Scoring system for estimating age in the foot skeleton

This study assesses chronological age of immature individuals from the degree of ossification evident in the foot skeleton. We considered all tarsal and ray bones in various combinations to determine the most sensitive indicators of chronological age. Skeletal maturity was rated according to a subjective but simple scoring system applied to radiographs of normal feet of children of known chronological age. Scales for assessing the primary center of ossification, secondary center of ossification, and state of fusion are defined. In general, as expected, females show earlier onset of skeletal maturity than males; in particular, females in our sample are skeletally mature in most elements beginning 48 months prior to the earliest incidence of skeletal maturity in males for the same bones. Females in our sample show a marked tendency toward skeletal maturity of all elements by 150 months of age, while males do not show the same tendency until approximately 200 months of age. In general within each sex, consecutive states of fusion show broad overlap in range of chronological age within each bone. Combining scores from several different bones enables a reasonable estimate of potential age in a test application of the model.     

Carpal bone maturation assessment by image analysis from computed tomography scans

Bone maturation is the only reliable indicator of growth and its radiologic assessment with or without automated systems is a qualitative method. Image processing allows the study of bone maturation with quantitative data. Carpal bone maturation was studied in 20 children (13 boys and 7 girls, ages ranging from 4 to 15 years) without any clinical evidence of endocrine disease by image analysis from computed tomography (CT) scans. Each wrist CT scan was processed in order to extract the carpal bones and to measure quantitative data regarding volume, axes of inertia and density for each bone. The volumes and the length of the inertia axes were significantly correlated with age. Whatever the age, there were strong correlations between the volume or the length of the main inertia axis of one carpal bone and that of all others. The decrease in the carpal bone volume measured from the processing procedure compared with the theoretical volume of bone defined from the length of the three inertia axes indicated a change in bone shape during growth. Although the mean density was constant, there was an increase in the standard deviation of density with age. Skeletal maturity assessment with image analysis from CT scans seems to be a good complementary investigation to determine bone age in children.     

A comparison between methods of calculating skeletal age (Greulich-Pyle)

The skeletal age of each individual bone of the hand-wrist was assessed in serial radiographs of 169 Melbourne children. Seven different methods were used to obtain area skeletal ages from these bone skeletal ages. Methods employing arithmetic means of all the bone skeletal ages, excluding only extreme values, excluding those derived from the carpals or from other selected bones yielded similar means during the age range studied in each sex. There were large, but not significant, differences between the means derived from averages of the skeletal ages of the most and least mature bones and those derived from all the bone skeletal ages. A system of weighting and exclusion of bone skeletal ages led to the recording of area skeletal ages that differed from the others and fluctuated markedly for individuals until ossification had occurred in every carpal bone. The findings suggest that the exclusion of the skeletal ages of the carpal bones or the use of selected skeletal ages could lead to quicker assessments without real changes in means and variability.     

Biracial study of arterial pressures in the first and second decades of life.

The blood pressures of young Black and White American schoolchildren were measured and compared with those of Nigerian children of similar ages. Both diastolic and systolic pressures were consistently higher in the Nigerian children than in the Americans, both Black and White. The White children had the lowest pressures at each age. The mean weights and heights at each age were not significantly different in the three groups. Although the blood pressure of African children was higher than that of Black Americans, mean adult pressures are known to be similar in both groups. This suggests that the difference in childhood pressures must be due more to environmental factors than to genetic ones.     

