Płudowski Paweł, Lebiedowski Michał, Lorenc Roman S
Department of Biochemistry and Experimental Medicine, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-736, Warsaw, Poland.
Osteoporos Int. 2004 Apr;15(4):317-22. doi: 10.1007/s00198-003-1545-6. Epub 2003 Nov 13.
The classical method of skeletal age assessment is based on the recognition of changes in the radiographic appearance of the maturity indicators in hand-wrist radiographs by comparison with a reference atlas. The purpose of this study was the evaluation of the possibility to assess bone age using a less invasive method such as dual-energy X-ray absorptiometry (DXA). Bone ages of 50 children free of any chronic diseases (5-18 years old) and ten with multihormonal pituitary deficiency (MPD) (8-20 years old) were assessed using an Expert-XL densitometer. Hand scans and classical hand-wrist radiographs were evaluated by two independent observers for bone age by visual comparison with reference standards of skeletal development published in the atlas. The precision errors of duplicate bone age ratings were low both for radiographs (<1%) and DXA hand scans (<0.9%). A high degree of agreement between bone age ratings done by two observers was assessed by intraclass correlation coefficients. The same bone age based on radiographs and DXA hand scans was assessed in 44 of 60 cases (73.3%); in 16 cases the differences between bone age were no higher than 0.5 year. No significant difference between mean bone age based on radiographs and DXA hand scans was observed ( P>0.05). Moreover, there was a very strong correlation between bone age results ( r=0.998; r(2)=0.996; P<0.0001), indicating agreement of bone age assessments based on DXA and radiographic images. Remarkable differences (up to 3 years) between bone age and chronological age were observed in healthy subjects, probably reflecting the effect of the secular trend towards earlier maturation or alterations in pubertal development. The study indicates that evaluation of skeletal maturity using DXA images is less invasive (up to 8 micro Sv) than radiography, giving results comparable to the classical method.
骨骼年龄评估的经典方法是通过将手部腕部X光片中成熟指标的放射学表现与参考图谱进行比较来识别变化。本研究的目的是评估使用双能X线吸收法（DXA）这种侵入性较小的方法来评估骨龄的可能性。使用Expert-XL骨密度仪对50名无任何慢性疾病的儿童（5 - 18岁）和10名患有多激素垂体功能减退（MPD）的儿童（8 - 20岁）的骨龄进行了评估。由两名独立观察者通过与图谱中公布的骨骼发育参考标准进行视觉比较，对手部扫描图像和经典的手部腕部X光片进行骨龄评估。对于X光片（<1%）和DXA手部扫描（<0.9%），重复骨龄评级的精确误差都很低。通过组内相关系数评估了两名观察者进行的骨龄评级之间的高度一致性。在60例中的44例（73.3%）中，基于X光片和DXA手部扫描评估出了相同的骨龄；在16例中，骨龄差异不超过0.5岁。基于X光片和DXA手部扫描的平均骨龄之间未观察到显著差异（P>0.05）。此外，骨龄结果之间存在非常强的相关性（r = 0.998；r² = 0.996；P<0.0001），表明基于DXA和放射图像的骨龄评估具有一致性。在健康受试者中观察到骨龄与实际年龄之间存在显著差异（高达3岁），这可能反映了早熟的长期趋势或青春期发育改变的影响。该研究表明，使用DXA图像评估骨骼成熟度的侵入性比放射成像小（高达8微希沃特），且结果与经典方法相当。
