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Bone Age Reading by DXA Images should not Replace Bone Age Reading by X-ray Images
Griselda-Adriana Cruz-Priego1, Miguel-Angel Guagnelli1, América Liliana Miranda-Lora2
1Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico.
Summary
Conventional X-ray is a reliable method for bone age estimation in children, unlike dual-energy X-ray absorptiometry (DXA) scans, which tend to overestimate bone age, especially in females during puberty.
Area of Science:
- Pediatric endocrinology
- Radiology
- Bone health
Background:
- Hand X-rays are standard for bone age assessment in children.
- Dual-energy X-ray absorptiometry (DXA) can acquire hand images, potentially for bone age estimation.
- Limited data exists on the agreement between conventional X-ray and DXA for bone age assessment.
Purpose of the Study:
- To evaluate the agreement between bone age estimations from conventional X-ray and DXA hand images.
- To assess the reliability of DXA for bone age determination in children and adolescents aged 5-16 years.
Main Methods:
- Analytical cross-sectional study involving 711 healthy children and adolescents (5-16 years).
- Independent bone age readings from conventional X-ray and DXA hand images by two blinded expert evaluators.
- Intraclass Correlation Coefficient (ICC) and Bland-Altman analysis for agreement and reproducibility.
Main Results:
- High agreement (ICC=0.99) between conventional X-ray and DXA bone age estimations, with DXA showing a mean overestimation of 6 months.
- Agreement limits were approximately ±2 years, encompassing 95% of differences.
- Differences were more pronounced in females, particularly during puberty.
Conclusions:
- Conventional X-ray remains the preferred method for accurate bone age assessment due to superior resolution.
- DXA hand images show significant overestimation of bone age and are considered less reliable for this purpose.
- Further research may be needed to refine DXA protocols if it is to be used for bone age estimation.
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