Sun Yuxin, Zhou Zhibo, Zheng Xueqing, Du Hanze, Wang Fengdan, Chen Shi, Pan Hui
Eight-Year Program of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Pediatr Radiol. 2025 Sep 2. doi: 10.1007/s00247-025-06363-7.
Hand-wrist radiographs may not fully reflect skeletal bone age (BA) during mid-to-late puberty. Knee magnetic resonance imaging (MRI), a non-radiative imaging technique, may provide detailed evaluation of the lower limbs.
To validate the San Diego MRI-based knee BA atlas in a Chinese adolescent cohort presenting with growth deceleration, evaluate the concordance between knee and hand-wrist BA, and explore factors influencing potential discrepancies.
This study involved 227 adolescents. Hand-wrist BA was assessed using the Greulich and Pyle atlas with hand-wrist radiographs, and knee BA using the San Diego atlas with knee MRI. Correlations between knee BA, hand-wrist BA, and chronological age (CA) were analyzed. Discrepancies between the two sites were further evaluated for associated clinical factors.
Knee BA correlated better with CA (r = 0.816, P < 0.001) than with hand-wrist BA (r = 0.763, P < 0.001). The mean difference between hand-wrist BA and CA was 1.08 ± 1.19 years, and between knee BA and CA was 0.71 ± 1.06 years (P < 0.001). 14.1% of adolescents showed more advanced knee maturity than hand-wrist bones. Thyroid-stimulating hormone (TSH) levels were positively associated with the difference between hand-wrist and knee BA (r = -0.198, P = 0.011). Subclinical hypothyroidism significantly increased the risk of knee overmaturity (OR = 6.022, P < 0.001).
Knee MRI is a reliable imaging modality for assessing skeletal maturity in adolescents with growth retardation. A moderate correlation was observed between hand-wrist and knee BA. In adolescents with elevated TSH levels, knee MRI may be preferable to hand-wrist radiographs for predicting final height, evaluating growth potential, and guiding growth hormone therapy decisions.
在青春期中后期，手部 - 腕部X光片可能无法完全反映骨骼年龄（BA）。膝关节磁共振成像（MRI）作为一种非辐射成像技术，可对下肢进行详细评估。
在中国一组生长减速的青少年队列中验证基于圣地亚哥MRI的膝关节BA图谱，评估膝关节和手部 - 腕部BA之间的一致性，并探讨影响潜在差异的因素。
本研究纳入227名青少年。通过手部 - 腕部X光片使用格雷利希和派尔图谱评估手部 - 腕部BA，通过膝关节MRI使用圣地亚哥图谱评估膝关节BA。分析膝关节BA、手部 - 腕部BA和实际年龄（CA）之间的相关性。进一步评估两个部位之间差异的相关临床因素。
膝关节BA与CA的相关性（r = 0.816，P < 0.001）优于与手部 - 腕部BA的相关性（r = 0.763，P < 0.001）。手部 - 腕部BA与CA的平均差异为1.08 ± 1.19岁，膝关节BA与CA的平均差异为0.71 ± 1.06岁（P < 0.001）。14.1%的青少年膝关节成熟度高于手部 - 腕部骨骼。促甲状腺激素（TSH）水平与手部 - 腕部和膝关节BA之间的差异呈正相关（r = -0.198，P = 0.011）。亚临床甲状腺功能减退显著增加膝关节过度成熟的风险（OR = 6.022，P < 0.001）。
膝关节MRI是评估生长迟缓青少年骨骼成熟度的可靠成像方式。手部 - 腕部和膝关节BA之间存在中度相关性。在TSH水平升高的青少年中，膝关节MRI在预测最终身高、评估生长潜力和指导生长激素治疗决策方面可能优于手部 - 腕部X光片。
