![]() For both sexes, however, the rate of skeletal maturation and the pubertal stage of development are clearly related. The reasons for these gender discrepancies in skeletal maturity remain unknown. Moreover, the skeletal maturation process lasts longer in boys than in girls. The difference is present at birth and persists throughout growth, although it is slightly more pronounced after the onset of puberty ( 2, 6). The Fels method is less frequently used (4).įemales, at any age, have advanced bone age when compared to boys. #BONE AGE LESS THAN CHRONOLOGICAL AGE FULL#These maturity indicators were then evaluated not in relation to chronological age, but in relation to their appearance within the full passage of each specific bone from immaturity to maturity. #BONE AGE LESS THAN CHRONOLOGICAL AGE SERIES#They defined a series of eight maturity indicators for each bone of the hand and wrist and nine for the radius. The original system (TW1) was refined and published as TW2 and, recently, as TW3 (3). A diffuse method based on these principles was conceived by Tanner and Whitehouse and named TW after their initials. The result of such a system would provide maturity standards for each bone considered. The models were generated through rigorous analyses of the maturation of each ossification center in the hands and wrists of healthy children and the construction of virtual images that incorporate composites of the average development for each ossification center in each age group (5).Īs an alternative to atlas-based techniques, other methods were developed that independently assess the maturation of each bone. Recently, these obstacles were circumvented through the selection of an alternative approach: the creation of artificial, idealized, sex- and age-specific images of skeletal development. However, the design of computer algorithms capable of automatically rendering bone age has been impeded by the complexity of evaluating the wide variations in bone mineralization tempo, shape and size encompassed in the large number of ossification centers in the hand and wrist. With the advent of digital imaging, multiple attempts have been made to develop image-processing techniques that automatically extract the key morphological features of ossification in the bones. The Greulich-Pyle atlas is founded on the assumption that the skeleton matures in a uniform fashion and is based on a reference collection of radiographs from normal Caucasian children of high socioeconomic status of different chronological ages (2). There are several methods to assess skeletal maturity, but the most commonly used in clinical practice are the atlas-based technique of Greulich and Pyle (2), followed by the Tanner-Whitehouse bone specific scoring technique (3) and the Fels method (4).Īll use left hand and wrist radiographs to estimate bone age, but the former differs in concept and method from the latter two. Indeed, chronological age associated with full skeletal maturity varies greatly among subjects, and children with the same bone age may have very divergent bone dimensions. Moreover, skeletal maturation is only weakly related to bone size. Skeletal maturation is a temporal process that, while expressed in years and months, is only loosely linked to chronological age. Although measures of skeletal maturation are often confused with measures of skeletal growth, maturation and growth reflect different processes growth represents a quantitative increase in size or mass, while maturation is a sequence of changes that lead to a highly organized, specialized and mature state. Assessments of skeletal maturation are frequently used as a diagnostic tool to evaluate clinical conditions associated with generalized growth abnormalities, to monitor response to medical treatment and to determine the growth potential of children. Skeletal maturity is a measure of bone development based primarily on the size, shape and degree of mineralization of the epiphyses and degree of closure of the physeal plates. In the skeleton, these changes include the maturation, longitudinal growth and acquisition of bone. Los Angeles, CA 90027 (United States of America)Ĭorrespondencia para Vicente Gilsanz, Departments of Radiology and Pediatrics, Childrens Hospital Los Angeles, USC, Keck School of Medicine, Los Angeles, CA 90027, United States of AmericaĬhildhood encompasses major changes in sexual development and body composition, which are highly variable and influenced by many genetic, hormonal, nutritional, environmental and socioeconomic factors (1). Childrens Hospital Los Angeles, USC, Keck School of Medicine. 2010ĭepartments of Radiology and Pediatrics. Rev Esp Endocrinol Pediatr 2010 1 Suppl(1):11-18 | Doi. ![]()
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