Paediatric Imaging Department, Queen Fabiola Children's Hospital (HUDERF), Université Libre de Bruxelles, Avenue Jean Joseph Crocq 15, 1020, Brussels, Belgium.
Department of Radiology, Auckland City Hospital, Auckland, New Zealand.
Pediatr Radiol. 2024 Feb;54(2):316-323. doi: 10.1007/s00247-023-05844-x. Epub 2024 Jan 16.
Several pathological conditions can lead to variations in bone mineral content during growth. When assessing bone age, bone mineral content can be estimated without supplementary cost and irradiation. Manual assessment of bone quality using the Exton-Smith index (ESI) and automated assessment of the bone health index (BHI) provided by the BoneXpert® software are available but still not validated in different ethnic groups.
Our aim is to provide normative values of the ESI and BHI for healthy European Caucasian and first-generation children of North Africans living in Europe.
A sex- and aged-match population of 214 girls (107 European-Caucasian and 107 North African) and 220 boys (111 European-Caucasian and 109 North African) were retrospectively and consecutively included in the study. Normal radiographs of the left hand and wrist from healthy children were retrieved from those performed in a single institution from 2008 to 2017 to rule out a left-hand fracture. Radiographs were processed by BoneXpert® to obtain the BHI and BHI standard deviation score (SDS). One radiologist, blinded to BHI values, manually calculated ESI for each patient. The variability for both methods was assessed and compared using the standard deviation (SD) of the median (%) for each class of age and sex, and ESI and BHI trends were compared by sex and ethnic group.
The final population comprised 434 children ages 3 to 15 years (214 girls). Overall, BHI was lower in North African children (mean = 4.23 for girls and 4.17 in boys) than in European Caucasians (mean = 4.50 for girls and 4.68 in boys) (P < 0.001). Regardless of ethnicity, 29 girls (13.6%) and 34 boys (15.5%) had BHI more than 2 SD from the mean. While correlated to BHI, ESI has a higher variability than BHI and is more pronounced from 8-12 years for both sexes (mean ESI in European Caucasian girls and boys 17.47 and 20.87, respectively) (P < 0.001). ESI showed more than 15% variability in European girls from 8-12 years and a plateau in North African boys from 12 years to 16 years. However, the BHI has less than 15% variability regardless of age and ethnic group.
BHI may be a reliable tool to detect children with abnormal bone mineral content, with lower variability compared to ESI and with specific trends depending on sex and ethnicity.
在生长过程中，有几种病理状况会导致骨矿物质含量发生变化。在评估骨龄时，可以在不增加额外成本和辐射的情况下估计骨矿物质含量。Exton-Smith 指数（ESI）的手动评估和 BoneXpert®软件提供的骨健康指数（BHI）的自动评估已经存在，但在不同种族中尚未得到验证。
我们旨在为生活在欧洲的欧洲白人和北非第一代儿童提供 ESI 和 BHI 的正常参考值。
本研究回顾性连续纳入了 214 名女孩（107 名欧洲白人和 107 名北非）和 220 名男孩（111 名欧洲白人和 109 名北非），这些儿童的左手和腕部正常 X 光片是从 2008 年至 2017 年在一家机构拍摄的，以排除左手骨折。通过 BoneXpert®处理 X 光片以获取 BHI 和 BHI 标准差评分（SDS）。一位对 BHI 值不知情的放射科医生为每位患者手动计算 ESI。使用每个年龄和性别的中位数（%）的标准差（SD）评估和比较两种方法的变异性，并按性别和种族组比较 ESI 和 BHI 趋势。
最终的研究人群包括 434 名 3 至 15 岁的儿童（214 名女孩）。总体而言，北非儿童的 BHI 低于欧洲白种人（女孩平均 4.23，男孩平均 4.17）（P<0.001）。无论种族如何，29 名女孩（13.6%）和 34 名男孩（15.5%）的 BHI 均高于平均值的 2 个标准差。虽然与 BHI 相关，但 ESI 的变异性高于 BHI，并且在男女两性 8-12 岁时更为明显（欧洲白种女孩和男孩的平均 ESI 分别为 17.47 和 20.87）（P<0.001）。在 8-12 岁时，欧洲女孩的 ESI 变异性超过 15%，而北非男孩的 ESI 从 12 岁到 16 岁时呈平台期。然而，BHI 的变异性无论年龄和种族群体如何均小于 15%。
BHI 可能是一种可靠的工具，可以检测到骨矿物质含量异常的儿童，与 ESI 相比，BHI 的变异性更低，并且具有特定的性别和种族趋势。
