 2151 536XDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasutomi Higashikuni
- grid.26999.3d0000 0001 2151 536XDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- grid.26999.3d0000 0001 2151 536XDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Akazawa
- grid.26999.3d0000 0001 2151 536XDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuo Iguchi
- grid.413411.2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | | | - Tsutomu Yoshikawa
- grid.413411.2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Issei Komuro
- grid.26999.3d0000 0001 2151 536XDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Pintana P, Upalananda W, Saekho S, Yarach U, Wantanajittikul K. Fully automated method for dental age estimation using the ACF detector and deep learning. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022. [DOI: 10.1186/s41935-022-00314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Abstract
Background
Dental age estimation plays an important role in identifying an unknown person. In forensic science, estimating age with high accuracy depends on the experience of the practitioner. Previous studies proposed classification of tooth development of the mandibular third molar by following Demirjian’s method, which is useful for dental age estimation. Although stage of tooth growth is very helpful in assessing age estimation, it must be performed manually. The drawback of this procedure is its need for skilled observers to carry out the tasks precisely and reproducibly because it is quite detailed. Therefore, this research aimed to apply computer-aid methods for reducing time and subjectivity in dental age estimation by using dental panoramic images based on Demirjian’s method. Dental panoramic images were collected from persons aged 15 to 23 years old. In accordance with Demirjian’s method, this study focused only on stages D to H of tooth development, which were discovered in the 15- to 23-year age range. The aggregate channel features detector was applied automatically to localize and crop only the lower left mandibular third molar in panoramic images. Then, the convolutional neural network model was applied to classify cropped images into D to H stages. Finally, the classified stages were used to estimate dental age.
Results
Experimental results showed that the proposed method in this study can localize the lower left mandibular third molar automatically with 99.5% accuracy, and training in the convolutional neural network model can achieve 83.25% classification accuracy using the transfer learning strategy with the Resnet50 network.
Conclusion
In this work, the aggregate channel features detector and convolutional neural network model were applied to localize a specific tooth in a panoramic image and identify the developmental stages automatically in order to estimate the age of the subjects. The proposed method can be applied in clinical practice as a tool that helps clinicians to reduce the time and subjectivity for dental age estimation.
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Otjen JP, Moore MM, Romberg EK, Perez FA, Iyer RS. The current and future roles of artificial intelligence in pediatric radiology. Pediatr Radiol 2022; 52:2065-2073. [PMID: 34046708 DOI: 10.1007/s00247-021-05086-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/27/2021] [Accepted: 04/20/2021] [Indexed: 12/11/2022]
Abstract
Artificial intelligence (AI) is a broad and complicated concept that has begun to affect many areas of medicine, perhaps none so much as radiology. While pediatric radiology has been less affected than other radiology subspecialties, there are some well-developed and some nascent applications within the field. This review focuses on the use of AI within pediatric radiology for image interpretation, with descriptive summaries of the literature to date. We highlight common features that enable successful application of the technology, along with some of the limitations that can inhibit the development of this field. We present some ideas for further research in this area and challenges that must be overcome, with an understanding that technology often advances in unpredictable ways.
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Affiliation(s)
- Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Michael M Moore
- Department of Radiology, Penn State Children's Hospital, Penn State Health System, Hershey, PA, USA
| | - Erin K Romberg
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Francisco A Perez
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA.
