title: Paraphyseal changes on bone-age studies predict risk of delayed radiation-associated skeletal complications following total body irradiation.
abstract: BACKGROUND
  Children undergoing total body irradiation (TBI) often develop delayed skeletal complications. Bone-age studies in these children often reveal subtle paraphyseal changes including physeal widening, metaphyseal irregularity and paraphyseal exostoses.
  
  
  OBJECTIVE
  To investigate whether paraphyseal changes on a bone-age study following TBI indicate a predisposition toward developing other radiation-associated skeletal complications.
  
  
  METHODS
  We retrospectively reviewed medical records and bone-age studies of 77 children receiving TBI at our institution between 1995 and 2008 who had at least 2 years of clinical follow-up and one bone-age study after TBI. We graded bone-age studies according to the severity of paraphyseal changes. All documented skeletal complications following TBI were tabulated. Kendall's tau-b was used to examine associations between degree of paraphyseal change and development of a skeletal complication.
  
  
  RESULTS
  Kendall's tau analyses showed that physeal widening and metaphyseal irregularity/sclerosis (tau = 0.87, P < 0.001) and paraphyseal exostoses (tau = 0.68, P < 0.001) seen on bone-age studies were significantly positively associated with the development of delayed skeletal complications following TBI. Thirty percent of children with no or mild paraphyseal changes developed a delayed skeletal complication, compared with 58% of children with moderate paraphyseal changes and 90% of children with severe paraphyseal changes.
  
  
  CONCLUSIONS
  Paraphyseal changes identified on a bone-age study correlate positively with the development of delayed skeletal complications elsewhere in the skeleton following TBI.
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA19104, USA. mkitazono@gmail.com
authors.forename: Mary T
authors.initials: MT
authors.lastname: Kitazono Hammell
authors.forename: Nancy
authors.initials: N
authors.lastname: Bunin
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Edgar
authors.forename: Diego
authors.initials: D
authors.lastname: Jaramillo
mesh_terms: D000293:Adolescent; D000365:Age Determination by Skeleton / Q000706:statistics & numerical data*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006132:Growth Plate / Q000000981:diagnostic imaging* / Q000528:radiation effects*; D006801:Humans; D015994:Incidence; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D011832:Radiation Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014916:Whole-Body Irradiation / Q000706:statistics & numerical data*
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