Skeletal growth in school children: maturation and bone mass

Skeletal growth and development was evaluated in 322 white children (age 6 to 14) using three different methods: (1) ¹²⁵I photon absorptiometry, (2) compact bone measures on radiographs, and (3) Greulich-Pyle skeletal age from hand-wrist radiographs. Bone mineral content, measured by photon absorptiometry, increased at an incremental rate of about 8.5% each year. Skeletal age was a poor predictor of skeletal status, i.e., bone mineral content (14% error), and did not decrease the predictive error substantially more than did chronological age. Gross morphology (height and weight) was in fact a better predictor of bone mineral content than were skeletal age, chronological age, and radiographic morphometry. Skeletal age deviations were correlated with deviations in body size. A bone mineral index was devised which was independent of body size and this index was also independent of skeletal age. Skeletal age is imprecise (3 to 6 months error) and the range of variation in normal children (13 months) overlaps the maturational delay of the malnourished and diseased. The difficulties in using skeletal maturation are discussed and it is suggested that particular maturational indices be used which better indicate skeletal growth than does a composite skeletal age.     

ACCURACY OF AGE DETERMINATION IN THE GREY SEAL HALICHOERUS GRYPUS OF EASTERN CANADA

The ages of 82 grey seals of known age from 1 to 10 yr were determined from growth layer groups in the cementum, readily seen in longitudinal sections 150 μm thick viewed under transmitted light. The sample of teeth was read five times in a series of blind replicates.
With only one reading, an accuracy of 84% was achieved. This increased to 93% on the basis of three readings but improved only marginally to 94% when all five readings were considered. Accuracy was best in the middle range of ages (3–6 yr) which are the critical years for estimating age-specific reproductive rates in population models.     

手腕部与膝部骨龄之间的差异

本文分别用Fels和RWT法评定了4902对2—17岁儿童青少年的手腕部和膝部骨龄。男女各年龄组骨龄的平均绝对差值为0.34—0.87岁,标准差为0.31—0.68岁。8—11岁前,这两个值往往随年龄增加;14岁前,男性一般大于女性。最大差值范围为1.45—2.99岁,其年龄变化往往不规律,但11岁前(男)和9岁前(女)常常增加。手腕部和膝部骨龄之间所存在的较大的绝对差值不能完全用观察误差加以解释。两部位的骨龄不能互相替代。所以,用骨龄预测成人身高和确定干骺固定术的时间,至少在5％的儿童中明显地受到骨龄部位的影响。     

Stature and body weight growth patterns from longitudinal data of Japanese children born during World War II

Stature and body weight data of 100 boys and 100 girls from 7 to 17 years of age in Shimodate City who were born during World War II were longitudinally analyzed. The children were significantly smaller and lighter throughout their growth period than those born 11 years after the end of the war. The correlation coefficient between statures at each age and at age 17 showed a gradual increase with increasing age, while that between statures at each age and at age 7 decreased with age. However, a drop in the correlation coefficient was found during puberty, at age 11 for girls and at age 13 for boys. Comparing the normalized distance from mean values of stature and body weight at age 7, at puberty, and at age 17, only 51% of the children continued to be in the same relative position for both height and weight, 6% of boys and 4% of girls showing a decreasing pattern for both and 4% of boys and 7% of girls showing an increasing pattern for both. Thus, about 60% of the children of either sex presented parallel stature and body weight growth patterns for ages from 7 to 17.     

Economic impact on tooth emergence

As shown in nearly 10,000 Negro and White boys and girls between 4.5 and 16.5 years of age, poverty-level children (with an income-to-needs ratio of 1.0) tend to be delayed in permanent tooth emergence as compared with those approximating median per-capita income. For boys, a per-capita income difference of $2200 was associated with a 0.15 standard deviation difference in emergence timiing of 28 permanent teeth.     

Assessment of type A behavior in preschoolers

Teachers and mothers of 219 four-year-old preschoolers assessed their children for Type A behavior pattern using the Matthews Youth Test for Health (MYTH). The sample was derived from five day care centers with Black, White, and Hispanic teachers and students from middle and lower class families. This study indicates that Type A behavior can be identified in four-year-old preschoolers on the basis of ratings by their teachers. A statistically significant difference was found between the ratings of Type A/B characteristics by teachers and those by mothers; however, these were not related to the sex or ethnicity of the children. Repeated measurements of Type A ratings in a subsample of the children at age five showed no significant change among boys or girls. However, repeated measurements at age six on a second subsample showed that boys had lower mean scores, i.e. were more Type B at age six than at age four.     

