Greulich-Pyle Atlas Research Articles

Precision and Accuracy of Radiological Bone Age Assessment in Children among Different Ethnic Groups: A Systematic Review.

The aim was to identify, evaluate, and summarize the findings of relevant individual studies on the precision and accuracy of radiological BA assessment procedures among children from different ethnic groups. A qualitative systematic review was carried out following the MOOSE statement and previously registered in PROSPERO (CRD42023449512). A search was performed in MEDLINE (PubMed) (n = 561), the Cochrane Library (n = 261), CINAHL (n = 103), Web of Science (WOS) (n = 181), and institutional repositories (n = 37) using MeSH and free terms combined with the Booleans "AND" and "OR". NOS and ROBINS-E were used to assess the methodological quality and the risk of bias of the included studies, respectively. A total of 51 articles (n = 20,100) on radiological BA assessment procedures were precise in terms of intra-observer and inter-observer reliability for all ethnic groups. In Caucasian and Hispanic children, the Greulich-Pyle Atlas (GPA) was accurate at all ages, but in youths, Tanner-Whitehouse radius-ulna-short bones 3 (TW3-RUS) could be an alternative. In Asian and Arab subjects, GPA and Tanner-Whitehouse 3 (TW3) overestimated the BA in adolescents near adulthood. In African youths, GPA overestimated the BA while TW3 was more accurate. GPA and TW3 radiological BA assessment procedures are both precise but their accuracy in estimating CA among children of different ethnic groups can be altered by racial bias.

Improvement of Bone Age Assessment Using a Deep Learning Model in Young Children: Significance of Carpal Bone Analysis

Background: Deep learning methods used for bone age assessment (BAA) mostly employ the whole hand or regional convolutional neural networks without carpal bones; therefore, their application is insufficient in young children. Objectives: This study aimed to improve the accuracy of BAA in young children by integrating a carpal bone analysis and to achieve a similar BAA accuracy for all age groups. Patients and Methods: A hybrid Greulich-Pyle (GP) and modified Tanner-Whitehouse deep learning model for BAA was trained by integrating an additional carpal bone analysis of an open dataset. A total of 453 hand radiographs from a single institution were selected for external validation. To create the reference standard, three human experts conducted a BAA, based on the GP Atlas, and then, interobserver agreement was evaluated. The model performance was estimated by comparing the mean absolute difference (MAD) and the root mean square error (RMSE) between the two BAA models, including one with a carpal bone analysis (M1) and one without a carpal bone analysis (M2), and the reference standard. The MAD of each model was compared between sex and age groups with respect to four major developmental stages, that is, pre-puberty, early and mid-puberty, late puberty, and post-puberty. Results: The M1 model showed a higher accuracy with a lower MAD (0.366; 95% confidence interval [CI]: 0.337 - 0.395) compared to the M2 model (0.388; 95% CI: 0.358 - 0.418) for all age groups, with a significant difference (P < 0.001). The RMSE values versus the reference standard were 0.483 and 0.505 years for the M1 and M2 models, respectively. According to sex and developmental stage distributions, the M1 model had a greater predictive ability compared to the M2 model for pre-pubertal patients, regardless of sex (P = 0.008 for males and P = 0.022 for females). Conclusion: Based on the present findings, the integration of a carpal bone analysis into the BAA model improved its accuracy, especially in young children.

Which method is more effective in predicting adult height in pubertal girls treated with gonadotropin-releasing hormone agonist?

The aim of the present study was to determine the efficiency of three different predictive models [Bayley-Pinneau (BP), Roche-Wainer-Thissen (RWT), and Tanner-Whitehouse 2 (TW2)] by comparing their predictions with near-adult height data of girls receiving gonadotropin-releasing hormone agonist (GnRHa) therapy. Clinical findings were retrospectively analyzed. Bone ages obtained before treatment were evaluated from left hand and wrist radiographs by three researchers. Predicted adult height (PAH) was calculated using the BP, RWT, and TW2 methods for each patient at the beginning of therapy. The median age at diagnosis of the 48 patients included in the study was 8.8 (8.9-9.3) years. There was no significant difference between the mean bone ages evaluated separately with the Greulich-Pyle atlas and the TW3-RUS method (p=0.34). Among the PAH methods, only PAH measured by the BP method was very close to and no different from near adult height (NAH) [159.8±6.3 vs. 158.8±9.3 cm. p=0.3; (-0.5±1.1) vs. (-0.7±1.6) standard deviation score, p=0.1]. Accordingly, the BP method was found to be the most accurate prediction tool in girls with puberty treated with GnRHa. The BP method is more effective at predicting adult height than the RWT and TW2 methods in female patients who will receive GnRHa treatment.