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Cruz-Priego GA, Guagnelli MA, Miranda-Lora AL, Lopez-Gonzalez D, Clark P. Bone Age Reading by DXA Images should not Replace Bone Age Reading by X-ray Images. J Clin Densitom 2022; 25:456-463. [PMID: 36109296 DOI: 10.1016/j.jocd.2022.08.004] [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: 05/30/2022] [Revised: 08/02/2022] [Accepted: 08/14/2022] [Indexed: 10/15/2022]
Abstract
X-ray image of the hand is the most used technique to estimate bone age in children. For the analysis of bone mineral density using DXA in children, bone age may help to adjust such measurement in some cases. During image acquisition in DXA, an anteroposterior image of the hand may be acquired and used to evaluate bone age but few studies have evaluated the agreement between conventional X-ray and DXA images. The aim of the study was to determine bone age estimation agreement between conventional X-ray images and DXA in children and adolescents aged 5 to 16 years of age. We performed an analytical cross-sectional study of 711 healthy subjects. Subject´s bone age, both in conventional X-ray, and DXA images were read independently by two expert evaluators blinded for chronological age. Intraobserver and inter-observer reproducibility were evaluated using Intraclass Correlation Coefficient (ICC), and the agreement between bone age estimations made by both evaluators was analyzed using ICC and Bland-Altman analysis. General agreement between techniques measured through ICC was 0.99 with a mean difference of 6 months between techniques being older the ages obtained by DXA. The agreement limits were around ±2 years, which means that 95% of all differences between techniques were covered within this range. We found a high level of ICC agreement in bone age readings from X-ray and DXA images although we observed overestimation of bone age measurements in DXA. Differences between techniques were greater in women than in men, especially at the ages corresponding to puberty. Bone age measurement in DXA images appears not to be reliable; hence it should be suggested to perform conventional radiography of the hand to assess bone age taking into account that X-ray images have better resolution.
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Affiliation(s)
- Griselda-Adriana Cruz-Priego
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Miguel-Angel Guagnelli
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Desiree Lopez-Gonzalez
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Patricia Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico.
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A comparison of bone age assessments using automated and manual methods in children of Indian ethnicity. Pediatr Radiol 2022; 52:2188-2196. [PMID: 36123410 DOI: 10.1007/s00247-022-05516-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/22/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Bone age is useful for pediatric endocrinologists in evaluating various disorders related to growth and puberty. Traditional methods of bone age assessment, namely Greulich and Pyle (GP) and Tanner-Whitehouse (TW), have intra- and interobserver variations. Use of computer-automated methods like BoneXpert might overcome these subjective variations. OBJECTIVE The aim of our study was to assess the validity of BoneXpert in comparison to manual GP and TW methods for assessing bone age in children of Asian Indian ethnicity. MATERIALS AND METHODS We extracted from a previous study the deidentified left hand radiographs of 920 healthy children aged 2-19 years. We compared bone age as determined by four well-trained manual raters using GP and TW methods with the BoneXpert ratings. We computed accuracy using root mean square error (RMSE) to assess how close the bone age estimated by BoneXpert was to the reference rating. RESULTS The standard deviations (SDs) of rating among the four manual raters were 0.52 years, 0.52 years and 0.47 years for GP, TW2 and TW3 methods, respectively. The RMSEs between the automated bone age estimates and the true ratings were 0.39 years, 0.41 years and 0.36 years, respectively, for the same methods. The RMSE values were significantly lower in girls than in boys (0.53, 0.5 and 0.47 vs. 0.39, 0.47 and 0.4) by all the methods; however, no such difference was noted in classification by body mass index. The best agreement between BoneXpert and manual rating was obtained by using 50% weight on carpals (GP50). The carpal bone age was retarded in Indian children, more so in boys. CONCLUSION BoneXpert was accurate and performed well in estimating bone age by both GP and TW methods in healthy Asian Indian children; the error was larger in boys. The GP50 establishes "backward compatibility" with manual rating.
