Authors:
M. Y. K. Bilgili, S. Bulbul, S. A. Kara, C. Sanli, H. H. Erdal, D. Altinok; Ankara/TR
DOI:
10.1594/ECR03/C-0727
Conclusion
Because the bones of human body, undergo changes in shape and function as well as changes in size, roentgenologists and pediatricians have proposed numerous methods for appraising the skeletal change of children (6). The roentgenologist and the pediatrician have used them to determine whether individual children were skeletally advanced or retarded, since appraisal of advancement or retardation is an aid in the diagnosis of endocrine and nutritional disorders (6). Research workers, in the field have been interested because they wished an objective measure of the progress of one of the developing systems of the child for comparison with the progress of other developing systems, for correlation with his mental scores, economic status, height, weight or dentition. Skeletal development has been depicted by means of ratios of bone growth measured from roentgenograms. Two distinctly different systems for determining and evaluating bone maturation by X-ray examination are extensively used: The Tanner-Whitehouse method involves measuring individual bone parts to create an index value; whereas the Greulich-Pyle matches the overall pattern of maturation of the subject to a set of reference patterns. Other techniques comparing radiographs of the hand/wrist area and the elbow, knee, cervical vertebra and pelvis to standard atlases have been used (7, 8, 9, 10, 11). The most complicated technique is the Oxford method, which adds points for certain maturity factors of the hip and pelvis (12). Sontag also demonstrated a scale for rating progressive skeletal development of boys and girls form birth to age of 5 years, based on radiography of left upper and lower extremities (6). US also took place for the bone age determination; Scanderberg-Catriota concluded that US examination of the hip is a safe and cost-effective method for assessment of skeletal age, but its low accuracy makes it currently unsuitable for clinical use, whereas Wagner et al suggested that US of the iliac bone apophysis, distal radial epiphysis is a useful and highly acceptable tool for bone age determination (13, 14). Also, Nessi et al reported that ossification centers of the hand and wrist (pisiform, adductor sesamoid bones of the metacarpophalangeal joint of the thumb and the cartilage of the distal phalanx of the third finger) scanned by US is as a simple, valuable radiation free method for the follow-up skeletal maturation (15).As shown in previous studies, maturity of the carpal bones varies greatly and skeletal age will be interpreted as younger then it actually is, if too much emphasis is placed on the carpals (16, 17). Carpenter et al demonstrated that skeletal age estimation based on the metacarpals and phalanxes more closely approximated chronological age then the wrist and carpal bone age readings (7). This is why in the present study we not only focused on carpal bones but too much emphasis is placed in the phalangeal and metacarpal epiphysis. There is no difference in the presence of the ossification centers in the epiphysis of the metacarpals and phalanxes, as well as the carpal bones from months to 1 year and 3 months for boys and, from 3 months to 9 months, and from 5 years to 5 years and 9 months for girls. But in our study, this period did not cause, over or under estimation of bone age because; for boys, we are able to say if the patient is less then or more then 3 months during the 0-12 months and also we can determine if the patient is less or more then 1 year and 3 months. So, we can say, if the boy is more or less then 3 months; or between 3 months and 1 year and 3 months; or over 1 year and 3 months. Also for girls, we can determine if the children is less or more then months or 9 months. And there is an ability to determine if the girl is less then 5 years or more then 5 years and 9 months. And the estimated age of derived from hand and wrist US chart showed excellent correlation with the estimated bone age derived from the plain radiography not only during these period but also throughout the period incuded in our study.Also bone age estimation using US did not seemed to be time consuming: the presence of the bones of the each carpal bone and the visible epiphysis of metacarpals and phalanxes are noted on the hand and wrist US chart and this is done by placing the probe in two planes (longitudinal and transverse) for each finger, this takes average two to three minutes according to experience of the radiologist. This enables the radiologist to estimate the bone age even in the US department with Greulich-Pyle atlas simply. As a limitation of our study: the shape of epiphysis is very important in the age assessment and the hand and wrist US chart does not represent the true sonographic picture of the wrist, but only a cumulative measures on a diagram but the estimated age derived from plain radiography chart and hand and wrist US chart are highly correlated to each other. Also hand and wrist US chart can be preserved like plain radiography. It is obvious that plain radiography of the hand and wrist is still and will be the most popular method for the bone age estimation in future; but keeping in mind that, even the US version of the Greulich-Pyle Atlas is a valid alternative of bone age estimation, it will enable the radiologist to estimate bone age in US departments easily with Greulich-Pyle Atlas which is free of radiation, and increase the choice of alternatives.