Is there any relationship between pubertal growth spurt and dental or bone age estimation methods?

ABSTRACT The aim of this study was to compare the accuracy of the Willems method, Nolla method, Cameriere dental age estimation method(CDM), Greulich-Pyle Atlas(GPA) method, and Cameriere bone age estimation method(CBM) for age estimation in healthy children aged between ten and 14.9 years, according to the pubertal growth stage(PGS). The accuracy was determined as the difference between estimated age(EA) and chronological age(CA) was assessed by analysing orthopantomograms and hand-wrist radiographs. At the onset of the PGS, the Willems method showed the closest value to the CA for both sexes(girls = 0.17 ± 0.78, boys = 0.006 ± 0.96 years). At the peak, the Willems method showed the closest value to the CA for girls(0.005 ± 1.09 years), and the GPA method for boys(0.05 ± 0.68 years). At the end of the PGS, the Willems method showed the closest value to the CA for girls(0.09 ± 1.23 years), and the CBM for boys(0.24 ± 0.74 years). It was observed that all methods concluded with the closest result to the CA at the onset period of the PGS. Our study demonstrates that sex and PGS are effective in over- or under- estimations that are obtained according to the CA.

Dental Age in Precocious and Delayed Puberty Periods.

Objectives Precocious puberty indicates quick growth inception and delayed puberty indicates retardation in growth. This study aimed to investigate whether dental development is synchronous with somatic development. Materials and Methods In this study, 62 girls and 34 boys with precocious puberty aged 5 to 9, 29 girls with delayed puberty aged 13 to 16, and 43 boys with delayed puberty aged 14 to 17; 169 children (91 girls and 78 boys) with normal development were compared about their dental ages through their panoramic radiographs by using the Demirjian method and skeletal ages from hand-wrist radiographs by using Greulich-Pyle atlas. Results The findings showed that, in all cases, the dental age values were higher than chronologic and skeletal age values to a statistically significant degree. In the precocious puberty group, the dental age values were higher than chronologic age values to a statistically significant degree. In the delayed puberty group, the difference determined between the chronological age and the dental age was not found to be statistically significant. Conclusion Given that the Demirjian method is inclined to make calculations that are higher than the chronological age, our findings suggest that the dental development was faster in the precocious puberty group and retarded in the delayed puberty group.

Bone age estimation with the Greulich-Pyle atlas using 3T MR images of hand and wrist

The age estimation of the hand bones by means of X-ray examination is a pillar of the forensic age estimation. Since the associated radiation exposure is controversial, the search for ionizing radiation-free alternatives such as MRI is part of forensic research. The aim of the current study was to use the Greulich-Pyle (GP) atlas on MR images of the hand and wrist to provide reference values for assessing the age of the hand bones. 3T hand MR images of 238 male participants between the ages of 13 and 21 were acquired using 3D gradient echo sequences (VIBE, DESS). Two readers rated the images using the X-ray-based GP atlas method. A descriptive analysis and a transitional analysis were used for the statistical processing of the data. The agreement between and within the raters was assessed. In addition, a comparison was made with the chronological age and with X-ray studies. The descriptive analysis and the transition analysis showed similar results. Both evaluations showed good agreement with X-ray studies. The comparison with the chronological age showed a difference of 0.37 and 0.54 years for the two readers. The age estimate based on the cross-validated transition analysis showed a mean error of −0.28 years. Inter- and intra-rater agreement were good. In summary, it can be concluded that age estimation of hand bones with MR images is routinely applicable with the GP atlas as an alternative without ionizing radiation. However, in order to reduce the estimation error, a multi-factorial assessment based on examinations of several body regions is still recommended.

