学龄前儿童骨龄测评方法比较研究

目的 评价G-P法与中华-05法(TW3-C RUS、TW3-C Carpal及RUS-CHN)评估学龄前儿童骨龄的一致性.方法 分析3～6岁学龄前儿童行骨龄评估的手腕部X线平片,以生活年龄1岁为1组,分为4组.对每张X线平片进行4种骨龄方法评估,配对分析两两评估方法的一致性.结果 共纳入196例学龄前儿童,各年龄组1...     

计算机辅助评估骨龄(中国人手腕骨发育标准CHN法的计算机化)

目的:把中国人手腕骨发育标准CHN骨龄评估法计算机化,以期提高骨龄评估的快速易用性及准确性。方法:笔者将CHN骨龄评估法计算机化,并配以计算机化的标准图谱编制成骨龄辅助评估应用软件,并对39 份2～17岁儿童手腕骨,共546 块骨的X片进行计算机辅助骨龄评估法与人工骨龄评估法的骨发育分级的一致性和所用时间进行对照。结果:计算机辅助法骨发育分级的一致性明显高于人工法(P< 0.01),并且骨龄评估所需的时间亦明显少于人工法。结论:本系统骨龄评估的快速易用性、准确性及重复性明显优于人工法,值得推广应用     

超声多元计数法对婴儿骨龄测定的价值

目的：探讨超声对婴儿骨龄检查的可行性及多元计数法婴儿骨龄测定的价值。方法：采用5～8MHz探头,扫查309例1岁以内婴儿左侧踝、膝、髋、腕、肘、肩6个关节的标志性骨化中心,其中正常组136例,异常组173例。以标志性骨化中心出现的中位时间为界,计算骨龄系数（标志性骨化中心已出现数/应出现数）和骨龄（实际月龄×骨龄系数）。结果：正常男女组骨龄系数（1.034±0.05;1.066±0.096）与异常男女组骨龄系数（0.888±0.067;0.871±0.064）两两相比均有显著性差异（P〈0.01）;同组间男女无显著性差异（P〉0.05）;异常组先天性甲低、生长迟缓、佝偻病、早产4组疾病骨龄系数无显著性差异（P〉0.05）。但生长迟缓组与其他两组间两两比较均有显著性差异（P〈0.01）。结论：超声骨龄检查简单经济、无伤无痛,比目前常用的X线检查方法能更多的选取标志性骨化中心,不但结果更精确,而且可反复多次检查。骨龄系数的引入有利于骨龄的计算,超声多元计数法骨龄测定可客观评价婴儿骨龄,具有重要的临床价值。     

人工智能软件对住院医师X线骨龄诊断辅助效果初探

目的 评估骨龄人工智能(AI)软件对住院医师骨龄X线诊断报告书写的辅助效果.方法 回顾性随机选择56例生理年龄为3～6岁的患儿骨龄X线平片作为读片库,采用随机交叉自身对照试验方法进行研究.6名住院医师对56例图像进行2次读片,1次有AI结果辅助,另1次无AI结果辅助.3名高级职称医师读片结果的骨龄平均值作为诊断金标准....     

《中国人手腕骨发育标准—中华05》RUS-CHN法在当代少年运动员中的应用

目的探讨《中国人手腕骨发育标准-中华05》RUS-CHN法在当代少年运动员中的应用效果。方法分别采用RUS-CHN法和原骨龄标准CHN法,评价245名8~18岁不同项目少年运动员的左手腕骨骨龄。结果不同运动项目的少年运动员,RUS-CHN骨龄与生活年龄间的差异无显著性,但原标准CHN法骨龄与生活年龄之间的差值为正数(0.71~0.91岁),且差异显著(P<0.01)。与原标准CHN方法相比,新标准RUS-CHN法骨龄读数组距更细,频数分布更均匀,并减少了骨龄与生活年龄差值等于或大于2岁的少年运动员的例数。结论当代少年运动员表现出了生长发育加速的长期趋势,《中国人手腕骨发育标准-中华05》RUS-CHN法更适用于当代少年运动员。     

