جستجوی مقالات مرتبط با کلیدواژه « bone age » در نشریات گروه « پزشکی »

Statement of the Problem: 

Bone age is a more accurate assessment for biologic development than chronological age. The most common method for bone age estimation is using Pyle and Greulich Atlas. Today, computer-based techniques are becoming more favorable among investigators. However, the morphological features in Greulich and Pyle method are difficult to be converted into quantitative measures. During recent years, metacarpal bones and metacarpophalangeal joints dimensions were shown to be highly correlated with skeletal age.

In this study, we have evaluated the accuracy and reliability of a trained neural network for bone age estimation with quantitative and recently introduced related data, including chronological age, height, trunk height, weight, metacarpal bones, and metacarpophalangeal joints dimensions.

In this cross sectional retrospective study, aneural network, using MATLAB, was utilized to determine bone age by employing quantitative features for 304 subjects. To evaluate the accuracy of age estimation software, paired t-test, and inter-class correlation was used.

The difference between the mean bone ages determined by the radiologists and the mean bone ages assessed by the age estimation software was not significant (p Value= 0.119 in male subjects and p= 0.922 in female subjects). The results from the software and radiologists showed a strong correlation -ICC=0.990 in male subjects and ICC=0.986 in female subjects (p< 0.001).

The results have shown an acceptable accuracy in bone age estimation with training neural network and using dimensions of bones and joints.

Diagnosis and management of precocious puberty are challenging. The two main classes of precocious puberty are Central Precocious Puberty (CPP) and Peripheral Precocious Puberty (PPP), which should be differentiated from normal pubertal variants. Radiology plays an essential role in the diagnosis and management of precocious puberty. We reviewed available studies in the case of different radiology modalities to find the role of these methods in precocious puberty assessment. We found that bone age assessment can be the initial step in the diagnosis of precocious puberty; however, a normal bone age cannot rule out precocious puberty in a deterministic manner. The use of pelvic ultrasound can further help the approach to precocious puberty. Moreover, suspected female and male cases of congenital adrenal hyperplasia should be evaluated with adrenal sonography. Testis and mammary ultrasound assessments are usually conducted in asymmetrical changes. Still, breast ultrasound staging may be helpful in even the diagnosis of precocious puberty. Brain magnetic resonance imaging is another modality used in CPP cases. The role of artificial intelligence is a neglected part, which is partly covered by BoneXpert software. Future studies should focus on scoring methods based on bone age as well as breast and pelvic (ovary and uterus) ultrasound assessments in diagnosing female precocious puberty cases and distinguishing the patients from normal pubertal variants.

Many parents are concerned about their child's final height with the onset of the larche. We decided to investigate the height potential in different stages of puberty.

731 healthy girls who had not yet completed puberty were studied. Bone age and predicted final height were assessed. The correlation of height potential with various indices has been investigated.

The Mean age was 9.88±1.3 years. The girls have a mean height potential of 28.90, 25.64, 20.89, and 13.76 cm in thelarche stages of 1, 2, 3, and 4, respectively (p =0.001), and a mean height
potential of 27.19, 21.46, 15.51 and 11.02 cm in pubarche stages of 1, 2, 3 and 4, respectively (p
=0.001). Height potential was inversely related to pubarche stage (p-value =0.004) , chronological age (r = 0.74, p-value =0.001), bone age (p-value <0.001) and Height Standard Deviation score (SDS) (p
<0.001). It was not related to the thelarche stage, target height, or BMI SDS. Linear regression showed that the height potential has a significant relationship with pubarche stage (P=0.004) but not with the thelarche stage ((P=0.267).

This study found that potential height has no significant relationship with the thelarche stage. On the other hand, pubarche is associated with advanced bone age and lower height potential.

 Since the determination of skeletal maturation by surveying concavity on lower surface of cervical vertebrae and evaluating shape of vertebrae is a subjective and quantitative study, this systematic review was performed to evaluate new quantitative and objective methods by using cervical vertebrae for determining skeletal maturation.