Kemik Yaşı Tayininde Kullanılan Greulich-Pyle ve Tanner-Whitehouse Yöntemlerinin Karşılaştırılması

Amaç: Pediatrik dönemde tıbbi ve adli açıdan önemi nedeniyle kemik yaşı tayini için çekilen sol el bileği grafisini değerlendirmede en çok kullanılan Greulich-Pyle atlası ve Tanner-Whitehouse yöntemlerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada kronolojik yaşları 11-16 arasında değişen 150 kız olgu ve 11-18 arasında değişen 210 erkek olgu incelenmiştir. Toplamda 360 olgu yıllara ve cinsiyete göre 12 gruba ayrılmıştır. Tüm olguların sol el bilek grafileri retrospektif olarak değerlendirilmiştir. Olguların kemik yaşı tespiti GP atlası, TW2 ve TW3 yöntemlerine göre yapılmıştır. TW yönteminde en çok kabul gören RUS skorları kullanılmıştır. Yöntemler ile kronolojik yaş arasında ilişki, fark ve kullanılabilirlik araştırılmıştır. Bulgular: Genelde TW2 yöntemi olguların yaşını daha büyük, TW3 yöntemi ise küçük göstermektedir. Kronolojik yaş ile kemik yaşı arasındaki farklar ise GP yönteminde anlamlı bulunmamış, TW3 yönteminde anlamlı bulunmuştur. Sonuç: Çalışmaya dâhil edilen yaş gruplarında GP atlasının daha kullanılabilir olduğu görülmüştür.

Evaluation of a Computer-Aided Diagnosis System for Automated Bone Age Assessment in Comparison to the Greulich-Pyle Atlas Method: A Multireader Study

The aim of this study was to investigate a novel version of a computer-aided diagnosis (CAD) system developed for automated bone age (BA) assessment in comparison to the Greulich and Pyle method, regarding its accuracy and the influence of carpal bones on BA assessment. Total BA, BA of the left distal radius, and BA of carpal bones in 305 patients were determined independently by 3 blinded radiologists and assessed by the CAD system. Pearson product-moment correlation, Bland-Altman plot, root-mean-square deviation, and further agreement analyses were computed. Mean total BA and BA of the distal radius showed high correlation between both approaches (r = 0.985 and r = 0.963). There was significantly higher correlation between values of total BA and BA of the distal radius (r = 0.969) compared with values of total BA and BA of carpal bones (r = 0.923). The assessment of carpal bones showed significantly lower interreader agreement compared with measurements of the distal radius (κ = 0.79 vs κ = 0.98). A novel version of a CAD system enables highly accurate automated BA assessment. The assessment of carpal bones revealed lower precision and interreader agreement. Therefore, methods determining BA without analyzing carpal bones may be more precise and accurate.

COMPARISION OF DENTAL SCORING SYSTEM WITH RADIOGRAPHIC SKELETAL SYSTEM IN AGE ESTIMATION

Objectives: To compare Demirjian Dental scoring method with Greulich-Pyle (GP) Skeletal method of age estimation in pubertal children. Materials and Methods: Sample of the study included 267 male healthy subjects of 11-16 years of age group.. Demirjian Scoring system was utilized to evaluate the orthopantomograms to assess their Dental age and the Hand-Wrist radiographs were analyzed to calculate the skeletal age by utilizing GP atlas. Chronological age was obtained from the date of birth of the subject .Both methods were compared with one another and with the chronological age. It was a cross-sectional study and only healthy male subjects without any clinical abnormalities were included in the study. Results: A total of 267 male subjects of 11-16 years of age group were assessed by Demirjian and Greulich Pyle Methods. Both were compared with Chronological Age. Data obtained was statistically analyzed and the Student “t” test was applied in the study population. The mean difference between Chronolgical age and dental age was 0.69years and that of chronological age and skeletal age was 0.87 years. It was observed from dental age assessment that it does not differ much from the skeletal age. Conclusion: It was concluded that Demirjian method of Age Estimation is more precise than Greulich Pyle method of Age Estimation. Furthermore both methods can be used selectively in Medicolegal cases to access bone age which can be easily correlated to chronological age.

Evaluation of skeletal maturation in individuals with cleft lip and palate

Abstract Objectives The assessment of hand-wrist films to identify skeletal maturation stage is a commonly used method for the determination of the status of a growing patient. However, there is limited information available regarding skeletal growth evaluation in subjects with a unilateral cleft lip and palate (UCLP). Therefore, the current study aimed to examine skeletal and chronological ages in subjects with a UCLP for comparison with those of a non-cleft control group to derive clinical guidelines. Methods Hand-wrist films of 45 UCLP subjects (24 male, 21 female) and 45 Angle Class I orthodontic patients (17 male, 28 female) were evaluated. Skeletal age was assessed by comparing ossification events with standard radiographs illustrated in the Greulich-Pyle atlas and recording based on the best match of maturity criteria. Results A high correlation coefficient was observed between skeletal and chronological ages in the overall study sample (p < 0.01) (N = 90). Skeletal age (11.4 years) was delayed in the UCLP group when compared with chronological age (12.3 years), although the difference between the two was statistically insignificant. Skeletal age (13.6 years) was similar to chronological age in the control group (13.1 years). Conclusions The discrepancy between chronological and skeletal age was greater in UCLP subjects compared with controls. Given that the skeletal age of male and female UCLP subjects was delayed in comparison with their chronological ages, it is of particular importance that hand-wrist films should be used instead of chronological age to assess the growth status of UCLP subjects.

