Application of ultrasound for bone age estimation in clinical practice

J Pediatr. 2009 Feb;154(2):243-7. doi: 10.1016/j.jpeds.2008.08.018. Epub 2008 Sep 27.


Objective: To assess the validity of bone age assessment by ultrasonography (US).

Study design: Wrist US was performed on children (n = 100) undergoing radiographic bone age and compared with bone age estimation by a radiologist in the clinic and by endocrinologists under blinded conditions with Greulich and Pyle (GP) and Tanner and Whitehouse (TW3) methods.

Results: The strongest correlation (r(2)) was seen in the radiographic bone age assessment between the 2 endocrinologists using the GP method (96.7%). The poorest correlation was seen when comparing radiographic methods to US of either wrist (74.6% to 82.6%). When bone age correlations were divided into normal, delayed or advanced, the highest correlation between the radiographic and US methods was found in the normal bone age group (80.9% to 86.1%) with weaker correlations for the delayed bone age group (77.1% to 86.9%) and the advanced bone age group (62.2% to 81.1%). US tended to overread delayed bone age and underread advanced bone age. US had poor positive and negative predictive value for identification of a normal or delayed bone age. The negative predictive value of US was 91% for an advanced bone age.

Conclusions: On the basis of our data, US assessment should not yet be considered a valid replacement for radiographic bone age determination.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Age Determination by Skeleton / methods*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Growth Disorders / epidemiology
  • Humans
  • Image Processing, Computer-Assisted
  • Linear Models
  • Male
  • Predictive Value of Tests
  • Radius / diagnostic imaging*
  • Sensitivity and Specificity
  • Ulna / diagnostic imaging*
  • Ultrasonography
  • Young Adult