 Related keywords were searched in Pubmed and Cochran database in order to find studies that were published in English from January 2000 to January 2019 and evaluated skeletal maturation based on cervical vertebrae by modern methods. Also, the references of the included studies were search for other related studies.

 From overall 1371 titles, 27 were selected by initial screening. Evaluation of the full texts resulted in inclusion of 13 articles. Among articles included in this review, three studies used CBCT images and another studies used lateral cephalogram. One study performed evaluation cervical vertebrae in the axial view of CBCT images while another evaluation was on sagittal view. Most of the studies used a regression model in order to determine bone age of vertebrae and then compared it with skeletal age obtained from hand wrist radiography.

 As the methods and measurements were different in the included studies it was not possible to reach a decisive conclusion regarding method for determining skeletal age based on cervical vertebrae. It is suggested to use a combination of maturation signs along with development stages of cervical vertebrae in order to determine skeletal maturation until a quantitative and valid method is presented.

Precocious puberty can cause several adverse effects on final growth and social behavior in girls. Recent studies showed that low serum level of vitamin D might be associated with precocious puberty. The aim of this research was to investigate the association between serum vitamin D level and central precocious puberty in girls. Girls with central precocious puberty under the age of eight were enrolled in the study. Subjects with brain tumor, inherent adrenal hyperplasia, or thyroid dysfunction were excluded from the study. Age, weight, height, serum level of vitamin D, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, free thyroxin (FT4), bone age, thyroid-stimulating hormone (TSH), and Tanner stages were determined for all the subjects. Healthy girls with no precocious puberty were considered as the control group. Finally, 58 girls (28 with central precocious puberty and 30 healthy) were included in the study. The average levels of serum vitamin D were 12.9 ± 7.8 ng/mL and 15.2±5.9 ng/mL in the case and control groups, respectively (P = 0.02). We found that 37% of girls with precocious puberty were in Tanner stage 2 and 63% in stage 3. The serum vitamin D level had considerable relationship with chronological-bone age difference (P < 0.01). Vitamin D deficiency was more common in girls with central precocious puberty than those with normal sexual maturation. Insufficiency and deficiency of vitamin D were more common in girls who were evaluated in this study in comparison with other studies.

Bone age determination is used in situations such a migration and sports. Radiography, MRI and ultrasound are different methods of determining bone age. This study was designed to evaluate the effectiveness of ultrasound in determining bone age in 14 -18 year olds.
100 male and 100 female students between 14 and 18 years old were evaluated. The thickness of the epiphysis of the left distal radius in the ventral, dorsal and lateral views, were measured.
In the females most of the growth plates were closed and the rest were inconclusive therefore ultrasound cannot be used in females in this age group. In the males, a minimum thickness of 0.7mm in dorsal and 0.8mm in ventral view in 14 and 15 year olds can be used to differentiate them from the 16 and 17 year olds. A maximum thickness of 1.6mm in dorsal and 1.1mm in ventral view can be used to differentiate 16 and 17 year olds from 14 and 15 year olds. Finally a maximum thickness of 0.8mm in the dorsal view can be used to differentiate 17 year olds from 16 year olds and younger.
Bone age determination via sonographic evaluation of the distal radius is an easy, fast and radiation free method that if confirmed by future studies can be used to differentiate 15 and younger from 16 and older boys. Ultrasound cannot be used to differentiate 14 to 18 year old girls.

