Transcript
Page 1: A Quan’ta’ve Method for Radiologic Assessment of …llrs.org/LLRS 2016 PDFS/A Quantitative Method for...Ques’ons • Is there a quick, quanHtave and reproducible method for esHmang

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

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Disclosure

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

insHtuHonforresearchfund

•  Idonotintendtodiscussanunapproved/invesHgaHveuseofacommercialproduct/deviceinmypresentaHon

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Background

•  AccurateesHmaHonofskeletalmaturity

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SkeletalMaturity

•  GreulichandPyleBoneAge– Significantcomplexity– Timeintensive– Comparabletochronologicage?

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ChronologicAge

•  ChronologicalAge– Widevariabilitybetweenchildren

ComplimentsofLoriKarol

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Background

•  Peakheightvelocity(PHV)averagesat90%offinalheight

Page 7: A Quan’ta’ve Method for Radiologic Assessment of …llrs.org/LLRS 2016 PDFS/A Quantitative Method for...Ques’ons • Is there a quick, quanHtave and reproducible method for esHmang

Background

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Background

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Ques'ons

•  Isthereaquick,quanHtaHveandreproduciblemethodforesHmaHngskeletalmaturityusingreadilyavailablepaHentinformaHon?

•  Howdoesthismethodcomparetocurrentlyusedmethods?– ChronologicAge– GreulichPyleBoneAge

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DistalFemoralPhysis

Liuetal.JPO,2013

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Methods

•  Source:BoltonBrushCollecHon•  Exclusion:– AbsenceofchronologicageorGreulichandPyleboneageat90%offinalheight

– Poorqualityradiographs

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Methods

•  IdenHfiedchronologicageassociatedwith90%offinalheight– ThisagewasmarkedasTime0

0

YearsFrom90%Growth

+1 +2-1-2-3

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

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Methods

1.PhysealLengthConnecHngBorders=PhysealLine

2.Recordlengthin(mm)

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Methods

3.MeasureDistanceFromPhysealLinetoCentralPeak4.Recordheight(mm)

X

CentralPeakHeight

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Methods

CentralPeakHeight(mm)PhysealLine(mm)

CentralPeakValue

InterclassCorrelaHonCoefficient(n=24radiographs)=0.994

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Sta's'calAnalysis

•  MulHpleRegressionAnalysis– Compare:

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

– CorrelaHonbetweenesHmatedageversustrue90%finalheightbetweenmethods

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Radiographs

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

195 194

MeanNumberofRadiographs/Subject

4.6±1.5 5.0±0.9

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MeanAgeat90%

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

13.2 11.3

StandardDeviaHon

0.6 0.8

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R2Values

ChronologicAge+Gender

GreulichPyleBoneAge+Gender

ChronologicAge+Gender+CentralPeak

CorrelaHontoTrueAgeat90%Growth

0.838 0.836 0.866

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DiscrepancyMeanDiscrepancyfromTrue90%Height(Years)

ChronologicAge+Gender

GreulichPyleBoneAge+Gender

ChronologicAge+Gender+CentralPeak

Mean 0.53 0.64 0.48StandardDeviaHon

0.40 0.56 0.37

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ResultsPercentageofValuesofby1-YearorGreater

ChronologicAge+Gender

GreulichPyleBoneAge+Gender

ChronologicAge+Gender+CentralPeak

PercentageofRadiographswithMeasurementsofby>1Year

13% 12% 10%

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Limita'ons

•  Onlytheleefemurwasavailableforanalysis

•  UnknownvaliditytootherethnicpopulaHons

•  NeedstobetestedonamodernpopulaHon

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Conclusion

•  CentralpeakvaluerepresentsavalidmethodforpredicHng90%offinalheight– EsHmatesaremoreaccuratethanGreulichandPyleBoneAge

– LesscomplexandHmeintensive

•  FirstPurelyQuanHtaHveMethod

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Thankyou


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