Determination of bone age and evaluating the applicability of Greulich-Pyle standards among the Turkish children

Yıl 2022, Cilt: 6 Sayı: 1, 9 - 13, 01.01.2022

Esra Özgül , Aylin Yücel Furkan Kaya , Serkan Bilge Koca , Ayşe Ertekin

https://doi.org/10.28982/josam.1021045

Öz

Background/Aim: Bone age (BA) is important in the diagnosis and follow-up of pediatric growth disorders. Skeletal maturation can vary according to the geographical region and climate. The goal of this study is to investigate whether Greulich-Pyle (GP) method is suitable for detecting BA for Turkish children for all age groups and both genders.
Methods: In our retrospective cohort study, the roentgenograms of all pediatric patients who visited the pediatrics or pediatric endocrinology outpatient clinics and underwent left hand and wrist radiographs for suspicious trauma or BA determination were examined with reference to the GP atlas. Patients without evidence of chronic disease or growth disorders with body size and weight values between the 25th-75th percentile were included. Poor quality roentgenograms were excluded.
Results: Radiographs of 665 patients were analyzed and 310 (161 boys and 149 girls, age range 13-203 months) patients were included. The rate of concordant BA with CA was significantly higher in the children above 120 months of age and low BA was significantly higher among the children aged 120 months or below (P<0.001). The rate of concordant BA with CA was significantly higher among girls and low BA was significantly higher among boys (P=0.014). Among patients aged 120 months or below, low BA was significantly higher in the boys (P<0.001). There were no significant differences between the boys and girls aged 120 months and above (P=1.000)
Conclusion: Although widely used in the determination BA, local studies on the accuracy and reliability of the GP method are insufficient in less developed countries. The accuracy of this method in Turkish children, especially boys under the age of 10 years, is controversial, and correct standards should be developed.

Anahtar Kelimeler

Bone age, Greulich-Pyle, Chronogical age, Wrist and hand, Skeletal maturation

Kaynakça

• 1. Govender D, Goodier M. Bone of contention: The applicability of the Greulich-Pyle method for skeletal age assessment in South Africa. SA J Radiol. 2018;22(1):1348. doi: 10.4102/sajr.v22i1.1348. PMID: 31754503; PMCID: PMC6837818.
• 2. Groell R, Lindbichler F, Riepl T, Gherra L, Roposch A, Fotter R. The reliability of bone age determination in central European children using the Greulich and Pyle method. Br J Radiol. 1999;72(857):461-4. doi: 10.1259/bjr.72.857.10505010. PMID: 10505010.
• 3. Aydin, AM, Poyraz, AK, Akarsu S, Ozdemir H, Yildirim H, Ogur E. Observer variability of pediatric bone age assessment by using the Greulich and Pyle method. Firat Med J. 2014;19(1):17-21.
• 4. Mora S, Boechat MI, Pietka E, Huang HK, Gilsanz V. Skeletal age determinations in children of European and African descent: applicability of the Greulich and Pyle standards. Pediatr Res. 2001;50(5):624-8. doi: 10.1203/00006450-200111000-00015
• 5. Cole AJ, Webb L, Cole TJ. Bone age estimation: A comparison of methods. Br J Radiol. 1988;61(728):683-6. doi: 10.1259/0007-1285-61-728-683
• 6. Gilli G. The assessment of skeletal maturation. Horm Res Paediatr. 1996;45(Suppl. 2):49-52. doi: 10.1159/000184847
• 7. King DG, Steventon DM, O'Sullivan MP, et al. Reproducibility of bone ages when performed by radiology registrars: an audit of Tanner and Whitehouse II versus Greulich and Pyle methods. Br J Radiol. 1994;67(801):848-51. doi: 10.1259/0007-1285-67-801-848.
• 8. Milner GR, Levick RK, Kay R. Assessment of bone age: a comparison of the Greulich and Pyle, and the Tanner and Whitehouse methods. Clin Radiol. 1986;37(2):119-21. doi:10.1016/s0009-9260(86)80376-2.
• 9. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. Am J Med Sci.1959;238(3):393. doi: 10.1097/00000441-195909000-00030
• 10. Büken B, Şafak AA, Yazıcı B, Büken E, Mayda AS. Is the assessment of bone age by the Greulich–Pyle method reliable at forensic age estimation for Turkish children? Forensic Sci Int. 2007;173(2):146-53. doi: 10.1016/j.forsciint.2007.02.023
• 11. Koç A, Karaoglanoglu M, Erdogan M, Kosecik M, Cesur Y. Assessment of bone ages: Is the Greulich Pyle method sufficient for Turkish boys? Pediatr Int. 2001;43(6):662-5. doi: 10.1046/j.1442-200X.2001.01470.x
• 12. Lewis C, Lavy C, Harrison W. Delay in skeletal maturity in Malawian children. Bone Joint J. 2002;84(5):732-4. doi: 10.1302/0301-620X.84B5.0840732
• 13. Moradi M, Sirous M, Morovatti P. The reliability of skeletal age determination in an Iranian sample using Greulich and Pyle method. Forensic Sci Int. 2012;223(1):372.e1-4. doi: 10.1016/j.forsciint.2012.08.030
• 14. Dembetembe KA, Morris AG. Is Greulich-Pyle age estimation applicable for determining maturation in male Africans? S Afr J Sci. 2012;108(9/10):1-6. doi: 10.4102/sajs.v108i9/10.1036
• 15. Van Rijn RR, Lequin MH, Robben SG, Hop WC, van Kuijk C. Is the Greulich and Pyle atlas still valid for Dutch Caucasian children today? Pediatr Radiol. 2001;31(10):748-52. doi: 10.1007/s002470100531
• 16. Chiang KH, Chou ASB, Yen PS, et al. The reliability of using Greulich-Pyle method to determine children’s bone age in Taiwan. Tzu Chi Med J. 2005;17(6):417-20.
• 17. Alshamrani K, Offiah AC. Applicability of two commonly used bone age assessment methods to twenty-first century UK children. Eur Radiol. 2020;30(1):504-13. doi: 10.1007/s00330-019-06300-x.
• 18. De Donno A, Santoro V, Lubelli S, Marrone M, Lozito P, Introna F. Age assessment using the Greulich and Pyle method on a heterogeneous sample of 300 Italian healthy and pathologic subjects. Forensic Sci Int. 2013;10;229(1-3):157.e1-6. doi: 10.1016/j.forsciint.2013.03.002.
• 19. Dantas I, Pontual A, Almeida M, et al. Evaluation of the Greulich and Pyle method in the determination of bone age and chronological age in a Brazilian population. Derecho y Cambio Social. 2015;12:1-14.
• 20. Cantekin K, Celikoglu M, Miloglu O, Dane A, Erdem A. Bone age assessment: the applicability of the Greulich-Pyle method in eastern Turkish children. J Forensic Sci. 2012;57(3):679-82. doi: 10.1111/j.1556-4029.2011.02035.x.
• 21. Gungor OE, Celikoglu M, Kale B, Gungor AY, Sari Z. The reliability of the Greulich and Pyle atlas when applied to a Southern Turkish population. Eur J Dent. 2015;9(2):251-4. doi: 10.4103/1305-7456.156846.