Tanner-Whitehouse Research Articles

Prediction of adult height by Tanner-Whitehouse method in young Caucasian male athletes

Although the accuracy of final height prediction using skeletal age development has been confirmed in many studies for children treated for congenital primary hypothyroidism, short normal children, constitutionally tall children, no studies compared the predicted adult height at young age with final stature in athletic population. In this study, the intention was to investigate to what extent the Tanner-Whitehouse (TW) method is adequate for prediction of final stature in young Caucasian male athletes. Prospective observational study. Plain radiographs of the left hand and wrist were obtained from 477 athletic children (ranging in age from 8.0 to 17.9 years) who came to the outpatient clinic between 2000 and 2011 for adult height estimation, with no orthopedic trauma suspected. Adult height was estimated using bone age rates according to TW method. Height was measured both at baseline and follow-up (at the age of 19 years). No significant difference was found between the estimated adult height (184.9 ± 9.7 cm) and final stature (185.6 ± 9.6 cm) [95% confidence interval (CI) 1.61-3.01, P = 0.55]. The relationship between estimated and final adult height was high (r = 0.96). Bland-Altman analysis confirmed that the 95% of differences between estimated adult height and final stature lie between limits of agreement (mean ± 2 SD) (-5.84 and 4.52 cm). TW method is an accurate method of predicting adult height in male normal-growing athletic boys.

Standardization of the Tanner-Whitehouse bone age method in the context of automated image analysis

Background/aims: The Tanner-Whitehouse (TW) method for bone age determination has been the basis for many population studies and it is used in many clinics. However, TW bone age raters can differ systematically from each other. The aim of the study was to present a new standard version of TW bone age rating implemented by the automated BoneXpert method and calibrated on the manual TW stage ratings of the First Zurich Longitudinal Study.Subjects: Hand radiographs of 231 children born in 1954–1956 were recorded annually from an average age of 5–20 years. For validation, 76 X-rays of Tanner's original Gold Series from eight boys were used.Results: The root mean square deviation between manual and automated TW ratings in the Zurich data was 0.67 years for boys in the TW bone age range 5–15 years and 0.63 years for girls, 5–14 years. The new standard TW rating differs systematically from two previous TW versions of the automated method, based on different raters.Conclusion: The new automated TW ratings show good accuracy relative to the manual ratings of the Zurich data and the Gold Series. There are significant differences between manual TW raters, an effect which is eliminated with the automated method.

Validation of a New Method for Automated Determination of Bone Age in Japanese Children

BoneXpert, an automated method for analysis of hand radiographs of children, has recently been developed and validated in European children. It determines Tanner-Whitehouse (TW) and Greulich Pyle (GP) bone ages (BA). The purpose of this work is to validate BoneXpert BA in Japanese children and determine the following two properties of the method: (1) The accuracy of the BA, i.e. the standard deviation from an experienced Japanese TW BA rater. (2) The precision of the BA, i.e. BoneXpert’s ability to yield the same BA value on a repeated radiograph. The data consist of two studies: 185 radiographs of 22 normal children followed longitudinally from approximately 7 years to full maturity, and 284 radiographs of 22 patients with growth hormone deficiency treated with growth hormone and gonadotropin-releasing hormone analogue followed from an age of 4–11 years to almost full maturity. All radiographs were rated manually according to the TW-Japan system. BoneXpert processed all images, and the accuracy (SD) of TW-Japan BA was 0.72 years (95% CI 0.68–0.76). The precision error (SD) on a single determination of GP BA was 0.17 years (95% CI 0.15–0.19). It is concluded that BoneXpert performs as well in Japanese children as it does in Caucasian children. This study accomplishes a calibration of BoneXpert to the TW-Japan standard, which performs well for the entire BA range from 4 years up to full maturity.

Can the TW3 Bone Age Determination Method Provide Additional Criteria for Growth Hormone Treatment in Adopted Girls with Early Puberty?

