Artificial intelligence (AI) is playing an ever-increasing role in radiology (more so in the adult world than in pediatrics), to the extent that there are unfounded fears it will completely take over ...the role of the radiologist. In relation to musculoskeletal applications of AI in pediatric radiology, we are far from the time when AI will replace radiologists; even for the commonest application (bone age assessment), AI is more often employed in an AI-assist mode rather than an AI-replace or AI-extend mode. AI for bone age assessment has been in clinical use for more than a decade and is the area in which most research has been conducted. Most other potential indications in children (such as appendicular and vertebral fracture detection) remain largely in the research domain. This article reviews the areas in which AI is most prominent in relation to the pediatric musculoskeletal system, briefly summarizing the current literature and highlighting areas for future research. Pediatric radiologists are encouraged to participate as members of the research teams conducting pediatric radiology artificial intelligence research.
Objective
To determine whether the Greulich and Pyle (G&P) atlas is applicable when applied to populations of different ethnicity.
Methods
A systematic review of studies published between 1959 and ...15th February 2017 identified from the Embase, MEDLINE and Cochrane databases was undertaken. Quality of the studies was assessed using the National Institute for Health and Care Excellence tool. Meta-analysis used mean differences and standard deviations as summary statistics for the difference between bone age (BA) and chronological age (CA).
Results
A total of 49 studies were included of which 27 (55%) were related to Caucasian populations. Of the 49 eligible studies, 35 were appropriate for further meta-analysis. In African females, meta-analysis showed a significant mean difference between BA and CA of 0.37 years (95% CI 0.04, 0.69). In Asian males, meta-analysis showed significant differences between BA and CA of -1.08, -1.35, -1.07, -0.80 and 0.50 years for chronological ages of 6, 7, 8, 9 and 17 years, respectively. Meta-analysis showed no significant differences between BA and CA in African males, Asian females, Caucasians and Hispanics.
Conclusions
The G&P standard is imprecise and should be used with caution when applied to Asian male and African female populations, particularly when aiming to determine chronological age for forensic/legal purposes.
Key Points
• In African females, bone age is significantly advanced when compared to the G&P standard.
• In Asian males, bone age is significantly delayed between 6 and 9 years old inclusive and significantly advanced at 17 years old when compared to the G&P standard.
• The G&P atlas should be used with caution when applied to Asian and African populations, particularly when aiming to determine chronological age for forensic/legal purposes.
Objectives
To assess the effect of secular change on skeletal maturation and thus on the applicability of the Greulich and Pyle (G&P) and Tanner and Whitehouse (TW3) methods.
Methods
BoneXpert was ...used to assess bone age from 392 hand trauma radiographs (206 males, 257 left). The paired sample
t
test was performed to assess the difference between mean bone age (BA) and mean chronological age (CA). ANOVA was used to assess the differences between groups based on socioeconomic status (taken from the Index of Multiple Deprivation).
Results
CA ranged from 2 to 15 years for females and 2.5 to 15 years for males. Numbers of children living in low, average and high socioeconomic areas were 216 (55%), 74 (19%) and 102 (26%) respectively. We found no statistically significant difference between BA and CA when using G&P. However, using TW3, CA was underestimated in females beyond the age of 3 years, with significant differences between BA and CA (− 0.43 years, SD 1.05,
p
= < 0.001) but not in males (0.01 years, SD 0.97,
p
= 0.76). Of the difference in females, 17.8% was accounted for by socioeconomic status.
Conclusion
No significant difference exists between BoneXpert-derived BA and CA when using the G&P atlas in our study population. There was a statistically significant underestimation of BoneXpert-derived BA compared with CA in females when using TW3, particularly in those from low and average socioeconomic backgrounds. Secular change has not led to significant advancement in skeletal maturation within our study population.
Key Points
• The Greulich and Pyle method can be applied to the present-day United Kingdom (UK) population.
• The Tanner and Whitehouse (TW3) method consistently underestimates the age of twenty-first century UK females by an average of 5 months.
• Secular change has not advanced skeletal maturity of present-day UK children compared with those of the mid-twentieth century.
