Value of Sonographic Examination of Left Wrist and Hand in Estimation of Bone Age in 0–6 Years Old Children

Background: Assessments of skeletal age are of great importance for the diagnosis of growth disorders, which are classified into two broad categories of primary and secondary growth defects with different etiologies, prognoses and treatments. Distinction between these categories can be made from clinical findings and skeletal age. "Greulich and Pyle" is the most prevalently employed skeletal age technique, based on the recognition of maturity in hand-wrist radiographs from birth to maturity. On the other hand, sonography is a developing method in examination of soft tissues and has some known advantages such as avoidance of radiation in children.

Objectives: The purpose of this study is evaluation of the value of sonographic examination of wrist and hand in estimating bone age in 0-6 years old children.

Patients and Methods: Fifty-one children, referred to Tabriz Children Hospital for determining bone age on the base of left wrist-hand radiograph, were introduced to sonographic examination before radiography. At first, in a sagittal sonogram of distal radius the persistence of distal radius epiphysis is detected. Then, in a transvers sonogram, the size of distal radius metaphysis and epiphysis were examined. After that, sagittal sonographic exam was obtained from first and third metacarpal bones and third finger to determine persistence and size of the osseous epiphysis. Sagittal and transvers exams of the wrist were also obtained, and the number and size of the epiphysis were measured. Based on these findings and comparison with the "Greulich and Pyle" atlas, the bone age was estimated. Then routine hand-wrist radiograph was obtained, and bone age was estimated with another radiologist, using also "Greulich and Pyle" atlas. The results of the sonographic and radiographic exams were listed and compared.

Results: Six children were less than 1 year (4 girls and 2 boys ), 8 children were 1–2 years old (4 girls, 4 boys), 8 children were 2–3 years old (4 girls, 4 boys), 7 children were 3–4 years old (3 girls, 4 boys), 8 children were 4–5 years old (4 girls, 4 boys) and 14 children were 5–6 years old (9 girls, 5 boys). Diagnostic value of sonography for estimation of bone age in comparison with plain radiograph was somehow equivalent, that is statically significant (P = 0.01).

Conclusions: Sonographic examination of wrist is a valuable method for estimating bone age in 0–6 years.