Relation between age of mothers with breast cancer and sex of their children.

In a consecutive series of 150 women with breast cancer 122 had borne one or more children. Sixty-two patients were aged below 55 years at diagnosis (group A) and 60 were 55 years or older (group B). In group A 91 out of 153 children (59%) were boys compared with 48 out of 141 (34%) in group B (p=0.000007). In group A 54 of the 62 patients (87%) had given birth to one or more boys compared with 35 of the 60 (58%) in group B (p=0.0003). The mean age at diagnosis in mothers of two or more boys was 49.0 years, in those of one boy 55.2 years, and in those of only girls 61.0 years. The differences between each of the mean ages was significant. The mean age at diagnosis in 28 nulliparous patients was 57.7 years. There was no significant correlation between the number of female pregnancies and age at diagnosis. These results suggest that in women liable to develop breast cancer male pregnancies are associated with an early onset of the disease.     

Normal variability in the age and first onset of ossification of the triquetral

The age and order of ossification of the triquetral, among the bones of the hand and wrist, were determined from serial radiographs of 108 males and 103 females of the Oxford Child Health Survey. Although the median ages of ossification agreed reasonably well with the mean ages reported by other authors, the distributions suggested that the former is the more appropriate statistic. The distributions of order of ossification were distinctly bimodal for both sexes because of the tendency of the triquetral to appear along with the epiphyseal centers. The triquetral appeared before the lunate in 184 children, after it in eight, and could not be sequentially distinguished in 19. Excluding these 19, triquetral sequence variability in the remaining was achieved, in 190, through alteration of its appearance relative to the epiphyseal centers and, in the other two through an alteration of the lunate appearance. Measures of median or average order of appearance are of very little value for the triquetral.     

Height, weight, and lines of arrested growth in young Guatemalan children

A cross-sectional study of height, weight and skeletal maturity as judged from radiographs of hand and wrist, of 1,412 children under seven years of age (694 boys and 718 girls) living in rural Guatemala was performed. Height and weight were compared to standards prepared by the Institute of Nutrition of Central America and Panama (INCAP). Skeletal age was assessed by the Tanner-Whitehouse and the Greulich and Pyle methods. All x-rays were read by the senior author. The children surveyed were significantly shorter and lighter than well noruished Guatemalan children. Differences were evident by age six months and at a maximum by age five years. Both methods showed skeletal age to lag behind chronological age so that the Guatemalan rural children mature at slower rates than either the British children or the Ohio, U.S.A., children, from whom the two sets of standards were developed. Children of both sexes with radio-opaque transverse lines at the metaphysis showed a consistent tendency to be shorter than children without such lines. Boys but not girls showed similar trends for weight. In general, the data are consistent with the view that the physical development in boys is more severely retarded by an adverse environment than that of girls.     

Bone growth aud development of secondary ossification centers of extremities in the cynomolgus monkey (Macaca fascicularis).

The development of so-called long bones in the extremity has been studied roentgenographically in forty-seven males and fifty-one females cynomolgus monkeys bred and reared at the National Institute of Health. The age of the females ranged from five months to eight years and nine months, and that of the males was from four months to seven years. In addition, the fetuses of six to twenty weeks of gestation age were examined for the time of appearance of ossification centers. As the biological parameters concerning body growth, the body weight and the bone length were measured and the secondary ossification centers were scrutinized and assessed the maturity process on the basis of the criteria that divided the state into eleven stages. Also the allometric analyses of body weight against bone length was conducted. Most of the secondary ossification centers except the proximal fibulal epiphysis appeared during the period from the prenatal stage (15-20 weeks of gestationage) to the postnatal one (several months of age). From four to five months of age, many ossification centers had developed to some extent. But, the appearance of proximal fibulal epiphysis was delayed and often lacking until 10 months of age in female and one year and three months of age in male. The earliest epiphyseal fusion was observed at the distal humeral epiphysis in both sexes. The latest epiphyseal fusion was observed at the distal ulnal epiphysis in both sexes and at the distal ulnal and radial epiphyses in female. From this study, the time of fusion was at five and three guarters years of age in females and at six and a half years of age in males. As a result, it is suggested that the estimation of animal's age might be put to practical use by introducing the assessing method that the score was given from the observation of the secondary ossification center.     

