ABSTRACT
BACKGROUND: Determination of bone age is routinely used for following up substitution therapy in congenital adrenal hyperplasia (CAH) but today is a procedure with significant subjectivity. OBJECTIVE: The aim was to test the performance of automatic bone age rating by the BoneXpert software package in all radiographs of children with CAH seen at our clinic from 1975 to 2006. MATERIALS AND METHODS: Eight hundred and ninety-two left-hand radiographs from 100 children aged 0 to 17 years were presented to a human rater and BoneXpert for bone age rating. Images where ratings differed by more than 1.5 years were each rerated by four human raters. RESULTS: Rerating was necessary in 20 images and the rerating result was closer to the BoneXpert result than to the original manual rating in 18/20 (90 %). Bone age rating precision based on the smoothness of longitudinal curves comprising a total of 327 data triplets spanning less than 1.7 years showed BoneXpert to be more precise (P<0.001). CONCLUSION: BoneXpert performs reliable bone age ratings in children with CAH.
Subject(s)
Adrenal Hyperplasia, Congenital/diagnostic imaging , Age Determination by Skeleton/methods , Algorithms , Hand Bones/diagnostic imaging , Pattern Recognition, Automated/methods , Radiographic Image Interpretation, Computer-Assisted/methods , Software , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Observer Variation , Radiographic Image Enhancement/methods , Reproducibility of Results , Sensitivity and Specificity , Software ValidationABSTRACT
BACKGROUND: A number of radiogrammetrical metacarpal indices are in use, some of which have been adapted for children. OBJECTIVE: The purpose of this study was to compare four known indices-bone mineral density (BMD), relative cortical area, Exton-Smith index, bending breaking resistance index-and the more recently defined pediatric bone index (PBI) according to the two criteria of minimum height dependence and minimum variability in children of equal bone age. MATERIALS AND METHODS: A total of 3,121 left-hand radiographs from 231 healthy Caucasian children ranging in age from 3 to 19 years old were analysed using BoneXpert®, a programme for automatic analysis of hand radiographs and assessment of bone age. RESULTS: Dependence on height for chronological age or bone age and the mean relative standard deviation were lowest in the PBI for both genders pooled. The differences in height dependence were statistically significant and are shown to be clinically relevant. Reference data for PBI are presented. CONCLUSION: PBI may be a better indicator than BMD for bone health in children; however, verification in a clinical group is needed.