儿童骨龄测定的价值与临床应用

目的 通过对部分儿童进行骨龄测定,分析儿童骨龄与出生年龄的差异状况,研究骨龄测定的价值与临床应用.方法 对116例儿童左手、腕骨DR片做骨龄检测结果分析.结果 56例男性儿童出生年龄平均6.93岁,骨龄平均6.74岁,出生年龄与骨骼年龄相差0.19岁.男性儿童骨骼年龄与出生年龄对比,骨骼年龄大于出生年龄26例(46.43％);骨骼年龄等于出生年龄1例(1.79％);骨骼年龄小于出生年龄29例(51.79％).60例女性儿童出生年龄平均6.61岁,骨龄平均7.65岁,出生年龄与骨骼年龄相差1.04岁.女性儿童骨骼年龄与出生年龄对比,骨骼年龄大于出生年龄37例(61.67％);骨骼年龄等于出生年龄1例(1.67％);骨骼年龄小于出生年龄22例(36.67％).结论 骨龄是反映身体发育成熟度的可靠指标,骨龄测定能评价男女儿童骨发育情况,有助于早期发现身高异常的遗传及内分泌疾病,对治疗及监护具有重要作用.     

青海省西宁市青少年腕部骨龄评价

目的 探讨青海省西宁市(海拔2 000 m以上)青少年骨发育变化趋势.方法 采用分层整群抽样调查的方法,随机选取在西宁出生、生活、体检健康的973例7～16岁青少年(男498例,女475例)为研究对象,按CHN法进行手腕部骨龄评价.结果 西宁地区青少年骨龄与生活年龄相关,男:r=0.948,女:r=0.923.依据CHN法测定骨龄,西宁市青少年骨龄和生活年龄比较,男性青少年骨龄7～10岁组明显低于生活年龄(P<0.01),11岁后虽然低于 生活年龄,但与生活年龄比较无统计学意 义(P>0.05),而女性青少年骨龄7岁、8岁组低于生活年龄(P<0.05),10岁后接近生活年龄.结论 西宁市青少年骨发育具有地区性特点,10岁前青少年骨发育落后于低海拔地区.     

学龄前儿童X线骨龄测评

目的 通过X线对健康学龄前儿童手腕部骨龄测评,了解其生长发育的特点和变化趋势,制定新的学龄前儿童骨龄标准.资料与方法 采用横断面调查方法,于2006年3月至2009年3月随机抽取贵州省贵阳市中心城区0～6岁学龄前儿童4404例,摄左侧手腕部正位X线平片,用TW3法测评骨成熟分(SMS).绘制SMS趋势图,制定学龄前儿童骨龄百分位表,统计各观察骨骨化中心萌出率.结果 低龄组儿童(＜1岁)各组SMS差异不大.按TW3标准测评R、C系列骨龄较实际年龄大;按TW2CH标准测评C系列与实际年龄基本相符.得到R、C系列SMS百分位表.得到各观察骨骨化中心萌出率表.结论 低龄组儿童进一步分组已无必要.TW3标准与国人出入较大,需要制定符合本国国情的骨龄评测标准.各观察骨骨化中心萌出情况与既往一致.     

西宁市青少年生长发育与骨龄的调查研究

目的：调查西宁市青少年骨龄状况,探讨其与生长发育的关系.方法：采用分层整群抽样调查的方法,随机选取在西宁出生、生活、经体检证明健康的973例7岁～16岁青少年为研究对象,调查身高、体重,按CHN法进行手腕部骨龄评价和营养状况评价,并与191995年测定标准和沿海城市身高、体重均数比较.结果：西宁市青少年骨龄与生活年龄呈高度正相关,男：r=0.948,女：r=0.923;青少年骨发育延迟.各年龄组青少年平均身高低于沿海城市平均身高;平均体重除男12岁以前各组高于1995年水平外,均低于沿海城市.结论：西宁市青少年生长发育有地区性特点,身高和体重低于低海拔地区,青少年体瘦与骨骼成熟度的延迟相关.     

