Hand MRI and the Greulich-Pyle atlas in skeletal age estimation in adolescents

Objective To evaluate the feasibility of hand MRI in age assessment in adolescents using the Greulich-Pyle (GP) atlas criteria. Materials and methods Two radiologists, who were blinded to the study subjects chronologic ages, semi-objectively evaluated 1.5-T MRIs of the left hands of ten patients (13.52.6 years) who had left-hand radiographs and 50 healthy volunteers (152 years). Results A coronal T1-weighted, volumetric, interpolated, breath-hold examination with water excitation (T1 VIBE-3D-WE) achieved the best image quality. The correlation between estimated patients ages on radiographs and MRI was high. The average estimated age difference between the MRIs and radiographs was 0.05 years for reader 1 and 0.175 years for reader 2. The interclass coefficients (ICCs) showed high interobserver agreement (radiographs: ICC=0.95, MRI: ICC=0.97). The ICC, calculated separately for the male and female volunteers estimated ages by MRI, also showed a high agreement between the two readers (male: ICC=0.97, female: ICC=0.95). Reader 1 estimated 94% of volunteers within 2 standard deviations (SD) and 62% within 1 SD. The results for reader 2 were 92% and 54%, respectively. Thirty-nine percent of girls and 27% of boys were estimated to be older using 1 SD. Conclusion MRI of the left hand is a feasible alternative to hand radiographs for skeletal age estimation in adolescents using the GP criteria with 2 SD. Using 1 SD, the age of healthy volunteers tended to be estimated as higher than the chronologic age. Future studies should evaluate the results in a larger number of participants.(VLID)358223