Use of the Greulich-Pyle "Atlas of Skeletal Development of the Hand and Wrist" in a clinical context

Assessments of the relative maturity of individual children have been widely used to improve estimations of future growth as well as in evaluations of physiological disorders. Skeletal age (Hand) has been the most commonly used method for these estimations. In the clinical use of skeletal ages, certain problems are inherent regardless of which standard is selected. One of these is the method of reporting so that the cliniciam may learn of the normal variation at each age as well as the operational error of the specific assessor. Another problem lies in the proper clinical interpretation to be put upon significantly variant skeletal age readings in infancy, in childhood, or in adolescence. A third problem arises in limiting the use of skeletal ages which are read from areas which are involved with osseous pathology. And fourthly, a child's level of maturity is not static throughout his growing years; even with no change in therapeutic regime, marked shifts in relative maturity have been often noted. The wealth of experience which has now been acquired with the Greulich-Pyle standard is not the least of the advantages in using the Hand for the assessment of skeletal age. The 30 centers in this small area of the body, however, may be harmonious in development or may vary in “maturity” by as much as three years in a single hand. The problems then are: Which centers best represent the individual child? Which centers are most closely related to growth? Is growth in the hand and accurate index of the growth in other areas of the body? In total stature? The clinical assessment of future growth may best be made from a consideration of the whole child: his size, his physical characteristics, and his skeletal age, as well as the pattern of change-with-age in each of these. These problems will be discussed with illustrations drawn from the longitudinal Growth Study at this institution.     

Bone maturation reflects the secular trend in growth

The aim of this study was to compare a series of X-rays from the mid-1990s with another taken in the mid-1980s in order to test the possibility that environmental causes affect the skeletal maturation. The first group of subjects included a total of 1,057 girls and 1, 055 boys participating in a project for Japan and China health research in 1986. The second group of subjects included a total of 382 girls and 629 boys participating in a project for bone mineral density research in 1996. The skeletal maturity score using the Tanner-Whitehouse 2-RUS method was used as the fundamental datum. This score was used to represent each group. The Wilcoxon's rank sum test was applied to examine the significance of the difference between the 1986 and the 1996 groups. The 1996 children had not matured more than the 1986 children; children in both groups reached the given scores at almost the same ages. In girls, there was little difference between the groups at 7 years of age, but it declined from 8 years of age onward. Some apparent differences arose at ages 14 and 15, but ceased by age 16 in girls. In boys, no differences were found in those aged from 7 to 17 years, except for 12-year-olds. We did not detect much of a difference in bone maturation between the 1986 and 1996 groups of children, and no differences in height during the same period. Our findings suggest that bone maturation reflects the secular trend in growth.     

