Automatic bone age assessment for adult height prediction in children with congenital adrenal hyperplasia

OBJECTIVES: This study aimed to evaluate the clinical accuracy of automated BoneXpert (BX) vs. clinician-based Greulich-Pyle (GP) bone age (BA) assessments by comparing their respective predicted adult heights (PAH) with near-final height (NFH) in patients with congenital adrenal hyperplasia (CAH). METHODS: Forty-seven patients with classic salt-wasting CAH diagnosed in the neonatal period who had reached NFH were included. Left hand-wrist radiographs obtained during the prepubertal period (6-9 years) were evaluated manually by two clinicians using the GP atlas and by the BX-GP method. PAH was calculated for both sexes using the Bayley-Pinneau (BP) method based on clinician- and BX-derived BA. PAH standard deviation scores (SDS) were compared with NFH-SDS and target height (TH)-SDS. Agreement was assessed using Bland-Altman analysis. RESULTS: Thirty patients (63.8 %) were female. Mean ages at bone age assessment and NFH were 7.3 and 16.1 years, respectively. Mean prepubertal height-SDS was 0.0 in girls and -0.25 in boys, while NFH-SDS was -0.79 and -1.14, respectively. Mean bone age according to clinician-GP was 7.80 years in girls and 8.16 in boys, and 7.69 and 8.14 years according to BX-GP. Clinician-based PAH-SDS was -1.0 in girls and -1.18 in boys, whereas BX-based PAH-SDS was -0.86 and -1.17, respectively. BX-based PAH was closer to NFH in girls (p<0.001), with no significant difference in boys. In both sexes, PAH-SDS and NFH-SDS were significantly lower than TH-SDS (p<0.001). CONCLUSIONS: PAH calculations using the BP method based on BX-derived GP bone age readings more accurately predicted NFH in patients with CAH.