Are Automated and Visual Greulich and Pyle-Based Methods Applicable to Caucasian European Children With a Moroccan Ethnic Origin When Assessing Bone Age?

Abstract

Introduction To test the accuracy of the visual and automated bone age assessment base on the Greulich and Pyle (GP) method in healthy Caucasian European children with a Moroccan ethnic origin. Material and methods Moroccan Caucasian (MC) children were retrospectively and consecutively enrolled along with age- and sex-matched control group (CG) of European Caucasian (EC) children enrolled from the general population. The two groups included 423 children aged from 2 to 15 years with a normal left-hand radiograph performed to rule out a trauma between March 2008 and December 2017. One radiologist, blinded to the BoneXpert® (Visiana, Holte, Denmark) estimates, visually reviewed the radiographs using the GP atlas. The BoneXpert® automatically analysed all 423 radiographs. The intraclass correlation coefficient (ICC), linear regression and Bland-Altman plots were performed to describe the agreement between each method and the chronological age (CA) and the agreement between the two methods. Results Visual bone age assessment was related to the CA in both girls (MC ICC 0.97; EC ICC 0.97) and boys (MC ICC 0.95; EC ICC 0.96). Automated bone age assessment was related to the CA in both girls (MC ICC 0.97; EC ICC 0.96) and boys (MC ICC 0.88; EC ICC 0.96). Bland-Altman plots showed an excellent agreement between the two methods in both sexes and ethnicities before puberty especially in Moroccan boys. Conclusion Visual and automatic bone age assessment based on the GP method, previously validated in the general population of Caucasian European children, can be confidently used in healthy Caucasian European children with a Moroccan ethnic origin.