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Fava D, Calandrino A, Calevo MG, Allegri AEM, Napoli F, Gastaldi R, Patti G, Casalini E, Bassi M, Accogli A, Alyasin ARAA, Ramaglia A, Rossi A, Maghnie M, Morana G, Di Iorgi N. Clinical, Endocrine and Neuroimaging Findings in Girls With Central Precocious Puberty. J Clin Endocrinol Metab 2022; 107:e4132-e4143. [PMID: 35881919 DOI: 10.1210/clinem/dgac422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT The etiology of central precocious puberty (CPP) includes a spectrum of conditions. Girls younger than age 6 years with CPP should undergo cranial magnetic resonance imaging (MRI), but it remains controversial whether all girls who develop CPP between the ages of 6 and 8 years require neuroimaging examination. OBJECTIVE To investigate the frequency of brain MRI abnormalities in girls diagnosed with CPP and the relationship between maternal factors, their age at presentation, clinical signs and symptoms, hormonal profiles, and neuroimaging findings. METHODS Data were collected between January 2005 and September 2019 from 112 girls who showed clinical pubertal progression before 8 years of age who underwent brain MRI. RESULTS MRI was normal in 47 (42%) idiopathic (I) scans, 54 (48%) patients had hypothalamic-pituitary anomalies (HPA) and/or extra-HP anomalies (EHPA), and 11 (10%) had brain tumors or tumor-like conditions (BT/TL), including 3 with neurological signs. Associated preexisting disorders were documented in 16. Girls with BT/TL had a higher LH peak after GnRH test (P = 0.01) than I, and those older than age 6 years had a higher craniocaudal diameter of the pituitary gland (P = 0.01); their baseline FSH and LH (P = 0.004) and peak FSH (P = 0.01) and LH (P = 0.05) values were higher than I. Logistic regression showed maternal age at menarche (P = 0.02) and peak FSH (P = 0.02) as BT/TL risk factors. CONCLUSIONS MRI provides valuable information in girls with CPP by demonstrating that fewer than half have a normal brain MRI and that few can have significant intracranial lesions after the age of 6, despite the absence of suggestive neurological signs.
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Affiliation(s)
- Daniela Fava
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Andrea Calandrino
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
| | | | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
| | - Roberto Gastaldi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
| | - Giuseppa Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Emilio Casalini
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Andrea Accogli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal H4A 3J1, Canada
- Department of Human Genetics, Faculty of Medicine, McGill University, Montreal H3A 1G1, Canada
| | - Abdel Razaq Ahmad A Alyasin
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Antonia Ramaglia
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa 16142, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Giovanni Morana
- Department of Neurosciences, Neuroradiology Unit, University of Turin, Turin 10126, Italy
| | - Natascia Di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
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Lee SY, Im SA. Comparison of Bone Agesin Early Puberty: Computerized Greulich-Pyle Based Bone Age vs. Sauvegrain Method. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1081-1089. [PMID: 36276197 PMCID: PMC9574274 DOI: 10.3348/jksr.2021.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/19/2021] [Accepted: 11/22/2021] [Indexed: 11/21/2022]
Abstract
Purpose To compare the computerized Greulich-Pyle based bone age with elbow bone age. Materials and Methods A total of 2126 patients (1525 girls; 601 boys) whose elbow bone age was within the evaluable range by the Sauvegrain method, and who simultaneously underwent hand radiography, were enrolled in the study. The 1st-bone age and VUNO score of the hand were evaluated using VUNOMed-BoneAge software. The correlation between the hand and elbow bone age was analyzed according to the child's gender and the probability of 1st-bone age. Results The correlation between VUNO score and elbow bone age (r = 0.898) was higher than the correlation between 1st-bone age and elbow bone age (r = 0.879). Moreover, the VUNO score showed a better correlation with the elbow bone age in patients with a 1st-bone age probability of less than 70%, or in girls. Elbow bone age was more advanced compared to hand bone age, and this difference increased until the middle of puberty and gradually decreased in the latter half. Conclusion The computerized Greulich-Pyle based hand bone age showed a significant correlation with the elbow bone age at puberty. However, since the elbow bone age tends to advance faster than the hand bone age, caution is required while judging the bone age during puberty.