Summary Background Post-mortem MRI is a potential diagnostic alternative to conventional autopsy, but few large prospective studies have compared its accuracy with that of conventional autopsy. We ...assessed the accuracy of whole-body, post-mortem MRI for detection of major pathological lesions associated with death in a prospective cohort of fetuses and children. Methods In this prospective validation study, we did pre-autopsy, post-mortem, whole-body MRI at 1·5 T in an unselected population of fetuses (≤24 weeks' or >24 weeks' gestation) and children (aged <16 years) at two UK centres in London between March 1, 2007 and Sept 30, 2011. With conventional autopsy as the diagnostic gold standard, we assessed MRI findings alone, or in conjunction with other minimally invasive post-mortem investigations (minimally invasive autopsy), for accuracy in detection of cause of death or major pathological abnormalities. A radiologist and pathologist who were masked to the autopsy findings indicated whether the minimally invasive autopsy would have been adequate. The primary outcome was concordance rate between minimally invasive and conventional autopsy. Findings We analysed 400 cases, of which 277 (69%) were fetuses and 123 (31%) were children. Cause of death or major pathological lesion detected by minimally invasive autopsy was concordant with conventional autopsy in 357 (89·3%, 95% CI 85·8–91·9) cases: 175 (94·6%, 90·3–97·0) of 185 fetuses at 24 weeks' gestation or less, 88 (95·7%, 89·3–98·3) of 92 fetuses at more than 24 weeks' gestation, 34 (81·0%, 66·7–90·0) of 42 newborns aged 1 month or younger, 45 (84·9%, 72·9–92·1) of 53 infants aged older than 1 month to 1 year or younger, and 15 (53·6%, 35·8–70·5) of 28 children aged older than 1 year to 16 years or younger. The dedicated radiologist or pathologist review of the minimally invasive autopsy showed that in 165 (41%) cases a full autopsy might not have been needed; in these cases, concordance between autopsy and minimally invasive autopsy was 99·4% (96·6–99·9). Interpretation Minimally invasive autopsy has accuracy similar to that of conventional autopsy for detection of cause of death or major pathological abnormality after death in fetuses, newborns, and infants, but was less accurate in older children. If undertaken jointly by pathologists and radiologists, minimally invasive autopsy could be an acceptable alternative to conventional autopsy in selected cases. Funding Policy research Programme, Department of Health, UK.
Skeletal imaging techniques have become clinically valuable methods for measuring and assessing bone mineral density in children and young people. Dual-energy X-ray absorptiometry (DXA) is the ...current reference standard for evaluating bone density, as recommended by the International Society for Clinical Densitometry (ISCD). Various bone imaging modalities, such as quantitative ultrasound (QUS), peripheral quantitative computed tomography (pQCT), high-resolution peripheral quantitative computed tomography (HR-pQCT), magnetic resonance imaging (MRI), and digital X-ray radiogrammetry (DXR) have been developed to further quantify bone health in children and adults. The purpose of this review, with meta-analysis, was to systematically research the literature to compare the various imaging methods and identify the best modality for assessing bone status in healthy papulations and children and young people with chronic disease (up to 18 years).
A systematic computerized search of Medline, PubMed, and Web of Science databases was conducted to identify English-only studies published between 1st January 1990 and 1st December 2019. In this review, clinical studies comparing imaging modalities with DXA were chosen according to the inclusion criteria. The risk of bias and quality of articles was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The meta-analysis to estimate the overall correlation was performed using a Fisher Z transformation of the correlation coefficient. Additionally, the diagnostic accuracy measures of different imaging methods compared with DXA were calculated.
The initial search strategy identified 13,412 papers, 29 of which matched the inclusion and exclusion criteria. Of these, twenty-two papers were included in the meta-analysis. DXA was compared to QUS in 17 papers, to DXR in 7 and to pQCT in 4 papers. A single paper compared DXA, DXR, and pQCT. The meta-analysis demonstrated that the strongest correlation was between DXR and DXA, with a coefficient of 0.71 95%CI: 0.43; 1.00, p-value < 0.001, while the correlation coefficients between QUS and DXA, and pQCT and DXA were 0.57 95%CI: 0.25; 0.90, p-value < 0.001 and 0.57 95%CI: 0.46; 0.67, p-value < 0.001, respectively. The overall sensitivity and specificity were statistically significant 0.71 and 0.80, respectively.
No current imaging modality provides a full evaluation of bone health in children and young adults, with each method having some limitations. Compared to QUS and pQCT, DXR achieved the strongest positive relationship with DXA. DXR should be further evaluated as a reliable method for assessing bone health and as a predictor of fractures in children and young people.
•No current imaging modality provides a full evaluation of bone health in children and young adults•To date, dual-energy X-ray absorptiometry (DXA) is the gold standard for evaluating BMD in children and adults, as recommended by the International Society for Clinical Densitometry (ISCD).•From meta-analysis, the strongest relationship was between digital X-ray radiogrammetry (DXR) and DXA, with a pooled estimate of 0.71.
Imaging has many uses, but in cases of suspected child abuse, radiographs and CT scans are vital in identifying fractures and head injury that may not be clinically obvious. There are growing ...concerns about the small but potential adverse effects of radiation, including cancer, in the paediatric population as a result of imaging. The vast majority of general paediatricians undertaking child abuse assessments request skeletal surveys and CT scans, subjecting children to significant amounts of radiation. Informed consent must be taken from parents for these procedures and therefore this paper aims to look at evidence of the dangers of radiation in children and raise awareness among paediatricians.
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