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
Recommended
