Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico.
Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gómez.
J Clin Densitom. 2022 Oct-Dec;25(4):456-463. doi: 10.1016/j.jocd.2022.08.004. Epub 2022 Aug 17.
X-ray image of the hand is the most used technique to estimate bone age in children. For the analysis of bone mineral density using DXA in children, bone age may help to adjust such measurement in some cases. During image acquisition in DXA, an anteroposterior image of the hand may be acquired and used to evaluate bone age but few studies have evaluated the agreement between conventional X-ray and DXA images. The aim of the study was to determine bone age estimation agreement between conventional X-ray images and DXA in children and adolescents aged 5 to 16 years of age. We performed an analytical cross-sectional study of 711 healthy subjects. Subject´s bone age, both in conventional X-ray, and DXA images were read independently by two expert evaluators blinded for chronological age. Intraobserver and inter-observer reproducibility were evaluated using Intraclass Correlation Coefficient (ICC), and the agreement between bone age estimations made by both evaluators was analyzed using ICC and Bland-Altman analysis. General agreement between techniques measured through ICC was 0.99 with a mean difference of 6 months between techniques being older the ages obtained by DXA. The agreement limits were around ±2 years, which means that 95% of all differences between techniques were covered within this range. We found a high level of ICC agreement in bone age readings from X-ray and DXA images although we observed overestimation of bone age measurements in DXA. Differences between techniques were greater in women than in men, especially at the ages corresponding to puberty. Bone age measurement in DXA images appears not to be reliable; hence it should be suggested to perform conventional radiography of the hand to assess bone age taking into account that X-ray images have better resolution.
手部 X 射线图像是估计儿童骨龄最常用的技术。对于使用 DXA 分析儿童的骨矿物质密度，在某些情况下，骨龄可能有助于调整这种测量。在 DXA 图像采集期间，可能会获取手部前后位图像，并用于评估骨龄，但很少有研究评估常规 X 射线和 DXA 图像之间的一致性。本研究的目的是确定 5 至 16 岁儿童和青少年常规 X 射线和 DXA 图像之间骨龄估计的一致性。我们对 711 名健康受试者进行了分析性横断面研究。由两名独立的专家评估者在不知道实际年龄的情况下对受试者的常规 X 射线和 DXA 图像的骨龄进行了阅读。使用组内相关系数（ICC）评估了观察者内和观察者间的可重复性，并使用 ICC 和 Bland-Altman 分析评估了两位评估者之间的骨龄估计一致性。通过 ICC 测量的两种技术之间的总体一致性为 0.99，平均差异为 6 个月，DXA 获得的年龄较大。协议范围在±2 年左右，这意味着两种技术之间 95%的所有差异都在该范围内。我们发现 X 射线和 DXA 图像的骨龄读数具有很高的 ICC 一致性，但我们观察到 DXA 中的骨龄测量值存在高估。在女性中，技术之间的差异大于男性，尤其是在对应于青春期的年龄。DXA 图像中的骨龄测量似乎不可靠；因此，建议对手部进行常规 X 射线检查以评估骨龄，同时考虑到 X 射线图像具有更好的分辨率。