Bone age assessment: comparison of children from two different regions with the Greulich–Pyle method In Turkey

The aim of this study was to identify and compare bone age assessments of Turkish children in regions of Central Anatolia and Eastern Anatolia using the Greulich-Pyle (GP) method. Evaluation was made of 849 (375 boys, 514 girls) adolescents aged between 9 and 17 years, who lived in two geographically different regions of Turkey. The selection criteria included normal growth and development, a state of good physical and mental health with no previous history of chronic or acute illnesses, no past trauma or injury to the hand-wrist region, no congenital or acquired malformations of the hand-wrist area, no hormonal disorders, and good quality hand-wrist radiographs. Bone age (BA) was evaluated using the GP method from definitive radiographs of the left hand-wrist. The total mean differences between BA and chronological age (CA) for girls and boys were found to be 1.19 ± 1.2 (p < 0.05) and 0.90 ± 1.2 (p < 0.05) years in the Eastern Anatolia region and 0.28 ± 0.6 (p > 0.05) and –0.10 ± 0.3 (p > 0.05) years in the Central Anatolia region. There were significant differences between BA and CA in all age groups for girls and boys in Malatya (a city in the Eastern Anatolia region) and in 10 and 13 year olds for girls and 12, 13, 15, and 16 year olds for boys in Sivas (a city in the Central Anatolia region). Statistically significant differences were determined between the BA and CA of the subjects living in Malatya and Sivas (p < 0.05). The results of this study using the Greulich–Pyle atlas indicate that bone development is completed earlier in adolescents living in Malatya compared with those in Sivas.

Applicability study of the automatic bone age assessment of BoneXpert software in children and adolescent of China(Shanghai)

Objective To explore the application of the automatic bone age assessment of BoneXpert software in Children and adolescent of China(Shanghai). Methods Left hand and wrist radiographs of 434 cases of children from trauma(264 boys and 170 girls) were obtained from Jan.2010 to Dec.2013.Bone age was assessed by BoneXpert software and 40 radiographs were randomly chosen and re-evaluated after a week. Results Seven images were rejected by BoneXpert, so the efficiency of the software was 98.4% and it takes only 14.5 s for every image.Sample assessments by two times are exactly the same.As to BoneXpert software, there were statistical differences between bone age and chronological age in 8 groups: 7, 8, 9, 11 years old boys and 2, 3, 9, 11 years old girls(P<0.05) out of 26 groups, and the average difference was about 1 s. The following modifications suggested that 0.57, 0.79, 0.93, -0.38 and -0.22, 0.30, 0.37, 0.59 years could be added respectively for the groups of boys aged 7, 8, 9, 11 and girls aged 2, 3, 9, 11 years old according to their average differences between the bone age and the chronological age. Conclusions The BoneXpert method for automated determination of skeletal maturity which evaluates bone age objectively and quickly can be applied clinically after slight adjustment in some age groups.BoneXpert software is 100 percent automatic and could eliminate the subjective evaluation inaccuracy. Key words: Bone age; BoneXpert; Greulich-Pyle atlas; Child; Adolescent

Comparative study of Gilsanz-Ratib digital atlas and Greulich-Pyle atlas for bone age estimation in a Chinese sample

Background: The applicability of the Gilsanz-Ratib (GR) digital atlas to bone age (BA) determination in China has not been evaluated.Aim: To compare the validity of GR and the Greulich-Pyle (GP) atlas in BA determination for children in Shanghai.Subjects and methods: Left-hand radiographs of 243 girls and 375 boys aged 0–13 years were obtained for suspected trauma. They were divided into eight sub-groups according to gender and age (0–3, 3–7, 7–10 and 10–13 years). Radiographs were read by two radiologists, using both GP and GR atlases. The differences between BA and calendar age (CA) were analysed. The inter- and intra-observer consistency was evaluated.Results: Pearson’s correlation coefficients indicated a strong positive correlation between methods and between raters. The differences between BA and CA of two sub-groups (10–13-year-old boys, GR; 0–3-year-old girls, GP) were not only statistically significant, but exceeded 1 SD, suggesting biological significance.Conclusion: Both atlases can be used on most age groups. However, the GR atlas is not recommended in boys aged 10–13 years, while the GP atlas is not suitable for girls aged 0–3 years. Therefore, the use of the GP or GR atlas is practical, depending on the age of the child.

