Determination of bone age using MRI of hand/wrist: a pilot study

Transcription

1 Determination of bone age using MRI of hand/wrist: a pilot study Poster No.: C-0963 Congress: ECR 2011 Type: Scientific Exhibit Authors: E. Tomei, M. Marini, A. Stagnitti, A. sartori, L. bertana, N. Al Ansari, R. Passariello ; Rome/IT, Roma (RM)/IT, Roma/IT, 4 rome/it Keywords: Epidemiology, Diagnostic procedure, MR, Pediatric, Bones DOI: /ecr2011/C-0963 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 39

2 Purpose Fig. References: internet Page 2 of 39

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4 Fig.: Project co-financed by the EU References: internet The assessment of bone age with hand/wrist radiography has been in use for over 60 years. The atlas of Greulich and Pyle and the technique of Whitehouse and Tanner are masterpieces of radiological literature and they are both still in use in many countries. However they cannot be applied to different ethnic groups (Zhang A, Radiology Jan 2009); furthermore they do not include the impact of economic progress and modernization. Despite the small radiation dose, the x-ray is considered invasive and it is not accepted to up to date bone age determination. The purpose of our study is to explore the feasibility of bone age determination using MRI of hand/wrist. Images for this section: Page 4 of 39

5 Fig. 1: Project co-financed by the EU Page 5 of 39

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8 Methods and Materials This study has been approved by the institutional review board of our University; written informed consent has been signed by parents or tutors of each minor involved in the research. A low field open magnet (0.2 T ESAOTE) Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY was used for this study; a single sequence T13D lasting 1'39" with a slice thickness of 1.3 mm was the imaging protocol. Normal volunteers were recruited from Roman schools (96 F, 11 to 18 y.o. and 130 M 10 to 18 y.o.) Other subjects aged from 4 to 14 y.o. (20 F, 25 M) were referred from pediatricians. For data analysis, we based images were digitized into the DICOM format. After a MRI of the hand was acquired, the authors discussed and formed in consensus a graduated scale of skeletal development. The evaluation was made on the basis either of the knowledge of GP atlas and WT technique, or with our experience in musculoskeletal MRI. The appearance of cartilage, vacuolization of cartilage, provisional calcification, Page 8 of 39

9 progression of ossification, complete ossification were considered as they can be seen at MRI. To each step identified as progressive maturity of every carpal bone (8 bones) and of tubular bones (radius, ulna, 1 metacarpal bone and 1 finger) was attributed a number from 1 to 10 so in total 12 number, each to be added from 1 to 10. Authors knew the chronologic age and other information of the subjects studied. Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY Page 9 of 39

10 Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY Page 10 of 39

11 Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY Page 11 of 39

12 Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY Page 12 of 39

13 Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY Page 13 of 39

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17 Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY Images for this section: Page 17 of 39

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27 Results Each group of age showed peculiar aspects of progressive bone maturation: the lowest number was 15 in the 4 y.o. subject and the maximum was 120 in the 18 y.o. subject. The graduated scale of bone maturity must obviously, at the moment, be considered incomplete and provisional; furthermore appropriate standardized charts to express bone age, as in the WT technique, are not available. As for a possible new atlas like that of GP, the age of each figure showed, is the known chronological age of the subjects, that we think is representative of normal volunteers of the same age. Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY Page 27 of 39

28 Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY Page 28 of 39

29 Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY Page 29 of 39

30 Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY Page 30 of 39

31 Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY Page 31 of 39

32 Fig. References: E. Tomei; Istituto di Radiologia, Università di Roma, Rome, ITALY Images for this section: Page 32 of 39

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39 Conclusion The small number of subjects studied and the very few subjects under 10 y.o. are the limits of our study. The score we used, as well the age indicated in the figures are largely provisional. However the determination of bone age with MRI is feasible, either to implement a new atlas like that of GP or to use a maturity score like the WT technique. The study is necessary because the old radiography is more and more obsolete. In the era of globalization it is impossible to further rely on these old methods and techniques. Dedicated radiologists/pediatricians are familiar with the issues and problems of skeletal development and bone age assessment; so that to shift to MRI cannot be considered difficult. The final goal of the study should be the implementation of an automated computerized method. The way is long but it is time to start. References Racial diffrences in growth patterns of children assesses on the basis of bone age. Zhang A, W. Sayre J, Vachton L, J. Liu B (Radiology - January 2009) An appraisal of Greulich-Pyle Atlas for skeletal age assessment in Pakistan. Zafar A.M, Nadeem N, Husen Y, Ahmad M.N, (JPMA - Journal of The Pakistan Medical Association - July 2010) Age determination by magnetic resonance imaging of the wrist in adolescent male football players.dvorak J, George J, Junge A, Hodler J. (Br J - British journal of sport medicine - January 2007) Validation and reference values of automated bone age determination for four ethnicities. Thodberg HH, Savendahl L (Academic Radiology November 2010) Personal Information Page 39 of 39