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Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Fei Hong / Mericq, Veronica / Ogata, Tsutomu / Toppari, Jorma

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Volume 24, Issue 11-12


Validation of automatic bone age rating in children with precocious and early puberty

David D. Martin / Kathrin Meister / Roland Schweizer / Michael B. Ranke / Hans Henrik Thodberg / Gerhard Binder
Published Online: 2011-11-24 | DOI: https://doi.org/10.1515/JPEM.2011.420


Background and aims: Manual bone age (BA) rating in precocious puberty (PP) is associated with considerable rater variability. The aim was to evaluate a new method for automated Greulich and Pyle (GP) BA determination in children with PP.

Methods: Seven hundred forty-one archived X-rays from 13 boys and 103 girls with PP or early puberty of various etiologies (age range at time of X-ray, 0.3–14.8 years; mean BA advancement, 2.3 years) were rated. Automatic rating (BoneXpert BA, or BXBA) was compared with the original manual GP rating (manual BA, or ManBA). X-rays where BXBA deviated from ManBA by more than 1.5 years were rerated by three raters, and the average was formed (ReferenceBA).

Results: All 741 X-rays, except nine (three images had poor quality and six were from children with a chronological age younger than 1.5 years), were analyzed automatically. The mean difference of BXBA–ManBA was –0.19 years; the SD of the differences was 0.76 years (95% confidence interval 0.72–0.80). ReferenceBA was determined for 41 images. A discrepancy from ReferenceBA greater 1.5 years was found in four images against BXBA and in 10 images against ManBA.

Conclusion: Automated BA is efficient and reliable in children with PP.

Keywords: bone age rating; GnRH analog therapy; precocious puberty; skeletal maturation

About the article

Corresponding author: Dr. David D. Martin, Pediatric Endocrinology and Diabetology, University Children’s Hospital, Hoppe-Seyler Strasse 1, D-72076 Tuebingen, Germany Phone: +49 7071 29 83795, Fax: +49 7071 29 4157

Received: 2011-09-28

Accepted: 2011-10-24

Published Online: 2011-11-24

Published in Print: 2011-12-01

Citation Information: Journal of Pediatric Endocrinology and Metabolism, Volume 24, Issue 11-12, Pages 1009–1014, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/JPEM.2011.420.

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