Assessment of skeletal age in multiple epiphyseal dysplasia.

Determining the skeletal age in patients with multiple epiphyseal dysplasia (MED) is essential for predicting the adult height and guiding the timing of limb lengthening, epiphysiodesis, and other surgical procedures. In the present study, we examined the patterns of skeletal age delay using 3 different methods, the Greulich-Pyle (GP) atlas method, the Tanner-Whitehouse 3 (TW3) method using radius-ulna-short bones (RUS) scoring system, and the TW3 method using the carpal bone maturity scoring system. Left hand radiographs from 23 patients (age range, 3 to 14 y) with MED were examined to determine the skeletal age. We examined the reliability of the 3 different methods and evaluated the difference between the chronological age and the skeletal age. The interobserver and intraobserver reliabilities were higher with the GP atlas method and the TW3 RUS method compared with the TW3 carpal bone maturity scoring system. There was significant skeletal age delay irrespective of the method used (P<0.01). When we used the TW3 carpal method, the pattern of skeletal age delay was significantly distinct from the other 2 methods. According to the measurement method, there was no statistically significant difference in the developmental skeletal age pattern among the COMP gene group, the MATN3 gene group, and other gene groups. Our findings indicate that there is a distinct skeletal maturation pattern in patients with MED. The skeletal age is relatively delayed compared with the chronological age irrespective of the measuring method utilized. However, use of either the GP atlas or the TW3 RUS method provided more accurate information on the skeletal development in the patients with MED than that provided by the TW3 carpal bone maturity scoring system. Level I. Diagnostic study.

Assessment of bone ages: is the Greulich-Pyle method sufficient for Turkish boys?

The Greulich-Pyle (GP) Atlas of skeletal maturation has been prepared in white children who born between 1917 and 1942 in the USA, and is frequently used for assessment of skeletal maturity. In this study, we investigated whether or not the GP method is sufficient for Turkish children for the determination of the skeletal age. Plain radiographies of left hands and wrists of 225 healthy boys between 7 and 17 years of age were taken. Pubic hair (PH) stages of boys were determined by using the Tanner criteria. Mean chronological ages and mean skeletal ages according to GP Atlas were compared for each age groups and each PH stage. Mean skeletal ages were delayed 0.61, 0.72, 0.54, 0.39, 0.25, 0.39, and 0.32 years than the mean chronological ages in the 7-13 years age groups, respectively, and advanced 0.13, 0.01, 0.89, and 0.52 years in the 14-17 years age groups. In PH stages 1, 2, and 3, mean skeletal ages were delayed 0.67, 0.51 and 0.40 years than the mean chronological ages, respectively. In PH stages 4 and 5, mean skeletal ages were advanced 0.66 and 0.76 years than mean chronological ages. The results suggest that Turkish boys may have a different tempo of skeletal maturation during pubertal development from that of American children which GP standards were derived. Therefore, GP Atlas is not completely applicable to Turkish boys but can be used with some modification.

Skeletal maturity in Pakistani children.

Skeletal maturity in 750 normal Pakistani children (400 males, 350 females) aged 1-18 y was determined by the Greulich-Pyle atlas system. Male children during first year and female children during first 2 y of life matured in conformity with Greulich-Pyle standards. After that period mean bone ages were lower than the American standards up to 15 y in males and 13 y in females (at or around puberty), which may be due to malnutrition, ill health or other environmental factors. After puberty bone ages were higher than the American standards indicating earlier maturity in Pakistani than Western children. Hence for the proper evaluation of skeletal age in a given region, a longitudinal study on individuals in that region to establish normal standards is necessary.

