-
摘要: 骨龄是了解儿童生长发育最常用且有效的指标,在多种生长发育障碍性疾病的诊断与疗效评估中发挥重要作用。临床上最常拍摄左手和腕部X线片进行骨龄评估,但其存在一定辐射风险。超声可清晰显示骨骺及次级骨化中心,进行多部位扫查、动态测量,无辐射且便捷。近年来,利用超声进行骨龄评估的相关研究及临床应用取得了较大进展。本文通过回顾最新文献,探讨肌骨超声以及定量超声在骨龄评估中的价值,并提出超声评估骨龄研究中的问题及改进方向。Abstract: Bone age, the most commonly used and effective indicator for understanding children's growth and development, plays an important role in the diagnosis and efficacy evaluation of various growth and development disorders. Clinically, X-rays of the left hand and wrist are mostly taken for bone age assessment, but there is a certain radiation risk. Ultrasound can clearly display the epiphysis and secondary ossification center, and conveniently perform multi-site scanning and dynamic measurement without radiation. In recent years, great progress has been made in the research and clinical application of ultrasound in bone age assessment. This article, by reviewing the latest literature, discusses the value of musculoskeletal ultrasound and quantitative ultrasound in bone age assessment, raises the problems in the study of ultrasound assessment of bone age, and suggests direction for improvement.
-
Key words:
- ultrasonography /
- bone age /
- assessment /
- X-ray
作者贡献:赵泽庆负责文献检索及论文初稿撰写;张莉负责指导论文初稿修改;潘慧、王凤丹、陈适负责论文修订;杨筱、李建初负责论文选题设计及写作指导。利益冲突:所有作者均声明不存在利益冲突 -
[1] Creo A L, Schwenk W F 2nd. Bone age: a handy tool for pediatric providers[J]. Pediatrics, 2017, 140(6): e20171486. doi: 10.1542/peds.2017-1486 [2] Cavallo F, Mohn A, Chiarelli F, et al. Evaluation of bone age in children: a mini-review[J]. Front Pediatr, 2021, 9: 580314. doi: 10.3389/fped.2021.580314 [3] Martin D D, Wit J M, Hochberg Z, et al. The use of bone age in clinical practice-part 1[J]. Horm Res Paediatr, 2011, 76(1): 1-9. doi: 10.1159/000329372 [4] Spadoni G L, Cianfarani S. Bone age assessment in the workup of children with endocrine disorders[J]. Horm Res Paediatr, 2010, 73(1): 2-5. doi: 10.1159/000271910 [5] Ronckers C M, Doody M M, Lonstein J E, et al. Multiple diagnostic X-rays for spine deformities and risk of breast cancer[J]. Cancer Epidemiol Biomarkers Prev, 2008, 17(3): 605-613. doi: 10.1158/1055-9965.EPI-07-2628 [6] 伍小龙, 袁晓勇, 杨丽辉. 骨龄检测技术溯源及其进展[J]. 西藏医药, 2023, 44(1): 143-145. Wu X L, Yuan X Y, Yang L H. Tracing and progress of bone age detection technology[J]. Tibetan Med, 2023, 44(1): 143-145. [7] Lazar L, Phillip M. Pubertal disorders and bone maturation[J]. Endocrinol Metab Clin North Am, 2012, 41(4): 805-825. doi: 10.1016/j.ecl.2012.08.003 [8] Prokop-Piotrkowska M, Marszałek-Dziuba K, Moszczyńska E, et al. Traditional and new methods of bone age assessment-an overview[J]. J Clin Res Pediatr Endocrinol, 2021, 13(3): 251-262. doi: 10.4274/jcrpe.galenos.2020.2020.0091 [9] 袁新宇, 潘诗农, 程晓光. 构建儿童骨龄核心数据建立中国儿童骨龄标准体系[J]. 中华放射学杂志, 2023, 57(4): 341-343. Yuan X Y, Pan S N, Cheng X G. Establishing bone age database of contemporary healthy children and building the standard for assessment in China[J]. Chin J Radiol, 2023, 57(4): 341-343. [10] De Sanctis V, Di Maio S, Soliman A T, et al. Hand X-ray in pediatric endocrinology: skeletal age assessment and beyond[J]. Indian J Endocrinol Metab, 2014, 18(Suppl 1): S63-S71. [11] Spampinato C, Palazzo S, Giordano D, et al. Deep learning for automated skeletal bone age assessment in X-ray images[J]. Med Image Anal, 2017, 36: 41-51. doi: 10.1016/j.media.2016.10.010 [12] 王凤丹, 次旦旺久, 焦洋, 等. 人工智能在骨龄评估中的应用[J]. 