中国人手腕骨发育标准-中华05Ⅱ. RUS-CHN 和TW3-C腕骨方法的读片可靠性

目的检验《中国人手腕骨发育标准-中华05》的RUS-CHN和TW3-C对腕骨骨龄评价的可靠性.方法11名有不同骨龄评价经验的评价者以RUS-CHN法评价75名儿童左手腕后前位X线片(骨龄3-18岁),其中7名评价者以TW3-C腕骨方法评价46名儿童腕骨X线片(骨龄3～13.5岁);20天后重复阅读.结果评价者内的RUS-CHN骨发育等级评价重复率为63.4%～82.2%,单一读数的95%置信区间为±0.40岁～±0.76岁;评价者内的TW3-C腕骨等级评价重复率为65.6%～83.2%,单一读数的95%置信区间为±0.38岁～±0.71岁.评价者间的RUS-CHN等级评价重复率为61.3%～77.3%,单一读数的95%置信区间为±0.42岁～±0.96岁;评价者间的TW3-C腕骨等级评价重复率为77.4%～88.0%,单一读数的95%置信区间为±0.42岁～±0.78岁.结论具备不同经验的评价者,其评价骨龄的可靠性有显著性差异;有经验者读片可靠性水平较高,少数无经验者通过一次学习培训可以达到有经验者的水平,但大部分无经验者的评价可靠性较低,需进一步学习与实践.     

Skeletal age determination in children

Determination of skeletal age in the growing patient is very important for various diagnostic questions. It is the most objective criterion of growth and development. Accordingly, it is necessary to be familiar with the most common methods used at present to estimate bone age in childhood. In newborns and infants skeletal age is usually determined from a lateral x-ray of the left lower leg, including knee and foot; after three month of age, an x-ray of the left hand is used. We present methods of assessing bone age from lower leg (v. Harnack) and from the left hand (Greulich-Pyle; Tanner-Whitehouse; de Roo and Schr?der).     

Age-related changes in the global skeletal uptake of technetium-99m methylene diphosphonate in healthy women

A short-term evaluation of global skeletal uptake (GSU) of technetium-99m methylene diphosphonate (MDP) was performed in 40 healthy female subjects with a wide age range in order to investigate the clinical performance of the technique and to detect the age-related changes in bone turnover. The results obtained were compared with measurements of the main biochemical markers of skeletal metabolism. We found that GSU increases progressively with age, independently of concomitant changes in renal function; significant correlations with biochemical markers of bone formation were also found. Therefore, the method appears to provide useful information concerning the bone turnover rate, and is also applicable to elderly people owing to its simplicity.     

Skeletal age assessment in children and young adults: comparison between a newly developed sonographic method and conventional methods

Objective. To compare the performance of a new sonographic (US) method of bone age estimation with other methods currently in use. Design and patients. One hundred and fifteen subjects underwent left hand/wrist radiography and US examination of the hip for bone age assessment. For each patient, measurements of skeletal age were available based on Greulich-Pyle and Tanner and Whitehouse, the latter being presented in three subtypes (RUS, carpals, and B20) in addition to the US values. To assess agreement between methods, each method was compared with every other method. Differences between calculated skeletal age and chronological age were assessed, and the sensitivity, specificity, and predictive values of each method computed. Results. Coupled B20/RUS values showed the best agreement, with 95% of observations within 2.45 years of each other, followed by carpals/B20, B20/GP, and GP/RUS. The US method agreed the least (difference of 4.19–5.13 years) with the other methods. The US method provided 85.8% (US vs RUS) to 91.3% (US vs GP) concordant results in recognizing differences between skeletal and chronological age, and showed a 72.5% sensitivity and a 56.8% specificity. Conclusion. Although the US method promises to permit a safe and cost-effective assessment of skeletal age, its low accuracy makes it currently unsuitable for clinical use.     

