title: Knee radiography in the diagnosis of skeletal dysplasias.
abstract: BACKGROUND
  Flattening of the epiphyses of long bones is seen in several skeletal dysplasias and standardized measurements on a radiograph of the knee to detect skeletal dysplasias using this feature have been described. Since then only two other studies in which this method was used have been published, and both included only a small number of children and neither had a control group. In addition, the Dutch National Working Group on Skeletal Dysplasias began to have doubts about the reliability of the method. We therefore decided to re-evaluate its accuracy in a population of children with and without a skeletal dysplasia.
  
  
  OBJECTIVE
  To determine the diagnostic value of standardized measurements on conventional AP radiographs of the knee in children with a skeletal dysplasia.
  
  
  METHODS
  We measured the distal femoral metaphysis and epiphysis according to the published method on conventional AP radiographs of the knee in 45 healthy children and 52 children with a skeletal dysplasia. We compared graphically the height of the distal femoral epiphysis with its width and with the width of the femoral metaphysis. Receiver operating characteristic (ROC) curves were calculated for each group of children.
  
  
  RESULTS
  All graphs showed a considerable overlap between children with a skeletal dysplasia and healthy children. The size of the area under the ROC curves for the different groups was small, varying between 0.567 and 0.653.
  
  
  CONCLUSIONS
  This method does not discriminate between children with a skeletal dysplasia and healthy children. We therefore consider it to be of little diagnostic value.
authors.affiliation: Department of Radiology, KF 01.203.0, Wilhelmina Children's Hospital, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Kwee
authors.forename: Frits A
authors.initials: FA
authors.lastname: Beemer
authors.forename: Frederik J A
authors.initials: FJ
authors.lastname: Beek
authors.forename: Rutger A J
authors.initials: RA
authors.lastname: Nievelstein
mesh_terms: D000293:Adolescent; D001848:Bone Diseases, Developmental / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D004838:Epiphyses / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007223:Infant; D007717:Knee / Q000000981:diagnostic imaging*; D008297:Male; D012372:ROC Curve; D011859:Radiography; D012189:Retrospective Studies