Growth retardation following malnutrition is prevalent among patients with congenital heart diseases (CHDs). This study was designed to evaluate failure to thrive (FTT) and delay in bone age in children with CHDs who were referred to our hospital and subsequently to determine their relation with cyanosis and the pulmonary artery pressure.
We enrolled 120 consecutive patients who were referred to Rajaie Cardiovascular, Medical, and Research Center for cardiac catheterization or surgical correction. Growth parameters, comprising height (cm), weight (kg), and head circumference (cm), were measured by an experienced nurse. Bone age was evaluated by taking an anteroposterior wrist X-ray and reported by a radiologist, who was not aware of the exact cardiac diagnosis. The pulmonary artery pressure was measured during cardiac catheterization or surgical correction.
Bone growth retardation, FTT, short stature, and microcephaly were seen in 46.6%, 43.7%, 29.4%, and 5.1% of the patients, correspondingly. There was a significant relationship between the presence of cyanosis and delayed bone age, particularly when O2 saturation was less than 75% (P According to our results, delayed bone age and growth retardation are common findings in children with CHDs. The presence of cyanosis and/or pulmonary hypertension may further deteriorate these conditions and should be promptly managed. (Iranian Heart Journal 2017; 18(3):35-41)

Short stature is a manifestation of a wide variety of conditions that some of which may be amenable to timely treatment and a suboptimal growth rate may be an early marker pointing to the cause of growth retardation. This study was conducted to evaluate the diagnostic utility of growth rate in differential diagnosis of children with short stature.
All children between the ages of 2 and 18 years who visited in pediatric endocrinology clinic in a five years period were recruited in a prospective cohort study. Children with standing height
One hundred forty three patients fulfilled the inclusion criteria. Mean follow up period was 14.4±10.9 months. Etiologies of short stature were: constitutional growth delay (CGD) 46.9%, familial short stature (FSS) 28.7%, hypothyroidism 4.2%, growth hormone deficiency (GHD) 4.2% and miscellaneous causes in 16% of patients. Mean Z- score for children with constitutional growth delay was -2.3±0.69, in familial short stature was -2.3±0.65 and for other condition was -2.7±1.49. There was a meaningful statistical correlation between growth rate and etiology of short stature (P0.05).
There was significant difference in growth rate between children with constitutional growth delay and familial short stature in comparing to short stature due to endocrine problem and other etiologies. Assessment of growth rate has some utility in diagnosing the etiology of short stature.

To assess the validity of ultrasonography (US) in detection of secondary ossification centers (SOC) of the hand. Radiography is the standard technique for estimating skeletal bone age with its unwanted harmful effects mostly undesirable in little children. If efficient enough, US could be an appropriate substitute.

Left hand US was performed on 6-60 months children (n = 24, with 29 SOCs for each child in his/her hand and a total of 696 SOCs) referred for wrist radiography and bone age determination during a 4 months period. The presence of SOCs was investigated by US and radiography by two radiologists under blind conditions.

US was evaluated 696 SOCs, and 446 SOCs were detected, by US and 436 by radiography without statistically significant difference. The results of US and radiography in detection of SOCs of distal forearm (23 SOCs were detected by both US and radiography) and carpi (87 SOCs) were identical. However, in metacarpi (94 for US, 88 for radiography) and phalanges (242 for US, 238 for radiography) US appeared better.

On the base of our data, US is at least as effective as radiography in detection of SOCs and therefore can play a role in the skeletal age estimation.

Hypothyroidism is the most common endocrine disorder in children and presented with various sign and symptoms; its diagnosis needs a high index of suspicion. We report 3 cases with unusual presentations of hypothyroidism and with delay in diagnosis that referred to Pediatric Endocrine Outpatient Clinic in Mashhad University of Medical Sciences, Mashhad, Iran with different clinical manifestations. They had decreased Thyroxin (T4) and increased thyroid stimulating hormone (TSH) levels. One case had mental retardation and deafness, but the other two cases had normal neurodevelopment. Some additional interesting findings were as follows: short stature, delayed bone age, teeth eruption impairment, hair loss, anemia and hypercholesterolemia, persistent and long-term constipation that had led to several abdominal surgeries. After a year of hormonal replacement therapy, their growth parameters and hematological values improved. We recommend thyroid hormonal evaluation for any children with short stature, especially with delayed bone age, in order to detect and treat hypothyroidism at the right time. It seems that more attention to pediatric growth is necessary.