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Sousa-e-Silva P, Coelho-e-Silva MJ, Seabra A, Costa DC, Martinho DV, Duarte JP, Oliveira T, Gonçalves-Santos J, Rodrigues I, Ribeiro LP, Figueiredo AJ, Konarski JM, Cumming SP, Malina RM. Skeletal age assessed by TW2 using 20-bone, carpal and RUS score systems: Intra-observer and inter-observer agreement among male pubertal soccer players. PLoS One 2022; 17:e0271386. [PMID: 35998133 PMCID: PMC9397866 DOI: 10.1371/journal.pone.0271386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study was to determine intra- and inter-observer agreement for the three skeletal ages derived from the TW2 method among male pubertal soccer players. The sample included 142 participants aged 11.0–15.3 years. Films of the left hand-wrist were evaluated twice by each of two observers. Twenty bones were rated and three scoring systems used to determine SA adopting the TW2 version: 20-bone, CARPAL and RUS. Overall agreement rates were 95.1% and 93.8% for, respectively, Observer A and Observer B. Although, agreement rates between observers differed for 13 bones (5 carpals, metacarpal-I, metacarpal-III, metacarpal-V, proximal phalanges-I, III and V, distal phalanx-III), intra-class correlationa were as follows: 0.990 (20-bone), 0.969 (CARPAL), and 0.988 (RUS). For the three SA protocols, BIAS was negligible: 0.02 years (20-bone), 0.04 years (CARPAL), and 0.03 years (RUS). Observer-associated error was not significant for 20-bone SA (TEM = 0.25 years, %CV = 1.86) neither RUS SA (TEM = 0.31 years, %CV = 2.22). Although the mean difference for CARPAL SAs between observers (observer A: 12.48±1.18 years; observer B: 12.29±1.24 years; t = 4.662, p<0.01), the inter-observer disagreement had little impact (TEM: 0.34 years: %CV: 2.78). The concordance between bone-specific developmental stages seemed was somewhat more problematic for the carpals than for the long bones. Finally, when error due to the observer is not greater than one stage and the replicated assignments had equal probability for being lower or higher compared to initial assignments, the effect on SAs was trivial or small.
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Affiliation(s)
- Paulo Sousa-e-Silva
- University of Coimbra, FCDEF, Coimbra, Portugal
- University of Coimbra, CIDAF, Coimbra, Portugal
| | - Manuel J. Coelho-e-Silva
- University of Coimbra, FCDEF, Coimbra, Portugal
- University of Coimbra, CIDAF, Coimbra, Portugal
- * E-mail:
| | - Andre Seabra
- Portugal Football School, Portuguese Football Federation, Lisbon Portugal
- Faculty of Sport, University of Porto, CIAFEL, Porto, Portugal
| | - Daniela C. Costa
- University of Coimbra, FCDEF, Coimbra, Portugal
- University of Coimbra, CIDAF, Coimbra, Portugal
| | - Diogo V. Martinho
- University of Coimbra, FCDEF, Coimbra, Portugal
- University of Coimbra, CIDAF, Coimbra, Portugal
| | - João P. Duarte
- University of Coimbra, FCDEF, Coimbra, Portugal
- University of Coimbra, CIDAF, Coimbra, Portugal
| | | | | | | | | | - António J. Figueiredo
- University of Coimbra, FCDEF, Coimbra, Portugal
- University of Coimbra, CIDAF, Coimbra, Portugal
| | - Jan M. Konarski
- Poznań University of Physical Education, Theory of Sports Department (Sport Science), Poznań, Poland
| | - Sean P. Cumming
- Department of Health, University of Bath, Bath, United Kingdom
| | - Robert M. Malina
- Department of Kinesiology and Health Education, University of Texas, Austin, Texas, United States of America
- University of Louisville, School of Public Health and Information Sciences, Louisville, Kentucky, United States of America
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Abstract
Bone age is commonly used to reflect growth and development trends in children, predict adult heights, and diagnose endocrine disorders. Nevertheless, the existing automated bone age assessment (BAA) models do not consider the nonlinearity and continuity of hand bone development simultaneously. In addition, most existing BAA models are based on datasets from European and American children and may not be applicable to the developmental characteristics of Chinese children. Thus, this work proposes a cascade model that fuses prior knowledge. Specifically, a novel bone age representation is defined, which incorporates nonlinear and continuous features of skeletal development and is implemented by a cascade model. Moreover, corresponding regions of interest (RoIs) based on RUS-CHN were extracted by YOLO v5 as prior knowledge inputs to the model. In addition, based on MobileNet v2, an improved feature extractor was proposed by introducing the Convolutional Block Attention Module and increasing the receptive field to improve the accuracy of the evaluation. The experimental results show that the mean absolute error (MAE) is 4.44 months and significant correlations with the reference bone age is (r = 0.994, p < 0.01); accuracy is 94.04% for ground truth within ±1 year. Overall, the model design adequately considers hand bone development features and has high accuracy and consistency, and it also has some applicability on public datasets, showing potential for practical and clinical applications.
