AQuan'ta'veMethodforRadiologicAssessmentofSkeletalMaturityusingtheDistalFemur

DerrickM.Knapik,M.D.JamesO.Sanders,M.D.AllisonGilmore,M.D.DavidR.Weber,M.D.

DanielR.Cooperman,M.D.RaymondW.Liu,M.D.

RainbowBabiesandChildren’sHospital

CaseWesternReserveUniversity

Disclosure

•  IhavenorelevantfinancialrelaHonshipswiththemanufacturer(s)ofanycommercialproduct(s)and/orprovider(s)ofcommercialservicesdiscussedinthisCMEacHvity.•  JamesSanders:stockinAbbot,AbbvieGEHealthcare•  RaymondLiu:royalHesfromOrthopediatricsLLCpaidto

insHtuHonforresearchfund

•  Idonotintendtodiscussanunapproved/invesHgaHveuseofacommercialproduct/deviceinmypresentaHon

Background

•  AccurateesHmaHonofskeletalmaturity

SkeletalMaturity

•  GreulichandPyleBoneAge– Significantcomplexity– Timeintensive– Comparabletochronologicage?

ChronologicAge

•  ChronologicalAge– Widevariabilitybetweenchildren

ComplimentsofLoriKarol

Background

•  Peakheightvelocity(PHV)averagesat90%offinalheight

Background

Background

Ques'ons

•  Isthereaquick,quanHtaHveandreproduciblemethodforesHmaHngskeletalmaturityusingreadilyavailablepaHentinformaHon?

•  Howdoesthismethodcomparetocurrentlyusedmethods?– ChronologicAge– GreulichPyleBoneAge

DistalFemoralPhysis

Liuetal.JPO,2013

Methods

•  Source:BoltonBrushCollecHon•  Exclusion:– AbsenceofchronologicageorGreulichandPyleboneageat90%offinalheight

– Poorqualityradiographs

Methods

•  IdenHfiedchronologicageassociatedwith90%offinalheight– ThisagewasmarkedasTime0

0

YearsFrom90%Growth

+1 +2-1-2-3

•  81children(n=42female,n=39males)3yearspriortoTime0and2yearsaeer.

Methods

1.PhysealLengthConnecHngBorders=PhysealLine

2.Recordlengthin(mm)

Methods

3.MeasureDistanceFromPhysealLinetoCentralPeak4.Recordheight(mm)

X

CentralPeakHeight

Methods

CentralPeakHeight(mm)PhysealLine(mm)

CentralPeakValue

InterclassCorrelaHonCoefficient(n=24radiographs)=0.994

Sta's'calAnalysis

•  MulHpleRegressionAnalysis– Compare:

•  ChronologicAge+Gender•  GreulichandPyleBoneAge+Gender•  ChronologicAge+Gender+CentralPeakValue

– CorrelaHonbetweenesHmatedageversustrue90%finalheightbetweenmethods

Radiographs

Males(n=39) Females(n=42)TotalNumberofRadiographs

195 194

MeanNumberofRadiographs/Subject

4.6±1.5 5.0±0.9

MeanAgeat90%

Males(n=39) Females(n=42)MeanAge@90%Growth(years)

13.2 11.3

StandardDeviaHon

0.6 0.8

R2Values

ChronologicAge+Gender

GreulichPyleBoneAge+Gender

ChronologicAge+Gender+CentralPeak

CorrelaHontoTrueAgeat90%Growth

0.838 0.836 0.866

DiscrepancyMeanDiscrepancyfromTrue90%Height(Years)

ChronologicAge+Gender

GreulichPyleBoneAge+Gender

ChronologicAge+Gender+CentralPeak

Mean 0.53 0.64 0.48StandardDeviaHon

0.40 0.56 0.37

ResultsPercentageofValuesofby1-YearorGreater

ChronologicAge+Gender

GreulichPyleBoneAge+Gender

ChronologicAge+Gender+CentralPeak

PercentageofRadiographswithMeasurementsofby>1Year

13% 12% 10%

Limita'ons

•  Onlytheleefemurwasavailableforanalysis

•  UnknownvaliditytootherethnicpopulaHons

•  NeedstobetestedonamodernpopulaHon

Conclusion

•  CentralpeakvaluerepresentsavalidmethodforpredicHng90%offinalheight– EsHmatesaremoreaccuratethanGreulichandPyleBoneAge

– LesscomplexandHmeintensive

•  FirstPurelyQuanHtaHveMethod

Thankyou