Assessment of Bone Age in Prepubertal Healthy Korean Children: Comparison among the Korean Standard Bone Age Chart,Greulich-Pyle Method,and Tanner-Whitehouse Method

ObjectiveTo compare the reliability of the Greulich-Pyle (GP) method, Tanner-Whitehouse 3 (TW3) method and Korean standard bone age chart (KS) in the evaluation of bone age of prepubertal healthy Korean children.ResultsSignificant correlations were found between chronological age and bone age estimated by all three methods in whole group and in each gender (R² ranged from 0.87 to 0.9, p < 0.01). Although bone age estimated by KS was slightly closer to chronological age than those estimated by the GP and TW3 methods, the difference between three methods was not statistically significant (p > 0.01).ConclusionThe KS, GP, and TW3 methods show good reliability in the evaluation of bone age of prepubertal healthy Korean children without significant difference between them. Any are useful for evaluation of bone age in prepubertal healthy Korean children.     

Significance of radiologic skeletal age determination in clinical practice

Skeletal development is an important maturity indicator during childhood. In clinical practice determination of skeletal age is helpful for the diagnosis of disorders of growth and development. Most hormones have specific effects on skeletal maturation. Thus, different disease states (growth disorders, disorders of pubertal development, chronic disorders of the bowels, kidneys, heart etc.) are characterized by retardation or acceleration of skeletal maturation. Therapeutic effects as well as side effects of hormones can be monitored by skeletal age determination. Typical disharmonic patterns in the appearance of bone centres of hand and wrist have been found in certain disorders of development.     

Hand radiographic measurements in growth hormone deficiency before and after treatment.

Hand radiographs in 10 male patients (eight white, two black) with isolated growth hormone deficiency were studied before and after treatment. The length of the second metacarpal was the most significantly depressed measurement when considered by chronologic age and responded most to treatment with human growth hormone. All patients had osteoporosis even when evaluated by height age. The bone mass improved with treatment by subperiosteal new bone apposition. Skeletal maturation was retarded with the carpals showing more severe retardation than the tubular bones and responding more dramatically to treatment. The depression in height age and carpal age was very similar, indicating that the carpal age may have the greatest correlation with height. The greater sensitivity of the carpal age deficiency of growth hormone and its greater response to treatment suggest that the carpal age and the phalangeal-metacarpal age should be considered independently during evaluation of skeletal maturation.     

The prospect of incidental detection of unsuspected skeletal tuberculosis by bone scintigraphy should not be overlooked

BACKGROUND: The potential roles of bone scintigraphy in the evaluation of tuberculosis are not well-defined. It is commonly considered that skeletal tuberculosis occurs only after pulmonary tuberculosis. Bone scintigraphy was not known to be an effective imaging modality in the evaluation of skeletal tuberculosis, especially in those without known systemic tuberculosis. PURPOSE: To assess the prospect of bone scintigraphy in the detection of skeletal tuberculosis in patients who came to the department of nuclear medicine to evaluate back pain. METHODS: Patient records and the images of 1817 cases of consecutive bone scintigraphy performed for the evaluation of unknown causes of back pain were retrospectively reviewed. The imaging findings were compared with the status of tuberculosis before and after scintigraphy. RESULTS: Sixteen patients had skeletal tuberculosis confirmed by histopathological examination. Six patients had solitary while 10 had multifocal skeletal lesions. Before bone scintigraphy, 2 patients were suspected but not confirmed to have pulmonary tuberculosis, 4 were suspected to have skeletal tuberculosis by other modalities while the remaining 10 patients were not suspected to have tuberculosis in any part of the body. Following bone scintigraphy, among those 10 patients who were unsuspected of having tuberculosis, further tests demonstrated that 3 had pulmonary tuberculosis in addition to skeletal tuberculosis and 1 had cervical tuberculous lymphadenitis. In total, among those 16 patients with confirmed skeletal tuberculosis, only 6 had concurrent extraskeletal tuberculosis while 10 patients had their tuberculosis limited to the skeletal system. CONCLUSIONS: Our results indicate that pulmonary or systemic tuberculosis is not a prerequisite for skeletal tuberculosis. Skeletal tuberculosis should be among the differential diagnoses when there is a positive bone scan in patients without a malignancy in an endemic region.     