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A Global-Local Feature Fusion Convolutional Neural Network for Bone Age Assessment of Hand X-ray Images. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Bone age assessment plays a critical role in the investigation of endocrine, genetic, and growth disorders in children. This process is usually conducted manually, with some drawbacks, such as reliance on the pediatrician’s experience and extensive labor, as well as high variations among methods. Most deep learning models use one neural network to extract the global information from the whole input image, ignoring the local details that doctors care about. In this paper, we propose a global-local feature fusion convolutional neural network, including a global pathway to capture the global contextual information and a local pathway to extract the fine-grained information from local patches. The fine-grained information is integrated into the global context information layer-by-layer to assist in predicting bone age. We evaluated the proposed method on a dataset with 11,209 X-ray images with an age range of 4–18 years. Compared with other state-of-the-art methods, the proposed global-local network reduces the mean absolute error of the estimated ages to 0.427 years for males and 0.455 years for females; the average accuracy rate is within 6 months and 12 months, reaching 70% and 91%, respectively. In addition, the effectiveness and rationality of the model were verified on a public dataset.
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Yuh YS, Chou TY, Chow JC. Applicability of the Greulich and Pyle bone age standards to Taiwanese children: A Taipei experience. J Chin Med Assoc 2022; 85:767-773. [PMID: 35648187 DOI: 10.1097/jcma.0000000000000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Greulich and Pyle (GP) method is one of the most common radiographic techniques for bone age (BA) assessment. The applicability of this method to ethnic populations outside of the United States has been investigated in several recent studies worldwide. Currently, limited data are available on the accuracy of the GP method for the Taiwanese population. The purpose of this study was to determine whether the GP standards are applicable to contemporary Taipei children. METHODS Clinical data from October 1, 2010, to March 31, 2020, were retrospectively collected from a general hospital in Taipei. BA was determined by a senior pediatrician and was reviewed by a senior pediatric radiologist according to the GP standards. Comparison of BA and chronological age (CA) was performed in children with body weight and height in the 15th to the 85th percentiles of normal children. Ethnic variations in the maturation process in the ulnar bone were investigated. All data were statistically analyzed. RESULTS In total, 2465 medical records were collected. After excluding those with diseases and unqualified data, 654 records of boys and 809 of girls were analyzed. In boys, the mean BA was significantly delayed between 6 and 9 years of age compared with the CA. In girls, the mean BA was generally advanced between 7 and 15 years of age. Ulnar bone maturation tended to be delayed in young boys. CONCLUSION A significant discrepancy between CA and BA was observed in our population. Delayed ulnar bone maturation in young boys was confirmed. Children in Taipei exhibit a different maturation pattern than children on whom the GP standards were based.
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Affiliation(s)
- Yeong-Seng Yuh
- Department of Pediatrics, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ting Ywan Chou
- Department of Radiology, Cardinal Tien General Hospital, Taipei, Taiwan, ROC
- College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Jeffrey C Chow
- Department of Pediatrics, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
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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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Study of Multidimensional and High-Precision Height Model of Youth Based on Multilayer Perceptron. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:7843455. [PMID: 35761869 PMCID: PMC9233609 DOI: 10.1155/2022/7843455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/14/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022]
Abstract
Predicting the adult height of children accurately has great social value for the selection of outstanding athlete as well as early detection of children's growth disorders. Currently, the mainstream method used to predict adult height in China has three problems: its standards are not uniform; it is stale for current Chinese children; its accuracy is not satisfactory. This article uses the data collected by the Chinese Children and Adolescents' Physical Fitness and Growth Health Project in Zhejiang primary and secondary schools. We put forward a new multidimensional and high-precision youth growth curve prediction model, which is based on multilayer perceptron. First, this model uses multidimensional growth data of children as predictors and then utilizes multilayer perceptron to predict the children's adult height. Second, we find the Table of Height Standard Deviation of Chinese Children and fit the data of zero standard deviation to obtain the curve. This curve is regarded as Chinese children's mean growth curve. Third, we use the least-squares method and the mean curve to calculate the individual growth curve. Finally, the individual curve can be used to predict children's state height. Experimental results show that this adult height prediction model's accuracy (between 2 cm) of boys and girls reached 90.20% and 88.89% and the state height prediction accuracy reached 77.46% and 74.93%. Compared with Bayley–Pinneau, the adult height prediction is improved 19.61% for boys and 13.33% for girls. Compared with BoneXpert, the adult height prediction is improved 25.49% for boys and 6.67% for girls. Compared with the method based on the bone age growth map, the adult height prediction is improved 15.69% for boys and 24.45% for girls.