Approach to Skeletal Maturation

Skeletal maturation is marked by an orderly and reproducible sequence of recognizable changes in the appearance of the skeleton during childhood. Such changes include the timing and sequence of the appearance of the centers of ossification, specific alterations in the contours of the bones, and the timing and sequence of the ultimate closure of the growth plates. Radiographically, skeletal maturity can be assessed by comparing the radiographic appearance of portions of an individual child's skeleton with the standardized appearance in a comparable population of children at various stages in their progress toward maturity. Radiographic assessment of skeletal maturity in the child is most frequently based on the appearance of the hand and wrist. Considerable normative data are available for this examination. The Greulich-Pyle atlas is the system which is most frequently used in the United States. Assessment of skeletal maturity can be useful in the evaluation and management of children with various endocrinopathies (especially those involving the pituitary, thyroid, and gonads) and in children with malformation syndromes. Skeletal maturity assessment is also frequently requested as part of the evaluation of children who are either too tall or too short for their chronologic age and can be used to predict height at maturity. Such assessment can also be useful in planning orthopedic procedures in which the outcome may be influenced by subsequent growth of the child (e.g., surgical management of scoliosis or leg-length discrepancy).

PREDICTION OF ADULT HEIGHT WITH VARIOUS METHODS IN FINNISH CHILDREN

Successive height predictions were made by several methods for a group of healthy Finnish children (30 boys and 30 girls), examined annually at ages of 7 to 17 years (1st series) and for 7 boys aged 14 to 19 years with familial delayed growth and puberty (2nd series). The methods used were those of Bayley & Pinneau (BP), Walker (W), Tanner et al. (T) and RWT, and two simple principles: the relative height method (RH) which assumes constancy of height S.D.S. throughout growth, and the index of potential height (IPH) method which assumes constancy of height S.D.S. for bone age (BA). The predictions with RH, W and IPH were inaccurate. BP, T and RWT were for the 1st series as accurate as for the basic series of the respective methods, and none was superior to the others. The BA of average Finns was delayed as compared with the standards of Greulich-Pyle Atlas. When corrections were made for this delay, the IPH method gave predictions comparable in accuracy to BP, T or RWT. In the 2nd series prediction was more accurate with the corrected IPH, BP and RWT methods than with those using BA according to TW2RUS.

Estrogen Treatment of Girls With Constitutional Tall Stature

We define "tall stature" as a body height 2 SD or more above the mean of the population. The mean height for adult women in our country is 166 cm; the 97th percentile is 179 cm. Up to 1976, we treated tall girls if their expected definite height surpassed 180 cm. Under the impression of the publications of Ziel and Finkle1 and Smith and co-workers,2 at the end of last year we decided to restrict the indication for estrogen treatment to girls with a growth prognosis above 183 cm. The prognosis has been made with the Greulich-Pyle Atlas and the tables of Bayley and Pinneau. Bone age was always determined independently by two experts. This report is based on the therapeutic results in 41 girls aged 10 to 15 years whose treatment now is finished. At the start, their average age was 13 years and 2 months. In half of the girls, menarche had already occurred; their mean age was 13½ years. In the other half, this had not been the case; their mean age was 12 years and 9 months. Mean midparents' height was 177 cm for the whole series. This is considerably higher than the average for the population, which in Great Britain is 168 cm, according to Tanner et al.3 METHODS Therapy was performed with conjugated natural estrogens (Presomnen [Germany]; Premarin, comparable US product). The daily dose was six 1.25-mg tablets, ie, 7.5 mg/day. The estrogens were given continuously without any interruption. To obtain menstruation-like bleedings, the girls took an oral estrogen for five days in the fourth week, at first megestrol, later dydrogesterone.

Prediction of adult height

Different methods of height prediction were compared in healthy subjects of known adult height, 30 males and 30 females. Predictions were made yearly at ages 8-17 years. Epiphyseal bone age (BA) was determined with Greulich-Pyle Atlas (G-P) and TW 2 RUS. The methods assuming constant SDS for age (CD) or for BA (IPH), and the Walker method were inaccurate with mean absolute errors up to 10 cm, and systematic overprediction except for IPH with TW 2 RUS. The methods of Bayley and Pinneau (BP), Roche et al. (RWT) and Tanner et al. (T) had about equal accuracy with mean absolute errors of 2-4 cm. With G-P BA adjusted to the growth of Finnish children, the IPH was as accurate as BP, RWT and T. RWT, and BP in girls, tended to overpredict. The year-to-year variation of prediction was greatest with BP, IPH, and chronological age based T. In a group of 8 boys with delayed growth and maturation, IPH with the adjusted G-P BA proved to be the most accurate method.