title: Automated Greulich-Pyle bone age determination in children with chronic kidney disease.
abstract: BACKGROUND
  Growth restriction and retarded bone age are common findings in children with chronic kidney disease (CKD). We compared the automated BoneXpert™ method with the manual assessment of an X-ray of the non-dominant hand.
  
  
  METHODS
  In this retrospective multicenter study, 359 patients with CKD stages 2-5, aged 2-14.5 (girls) or 2.5-17 years (boys) were included. Bone age was determined manually by three experts (according to Greulich and Pyle). Automated determination of bone age was performed using the image analysis software BoneXpert™.
  
  
  RESULTS
  There was a strong correlation between the automatic and the manual method (r = 0.983, p < 0.001). The automatic method tended to generate higher bone age values (0.64 ± 0.73 years) in the younger patients (4-5 years) and to underestimate retardation or acceleration of bone age. The so-called "bone health index" (BHI) was reduced in comparison to the reference population. Bone health index standard deviation score (BHI-SDS) was not related to the stage of CKD, but weakly negatively correlated with plasma PTH concentrations (r = 0.12, p = 0.019).
  
  
  CONCLUSIONS
  BoneXpert™ allows an objective, time-saving, and in general valid bone age assessment in children with CKD. Possible underestimation of retarded or accelerated bone age should be taken into account. Validation of the BHI needs further study.
authors: Department of Pediatrics and Adolescent Medicine, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
authors: Eva
authors: E
authors: Nüsken
authors: Darja
authors: D
authors: Imschinetzki
authors: Kai-Dietrich
authors: KD
authors: Nüsken
authors: Friederike
authors: F
authors: Körber
authors: Hans-Joachim
authors: HJ
authors: Mentzel
authors: Joachim
authors: J
authors: Peitz
authors: Martin
authors: M
authors: Bald
authors: Rainer
authors: R
authors: Büscher
authors: Ulrike
authors: U
authors: John
authors: Günter
authors: G
authors: Klaus
authors: Martin
authors: M
authors: Konrad
authors: Lars
authors: L
authors: Pape
authors: Burkhard
authors: B
authors: Tönshoff
authors: David
authors: D
authors: Martin
authors: Lutz
authors: L
authors: Weber
authors: Jörg
authors: J
authors: Dötsch
mesh_terms: D000293:Adolescent; D000365:Age Determination by Skeleton / Q000379:methods*; D001331:Automation; D001847:Bone Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000209:etiology / Q000473:pathology; D006225:Hand / Q000000981:diagnostic imaging; D006304:Health Status; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007677:Kidney Function Tests; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D010281:Parathyroid Hormone