Maxillary volume growth in childhood

Nasomaxillary abnormalities in form, position, and development in children are often prominent features of craniosynostosis, and in particular, craniofacial dysostosis. While attempting to quantitatively assess the volumetric maxillary deficiency in these patients, it became apparent that there was no "normal" reference range for maxillary volumes throughout childhood that could be used for comparison. The aim of this study was to generate a model for measuring maxillary volume and subsequent changes throughout childhood. The technique of segmentation was applied to magnetic resonance images obtained in 55 healthy children (30 boys, 25 girls), aged 1 month to 184 months (15.33 years). Maxillary volumes were plotted against age for boys and girls to create a model for normal maxillary growth during the first 15 years of life. Maxillary volumes were larger in boys at all ages. However, the pattern of maxillary growth in boys and girls was similar and could be divided into three periods, each lasting approximately 5 years. During the first 5 years of life, there is a steady increase in maxillary volume, at the end of which the maxilla has reached 53 percent of the volume recorded at 15 years. There is an accelerated rate of growth between 5 and 11 years, which corresponds to the development and eruption of the permanent dentition. Thereafter, until the age of 15 years, the rate of growth of the maxilla plateaus. Maxillary volume in the first 12 months of life is, on average, 29 cm3 in boys and 25 cm3 in girls. By 15 years of age, it has increased to an average of 73.0 cm3 in boys and 59.4 cm3 in girls (an increase by a factor of 2.5 in boys and 2.4 in girls). The difference between the two sexes is statistically significant for the entire series (boys: mean maxillary volume = 56.55 cm3, SD = 24.61; girls: mean maxillary volume = 40.68, SD = 17.69, p = 0.009, one-way analysis of variance).     

Chronology of fusion of the primary and secondary ossification centers in the human sacrum and age estimation in child and adolescent skeletons

Little is known about fusion times of the primary and secondary centers of ossification in the sacrum, particularly from dry bone observations. In this study, the timing of union of these centers was studied in a sample of modern Portuguese skeletons (90 females and 101 males) between the ages of 0 and 30 years, taken from the Lisbon documented skeletal collection. A three‐stage scheme was used to assess fusion status between ossification centers as unfused, partially fused and completely fused. Posterior probability tables of age, given a certain stage of fusion, were calculated for most anatomical locations studied using both reference and uniform priors. Partial union of primary centers of ossification was observed from 1 to 8 years of age and partial union of secondary centers of ossification was observed from 15 to 21 years of age. The first primary centers of ossification to complete fusion are the neural arch with the centrum of the fifth sacral vertebrae and the last are the costal element with the centrum of the first sacral vertebra. The annular and sacroiliac epiphyses are the first, among the secondary centers of ossification observed, to complete fusion, after which the lateral margin fuses. This study offers information on timing of fusion of diverse locations in the developing sacrum useful for age estimation of complete or fragmented immature human skeletal remains and fills an important gap in the literature, by adding to previously published times of fusion of primary and secondary ossification centers in this sample. Am J Phys Anthropol 153:214–225, 2014. © 2013 Wiley Periodicals, Inc.     

Differences in Bone Age Readings Between Pediatric Endocrinologists and Radiologists

Objective: Pediatric endocrinologists (PEs) have historically read their own bone age (BA) X-rays based on the belief that radiologists do not accurately interpret these tests. Whether there are significant differences in BA interpretations between these two groups has not been systematically explored. The objectives of the study were to compare BA readings performed by PEs and radiologists and determine whether clinical variables were associated with discrepancies in readings.Methods: A retrospective chart review of children presenting for initial evaluation of short stature (SS) or precocious puberty (PP) who had a BA X-ray completed was performed. Clinical variables analyzed included age, gender, ethnicity, Tanner stage, body mass index, reason for referral, radiologist location (Children's vs. outside hospital), and PE and radiologist BA readings using the Greulich and Pyle method.Results: Of 103 patients aged 9 ± 3.66 years, there was a discrepancy between the PE and radiologist readings on 70 images (68%). Discrepancy ranged from -1.5 to 3.5 years, with a mean of 4 ± 12 months. Patients referred for PP were more likely to have discrepant interpretations than those referred for SS (8.4 months vs. 0.8 months; P = .007). No differences were seen in interpretations between in-house radiologists and those at outside hospitals.Conclusion: Radiologists interpreted BAs differently than PEs in the majority of images. In patients referred for PP, BAs were interpreted as being older by radiologists than by PEs, perhaps due to bias from the reason for referral. Our results provide support for continued independent BA interpretations by PEs.Abbreviations: BA = bone age; GP = Greulich and Pyle; PE = pediatric endocrinologist; PP = precocious puberty; SS = short stature