Natural history and distribution of bone and bone marrow infarction in sickle hemoglobinopathies.

METHODS: Over a period of 11 y, 50 patients (22 males, 28 females; age range, 8 mo to 22 y) presenting with sickle cell-associated bone pain underwent 93 sequential examinations with 99mTc-sulfur colloid bone marrow scanning and 99mTc-diphosphonate bone scanning. Multiple examinations were performed on 21 patients. The number and distribution of total acute, healed, and nonhealed infarcts by location were recorded on a skeletal homunculus. RESULTS: For this population, the total number of sites of bone and bone marrow infarction was 464. Of these, 175 were classified as acute by clinical and scintigraphic findings. There were a total of 61 nonhealed sites and 162 healed sites. CONCLUSION: Knowledge of the distribution and natural history of sites of bone and bone marrow infarction is of considerable clinical and diagnostic import in the ongoing evaluation and treatment of sickle hemoglobinopathies.     

Omission of bone scanning according to staging guidelines leads to futile therapy in non-small cell lung cancer

The leading European and American professional societies recommend that bone scans (BS) should be performed in the staging of lung cancer only in those patients with bone pain. This prospective study investigated the sensitivity of conventional skeletal scintigraphy in detecting osseous metastases in patients with lung cancer and addressed the potential consequences of failure to use this method in the work-up of asymptomatic patients. Subsequent to initial diagnosis of non-small cell lung cancer, 100 patients were examined and questioned regarding skeletal complaints. Two specialists in internal medicine decided whether they would recommend a bone scan on the basis of the clinical evaluation. Skeletal scintigraphy was then performed blinded to the findings of history and physical examination. The combined results of magnetic resonance imaging (MRI) of the vertebral column, positron emission tomography (PET) of skeletal bone and the subsequent clinical course served as the gold standard for the identification of osseous metastases. Bone scintigraphy showed an 87% sensitivity in the detection of bone metastases. Failure to perform skeletal scintigraphy in asymptomatic patients reduced the sensitivity of the method, depending on the interpretation of the symptoms, to 19–39%. Without the findings of skeletal scintigraphy and the gold standard methods, 14–22% of patients would have undergone unnecessary surgery or neoadjuvant therapy. On this basis it is concluded that bone scans should not be omitted in asymptomatic patients.     

Molecular age estimation based on posttranslational protein modifications in bone: why the type of bone matters

Age-at-death estimation is of great relevance for the identification of unknown deceased individuals. In skeletonised corpses, teeth and bones are theoretically available for age estimation, but in many cases, only single bones or even only bone fragments are available for examination. In these cases, conventional morphological methods may not be applicable, and the application of molecular methods may be considered. Protein-based molecular methods based on the D-aspartic acid (D-Asp) or pentosidine (Pen) content have already been successfully applied to bone samples. However, the impact of the analysed type of bone has not yet been systematically investigated, and it is still unclear whether data from samples of one skeletal region (e.g. skull) can also be used for age estimation for samples of other regions (e.g. femur). To address this question, D-Asp and Pen were analysed in bone samples from three skeletal regions (skull, clavicle, and rib), each from the same individual. Differences between the bone types were tested by t-test, and correlation coefficients (ρ) were calculated according to Spearman. In all types of bone, an age-dependent accumulation of D-Asp and Pen was observed. However, both parameters (D-Asp and Pen) exhibited significant differences between bone samples from different anatomical regions. These differences can be explained by differences in structure and metabolism in the examined bone types and have to be addressed in age estimation based on D-Asp and Pen. In future studies, bone type-specific training and test data have to be collected, and bone type-specific models have to be established.