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Madsen A, Almås B, Bruserud IS, Oehme NHB, Nielsen CS, Roelants M, Hundhausen T, Ljubicic ML, Bjerknes R, Mellgren G, Sagen JV, Juliusson PB, Viste K. Reference Curves for Pediatric Endocrinology: Leveraging Biomarker Z-Scores for Clinical Classifications. J Clin Endocrinol Metab 2022; 107:2004-2015. [PMID: 35299255 PMCID: PMC9202734 DOI: 10.1210/clinem/dgac155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Indexed: 12/13/2022]
Abstract
CONTEXT Hormone reference intervals in pediatric endocrinology are traditionally partitioned by age and lack the framework for benchmarking individual blood test results as normalized z-scores and plotting sequential measurements onto a chart. Reference curve modeling is applicable to endocrine variables and represents a standardized method to account for variation with gender and age. OBJECTIVE We aimed to establish gender-specific biomarker reference curves for clinical use and benchmark associations between hormones, pubertal phenotype, and body mass index (BMI). METHODS Using cross-sectional population sample data from 2139 healthy Norwegian children and adolescents, we analyzed the pubertal status, ultrasound measures of glandular breast tissue (girls) and testicular volume (boys), BMI, and laboratory measurements of 17 clinical biomarkers modeled using the established "LMS" growth chart algorithm in R. RESULTS Reference curves for puberty hormones and pertinent biomarkers were modeled to adjust for age and gender. Z-score equivalents of biomarker levels and anthropometric measurements were compiled in a comprehensive beta coefficient matrix for each gender. Excerpted from this analysis and independently of age, BMI was positively associated with female glandular breast volume (β = 0.5, P < 0.001) and leptin (β = 0.6, P < 0.001), and inversely correlated with serum levels of sex hormone-binding globulin (SHBG) (β = -0.4, P < 0.001). Biomarker z-score profiles differed significantly between cohort subgroups stratified by puberty phenotype and BMI weight class. CONCLUSION Biomarker reference curves and corresponding z-scores provide an intuitive framework for clinical implementation in pediatric endocrinology and facilitate the application of machine learning classification and covariate precision medicine for pediatric patients.
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Affiliation(s)
- Andre Madsen
- Correspondence: André Madsen, PhD, Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, N-5021 Bergen, Norway.
| | - Bjørg Almås
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Ingvild S Bruserud
- Faculty of Health, VID Specialized University, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | | | - Christopher Sivert Nielsen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Mathieu Roelants
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - Thomas Hundhausen
- Department of Medical Biochemistry, Southern Norway Hospital Trust, Kristiansand, Norway
- Department of Natural Sciences, University of Agder, Kristiansand, Norway
| | - Marie Lindhardt Ljubicic
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen, Denmark
| | - Robert Bjerknes
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gunnar Mellgren
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway
| | - Jørn V Sagen
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Heterozygous NPR2 Variants in Idiopathic Short Stature. Genes (Basel) 2022; 13:genes13061065. [PMID: 35741827 PMCID: PMC9222219 DOI: 10.3390/genes13061065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 02/04/2023] Open
Abstract
Heterozygous variants in the NPR2 gene, which encodes the B-type natriuretic peptide receptor (NPR-B), a regulator of skeletal growth, were reported in 2-6% cases of idiopathic short stature (ISS). Using next-generation sequencing (NGS), we aimed to assess the frequency of NPR2 variants in our study cohort consisting of 150 children and adolescents with ISS, describe the NPR2 phenotypic spectrum with a growth pattern including birth data, and study the response to growth hormone (GH) treatment. A total of ten heterozygous pathogenic/likely pathogenic NPR2 variants and two heterozygous NPR2 variants of uncertain significance were detected in twelve participants (frequency of causal variants: 10/150, 6.7%). During follow-up, the NPR2 individuals presented with a growth pattern varying from low-normal to significant short stature. A clinically relevant increase in BMI (a mean gain in the BMI SDS of +1.41), a characteristic previously not reported in NPR2 individuals, was observed. In total, 8.8% participants born small for their gestational age (SGA) carried the NPR2 causal variant. The response to GH treatment was variable (SDS height gain ranging from -0.01 to +0.74). According to the results, NPR2 variants present a frequent cause of ISS and familial short stature. Phenotyping variability in growth patterns and variable responses to GH treatment should be considered.
