Validation of automatic bone age rating in children with precocious and early puberty.
OBJECTIVE
Manual bone age (BA) rating in precocious puberty (PP) is associated with considerable rater variability. The aim was to evaluate a new method for automated Greulich and Pyle (GP) BA determination in children with PP.


METHODS
Seven hundred forty-one archived X-rays from 13 boys and 103 girls with PP or early puberty of various etiologies (age range at time of X-ray, 0.3-14.8 years; mean BA advancement, 2.3 years) were rated. Automatic rating (BoneXpert BA, or BXBA) was compared with the original manual GP rating (manual BA, or ManBA). X-rays where BXBA deviated from ManBA by more than 1.5 years were rerated by three raters, and the average was formed (ReferenceBA).


RESULTS
All 741 X-rays, except nine (three images had poor quality and six were from children with a chronological age younger than 1.5 years), were analyzed automatically. The mean difference of BXBA-ManBA was -0.19 years; the SD of the differences was 0.76 years (95% confidence interval 0.72-0.80). ReferenceBA was determined for 41 images. A discrepancy from ReferenceBA greater 1.5 years was found in four images against BXBA and in 10 images against ManBA.


CONCLUSIONS
Automated BA is efficient and reliable in children with PP.
Pediatric Endocrinology and Diabetology, University Children's Hospital, Tübingen, Germany. david.martin@med.uni-tuebingen.de
David D
DD
Martin
Kathrin
K
Meister
Roland
R
Schweizer
Michael B
MB
Ranke
Hans Henrik
HH
Thodberg
Gerhard
G
Binder
D000293:Adolescent; D000365:Age Determination by Skeleton / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D050276:Hand Bones / Q000000981:diagnostic imaging* / Q000254:growth & development; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D011627:Puberty; D011629:Puberty, Precocious / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015203:Reproducibility of Results
D007987:Gonadotropin-Releasing Hormone