Endocrine Abstracts

Background: X-rays of the hand and wrist are routinely performed to evaluate bone age (BA) in children with endocrine and growth disorders. BA is used essentially to assess growth potential, but the BA x-ray can reveal additional morphological abnormalities. Incidental findings on the BA x-ray can aid clinical diagnosis and prompt appropriate further investigations to establish the child’s final diagnosis.

Methods: A 10-year retrospective review of 1535 BA x-rays performed at a single teaching hospital was conducted. The age range of the patients was 2–17 yrs, and 60% were male. Bone age is routinely reported using Greulich and Pyle methodology. From this cohort, x-rays were identified where morphological abnormalities were reported and the incidence and nature of the abnormalities was determined. The x-ray findings were correlated with the original x-ray request details, clinical notes and subsequent diagnosis.

Results: 99 (7%) of the x-rays were reported showing additional morphological abnormalities. Abnormalities such as clinodactyly, Madelung deformity and short phalanges were noted, as well as more diffuse abnormalities such as osteopaenia or osteosclerosis. Many suspected diagnoses were supported by the additional findings on the bone age radiograph. However, in nine cases the bone age x-ray alone pointed to a previously unsuspected diagnosis and prompted further imaging including skeletal survey (n=7) and bone lesion characterization (n=2) to establish the correct final diagnoses.

Conclusion: This large retrospective study demonstrated that 7% of BA x-rays showed incidental morphological abnormalities. In 9 (9%) of these cases, the findings pointed to a previously unsuspected diagnosis. Recently there has been a focus on the use of automated BA assessment software in place of radiologist reporting. We believe that ongoing paediatric radiologist review of BA x-rays (and close working between radiologist and paediatric endocrinologist) is essential to identify additional morphological abnormalities and prompt appropriate further investigations, which can prove crucial to the accurate diagnosis of the patient’s underlying condition.