基础医学与临床, 2022, 42(11): 1776-1780. https://www.cnki.com.cn/Article/CJFDTOTAL-JCYL202211027.htm Wang F D, Cidanwangjiu, Jiao Y, et al. Use of artificial intelligence in bone age assessment[J]. Basic Clin Med, 2022, 42(11): 1776-1780. https://www.cnki.com.cn/Article/CJFDTOTAL-JCYL202211027.htm [13] Rubin D A. Assessing bone age: a paradigm for the next generation of artificial intelligence in radiology[J]. Radiology, 2021, 301(3): 700-701. doi: 10.1148/radiol.2021211339 [14] Lee B D, Lee M S. Automated bone age assessment using artificial intelligence: the future of bone age assessment[J]. Korean J Radiol, 2021, 22(5): 792-800. doi: 10.3348/kjr.2020.0941 [15] Daneff M, Casalis C, Bruno C H, et al. Bone age assessment with conventional ultrasonography in healthy infants from 1 to 24 months of age[J]. Pediatr Radiol, 2015, 45(7): 1007-1015. doi: 10.1007/s00247-014-3253-0 [16] Bilgili Y, Hizel S, Kara S A, et al. Accuracy of skeletal age assessment in children from birth to 6 years of age with the ultrasonographic version of the Greulich-Pyle atlas[J]. J Ultrasound Med, 2003, 22(7): 683-690. doi: 10.7863/jum.2003.22.7.683 [17] Hajalioghli P, Tarzamni M K, Arami S, et al. The utility of ultrasonographic bone age determination in detecting growth disturbances; a comparative study with the conventional radiographic technique[J]. Skeletal Radiol, 2015, 44(9): 1351-1356. doi: 10.1007/s00256-015-2175-8 [18] Torenek Ağirman K, Bilge O M, Miloğlu Ö. Ultrasono-graphy in determining pubertal growth and bone age[J]. Dentomaxillofac Radiol, 2018, 47(7): 20170398. doi: 10.1259/dmfr.20170398 [19] Nicholas J L, Douglas K E, Waters W, et al. US evaluation of bone age in rural Ecuadorian children: association with anthropometry and nutrition[J]. Radiology, 2020, 296(1): 161-169. doi: 10.1148/radiol.2020190606 [20] Laor T, Jaramillo D. MR imaging insights into skeletal maturation: what is normal?[J]. Radiology, 2009, 250(1): 28-38. doi: 10.1148/radiol.2501071322 [21] 赵莹, 洪恺, 冯群群, 等. 常规超声定量评估骨龄[J]. 中国医学影像技术, 2021, 37(9): 1405-1409. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX202109036.htm Zhao Y, Hong K, Feng Q Q, et al. Conventional ultrasound for quantitative evaluation on bone age[J]. Chin J Med Imaging Technol, 2021, 37(9): 1405-1409. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX202109036.htm [22] Wan J, Zhao Y, Feng Q Q, et al. Potential value of conventional ultrasound in estimation of bone age in patients from birth to near adulthood[J]. Ultrasound Med Biol, 2019, 45(11): 2878-2886. doi: 10.1016/j.ultrasmedbio.2019.07.681 [23] Wan J, Zhao Y, Feng Q Q, et al. Summation of ossification ratios of radius, ulna and femur: a new parameter to evaluate bone age by ultrasound[J]. Ultrasound Med Biol, 2020, 46(7): 1761-1768. doi: 10.1016/j.ultrasmedbio.2020.03.021 [24] Wan J, Zhao Y, Feng Q Q, et al. Statistical confirmation of a method of US determination of bone age[J]. Radiology, 2021, 300(1): 176-183. doi: 10.1148/radiol.2021204353 [25] Lv P, Zhang C. Tanner-Whitehouse skeletal maturity score derived from ultrasound images to evaluate bone age[J]. Eur Radiol, 2023, 33(4): 2399-2406. [26] 祝丹, 余文, 徐健. 腕骨发育评价在青春期前儿童生长激素缺乏症诊断中的参考作用[J]. 中国儿童保健杂志, 2020, 28(7): 733-736. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202007006.htm Zhu D, Yu W, Xu J. Reference role of carpal bone age in the diagnosis of child growth hormone deficiency[J]. Chin J Child Health Care, 2020, 28(7): 733-736. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202007006.htm [27] Castriota-Scanderbeg A, De Micheli V. Ultrasound of femoral head cartilage: a new method of assessing bone age[J]. Skeletal Radiol, 1995, 24(3): 197-200. doi: 10.1007/BF00228922 [28] Castriota-Scanderbeg A, Sacco M C, Emberti-Gialloreti L, et al. Skeletal age assessment in children and young adults: comparison between a newly developed sonographic method and conventional methods[J]. Skeletal Radiol, 1998, 27(5): 271-277. doi: 10.1007/s002560050380 [29] Sherif H, Noureldin M, Bakr A F, et al. Sonographic measurement of calcaneal volume for determination of skeletal age in children[J]. J Clin Ultrasound, 2003, 31(9): 457-460. doi: 10.1002/jcu.10213 [30] 杨晓, 高建松, 吴怡玲. B超多元计数法计算婴儿骨龄及超声标准与X线标准分析对比[J]. 中国妇幼保健, 2009, 24(3): 318-321. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB200903011.htm Yang X, Gao J S, Wu Y L. Calculation of infant bone age using B-ultrasound multivariate counting method and comparison of ultrasound standard and X-ray standard analysis[J]. Matern Child Health Care Chin, 2009, 24(3): 318-321. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB200903011.htm [31] 杨晓, 高建松, 吴怡玲. 超声多元计数法诊断206例婴儿骨龄及临床应用[J]. 医学研究杂志, 2007, 36(6): 77-80. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYZ200706029.htm Yang X, Gao J S, Wu Y L. A study of comprehensive method diagnoses 206 infants bone age by sonography and it's clinical using[J]. J Med Res, 2007, 36(6): 77-80. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYZ200706029.htm [32] Torlak G, Kiter E, Oto M, et al. Ultrasonographic evaluation of the Risser sign. Is it a reliable and reproducible method?[J]. Spine (Phila Pa 1976), 2012, 37(4): 316-320. doi: 10.1097/BRS.0b013e31821cfe3f [33] Wagner U A, Diedrich V, Schmitt O. Determination of skeletal maturity by ultrasound: a preliminary report[J]. Skeletal Radiol, 1995, 24(6): 417-420. doi: 10.1007/BF00941236 [34] Thaler M, Kaufmann G, Steingruber I, et al. Radiographic versus ultrasound evaluation of the Risser Grade in adoles-cent idiopathic scoliosis: a prospective study of 46 patients[J]. Eur Spine J, 2008, 17(9): 1251-1255. doi: 10.1007/s00586-008-0726-6 [35] Gregg E W, Kriska A M, Salamone L M, et al. The epidemiology of quantitative ultrasound: a review of the relationships with bone mass, osteoporosis and fracture risk[J]. Osteoporos Int, 1997, 7(2): 89-99. doi: 10.1007/BF01623682 [36] Baroncelli G I. Quantitative ultrasound methods to assess bone mineral status in children: technical characteristics, performance, and clinical application[J]. Pediatr Res, 2008, 63(3): 220-228. doi: 10.1203/PDR.0b013e318163a286 [37] Glüer C C, Barkmann R. Quantitative ultrasound: use in the detection of fractures and in the assessment of bone composition[J]. Curr Osteoporos Rep, 2003, 1(3): 98-104. doi: 10.1007/s11914-996-0003-8 [38] Mentzel H J, Vilser C, Eulenstein M, et al. Assessment of skeletal age at the wrist in children with a new ultrasound device[J]. Pediatr Radiol, 2005, 35(4): 429-433. doi: 10.1007/s00247-004-1385-3 [39] 蔡广, 沈勋章, 余卫东, 等. 超声骨龄和中国人骨发育判读标准的骨龄判读对比分析[J]. 体育科研, 2006, 27(3): 42-44. https://www.cnki.com.cn/Article/CJFDTOTAL-TYKA200603010.htm Cai G, Shen X Z, Yu W D, et al. Comparing analysis between ultrasonic BonAge and CHN method[J]. Sport Sci Res, 2006, 27(3): 42-44. https://www.cnki.com.cn/Article/CJFDTOTAL-TYKA200603010.htm [40] Khan K M, Miller B S, Hoggard E, et al. Application of ultrasound for bone age estimation in clinical practice[J]. J Pediatr, 2009, 154(2): 243-247. doi: 10.1016/j.jpeds.2008.08.018 [41] Utczas K, Muzsnai A, Cameron N, et al. A comparison of skeletal maturity assessed by radiological and ultrasonic methods[J]. Am J Hum Biol, 2017, 29(4): e22966. doi: 10.1002/ajhb.22966
点击查看大图
计量
- 文章访问数: 306
- HTML全文浏览量: 35
- PDF下载量: 61
- 被引次数: 0