De Sanctis Vincenzo, Soliman Ashraf T, Di Maio Salvatore, Bedair Said
Quisisana Hospital, Ferrara, Italy.
Pediatr Endocrinol Rev. 2014 Dec;12(2):200-5.
Bone Age Assessment (BAA) is performed worldwide for the evaluation of endocrine, genetic and chronic diseases, to monitor response to medical therapy and to determine the growth potential of children and adolescents. It is also used for consultation in planning orthopedic procedures, for determination of chronological age for adopted children, youth sports participation and in forensic settings. The main clinical methods for skeletal bone age estimation are the Greulich and Pyle (GP) and the Tanner and Whitehouse (TW) methods. Seventy six per cent (76%) of radiologists or pediatricians usually use the method of GP, 20% that of TW and 4% other methods. The advantages of using the TW method, as opposed to the GP method, are that it overcomes the subjectivity problem and results are more reproducible. However, it is complex and time consuming; for this reason its usage is just about 20% on a world-wide scale. Moreover, there are some evidences that bone age assignments by different physicians can differ significantly. Computerized and Quantitative Ultrasound Technologies (QUS) for assessing skeletal maturity have been developed with the aim of reducing many of the inconsistencies associated with radiographic investigations. In spite of the fact that the volume of automated methods for BAA has increased, the majotity of them are still in an early phase of development. QUS is comparable to the GP based method, but there is not enough established data yet for the healthy population. The Authors wish to stimulate the attention on the accuracy, reliability and consistency of BAA and to initiate a debate on manual versus automated approaches to enhance our assessment for skeletal matutation in children and adolescents.
骨龄评估（BAA）在全球范围内用于评估内分泌、遗传和慢性疾病，监测药物治疗反应，以及确定儿童和青少年的生长潜力。它还用于骨科手术规划咨询、确定领养儿童的实足年龄、青少年体育参与以及法医鉴定。骨骼骨龄估计的主要临床方法是格吕利希和派尔（GP）法以及坦纳和怀特豪斯（TW）法。76%的放射科医生或儿科医生通常使用GP法，20%使用TW法，4%使用其他方法。与GP法相比，使用TW法的优点是它克服了主观性问题，结果更具可重复性。然而，它复杂且耗时；因此，其在全球范围内的使用率仅约为20%。此外，有一些证据表明不同医生给出的骨龄判定可能存在显著差异。为评估骨骼成熟度而开发的计算机化和定量超声技术（QUS），旨在减少与放射学检查相关的许多不一致性。尽管用于骨龄评估的自动化方法数量有所增加，但其中大多数仍处于早期开发阶段。QUS与基于GP的方法相当，但针对健康人群的既定数据还不够。作者希望引起人们对骨龄评估的准确性、可靠性和一致性的关注，并引发一场关于手动与自动方法的辩论，以加强我们对儿童和青少年骨骼成熟度的评估。