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Bowden JJ, Bowden SA, Ruess L, Adler BH, Hu H, Krishnamurthy R, Krishnamurthy R. Validation of automated bone age analysis from hand radiographs in a North American pediatric population. Pediatr Radiol 2022; 52:1347-1355. [PMID: 35325266 DOI: 10.1007/s00247-022-05310-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 12/21/2021] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Radiographic bone age assessment by automated software is precise and instantaneous. OBJECTIVE The aim of this study was to evaluate the accuracy of an automated tool for bone age assessment. MATERIALS AND METHODS We compared a total of 586 bone age radiographs from 451 patients, which had been assessed by three radiologists from 2013 to 2018, with bone age analysis by BoneXpert, using the Greulich and Pyle method. We made bone age comparisons in different patient groups based on gender, diagnosis and race, and in a subset with repeated bone age studies. We calculated Spearman correlation (r) and accuracy (root mean square error, or R2). RESULTS Bone age analyses by automated and manual assessments showed a strong correlation (r=0.98; R2=0.96; P<0.0001), with the mean bone age difference of 0.12±0.76 years. Bone age comparisons by the two methods remained strongly correlated (P<0.0001) when stratified by gender, common endocrine conditions including growth disorders and early/precocious puberty, and race. In the longitudinal analysis, we also found a strong correlation between the automated software and manual bone age over time (r=0.7852; R2=0.63; P<0.01). CONCLUSION Automated bone age assessment was found to be reliable and accurate in a large cohort of pediatric patients in a clinical practice setting in North America.
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Affiliation(s)
| | - Sasigarn A Bowden
- Department of Pediatric Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Lynne Ruess
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Brent H Adler
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Houchun Hu
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ramkumar Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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Martin DD, Calder AD, Ranke MB, Binder G, Thodberg HH. Accuracy and self-validation of automated bone age determination. Sci Rep 2022; 12:6388. [PMID: 35430607 PMCID: PMC9013398 DOI: 10.1038/s41598-022-10292-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/29/2022] [Indexed: 11/20/2022] Open
Abstract
The BoneXpert method for automated determination of bone age from hand X-rays was introduced in 2009 and is currently running in over 200 hospitals. The aim of this work is to present version 3 of the method and validate its accuracy and self-validation mechanism that automatically rejects an image if it is at risk of being analysed incorrectly. The training set included 14,036 images from the 2017 Radiological Society of North America (RSNA) Bone Age Challenge, 1642 images of normal Dutch and Californian children, and 8250 images from Tübingen from patients with Short Stature, Congenital Adrenal Hyperplasia and Precocious Puberty. The study resulted in a cross-validated root mean square (RMS) error in the Tübingen images of 0.62 y, compared to 0.72 y in the previous version. The RMS error on the RSNA test set of 200 images was 0.45 y relative to the average of six manual ratings. The self-validation mechanism rejected 0.4% of the RSNA images. 121 outliers among the self-validated images of the Tübingen study were rerated, resulting in 6 cases where BoneXpert deviated more than 1.5 years from the average of the three re-ratings, compared to 72 such cases for the original manual ratings. The accuracy of BoneXpert is clearly better than the accuracy of a single manual rating. The self-validation mechanism rejected very few images, typically with abnormal anatomy, and among the accepted images, there were 12 times fewer severe bone age errors than in manual ratings, suggesting that BoneXpert could be safer than manual rating.
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