Background/Aims: Gonadotropin-releasing hormone analogues (GnRHa) are the accepted treatment of idiopathic central precocious puberty. As it has been found that growth velocity may be decreased with GnRHa treatment, clinical trials with GnRHa combined with growth hormone (GH) have been carried out. In a recent study 46 adopted girls with early or precocious puberty were randomly assigned to treatment with either GnRHa or GnRHa combined with GH, and followed to final height (FH). It was found that FH was significantly higher in the combined treatment group, 158.9 compared with 155.8 cm in the GnRHa treated group. In order to select the patients who could benefit from added GH, predictions of FH at the start of treatment according to the methods of bone age determination of Greulich-Pyle (GP) and Tanner-Whitehouse 2 (TW2) were compared. It was found that the GP method was the most useful method for patient selection. Recently, a revision of the Tanner-Whitehouse method, named Tanner-Whitehouse 3 (TW3), has been developed. The present study examined the usefulness of the TW3 method in selecting suitable patients for combined treatment. Method: The TW3 method bone age determinations of the 46 girls were compared to the GP and TW2 method determinations, using the differences between actual FH and predicted adult height (PAH). Beside accuracy of prediction of FH, the criteria of efficiency of selection and replicability were applied in the comparison. Results: We found that the GP method, also when compared to the TW3 method, gave the most accurate prediction of the FH on only GnRHa treatment. This gives the best ground for selection of patients who can benefit from combined treatment. The GP method was also the most efficient in selecting patients, i.e., it could select the least number of patients that needed the combined treatment. The only drawback of the GP method was that it requires an experienced pediatric radiologist. Automated methods are being developed and may soon facilitate the use of the GP method for those less experienced. The FH after combined treatment could be predicted with an equation including PAH GP as well as PAH TW3 as variables. Conclusion: The GP method remains the most useful method for selection of those patients who will benefit most from the addition of GH to GnRHa in the treatment of idiopathic central precocious or early puberty. FH prediction after combined treatment requires PAH GP as well as PAH TW3.

The BoneXpert Method for Automated Determination of Skeletal Maturity

Bone age rating is associated with a considerable variability from the human interpretation, and this is the motivation for presenting a new method for automated determination of bone age (skeletal maturity). The method, called BoneXpert, reconstructs, from radiographs of the hand, the borders of 15 bones automatically and then computes "intrinsic" bone ages for each of 13 bones (radius, ulna, and 11 short bones). Finally, it transforms the intrinsic bone ages into Greulich Pyle (GP) or Tanner Whitehouse (TW) bone age. The bone reconstruction method automatically rejects images with abnormal bone morphology or very poor image quality. From the methodological point of view, BoneXpert contains the following innovations: 1) a generative model (active appearance model) for the bone reconstruction; 2) the prediction of bone age from shape, intensity, and texture scores derived from principal component analysis; 3) the consensus bone age concept that defines bone age of each bone as the best estimate of the bone age of the other bones in the hand; 4) a common bone age model for males and females; and 5) the unified modelling of TW and GP bone age. BoneXpert is developed on 1559 images. It is validated on the Greulich Pyle atlas in the age range 2-17 years yielding an SD of 0.42 years [0.37; 0.47] 95% conf, and on 84 clinical TW-rated images yielding an SD of 0.80 years [0.68; 0.93] 95% conf. The precision of the GP bone age determination (its ability to yield the same result on a repeated radiograph) is inferred under suitable assumptions from six longitudinal series of radiographs. The result is an SD on a single determination of 0.17 years [0.13; 0.21] 95% conf.

Gene–environment interaction in skeletal maturity and body dimensions of urban Oaxaca Mestizo schoolchildren

Objective: The study analyzed the relationship between skeletal age (SA) and the difference between skeletal and chronological ages (SA–CA) and body size among growth-stunted and well-nourished children.Methods and materials: Tanner–Whitehouse 2 (TW2) 20 bone, radius–ulna–short (RUS) bone, and carpal SAs were analyzed in three cross-sectional samples of school children aged 6–13 years: Mestizo children (n = 396) from the city of Oaxaca, southern Mexico, and American Black (n = 570) and White (n = 432) from Philadelphia. The Oaxaca children were mild-to-moderately undernourished while the Philadelphia children were well nourished. The total sample included 1398 radiographs assessed with the Tanner–Whitehouse protocol by a single, experienced rater. Maturity scores were converted to TW2 20 bone, RUS and carpal SAs.Results: Correlations of SA and SA–CA differences with body dimensions (height, sitting height, leg length, weight, triceps skinfold, arm and estimated midarm muscle circumferences) were consistent and approximately equal in magnitude for the well-nourished samples but were different among Oaxaca children. SAs of Philadelphia children were significantly more highly correlated with body dimensions than were SA–CA differences compared to Oaxaca Mestizo children. Patterns of RUS and carpal SA correlations with body size (height, sitting height, and leg length) in Oaxaca children were different from the Philadelphia samples. Oaxaca children tended to have advanced RUS SA and delayed carpal SA.Conclusion: Long bone complexes mature earlier than round bone complexes in Oaxaca children compared to Philadelphia Black and White children, resulting in short stature in Oaxaca children. Results suggest a gene–environment interaction effect on the program for skeletal growth and maturation in undernourished Oaxaca children compared to well-nourished Black and White children from Philadelphia.

Is TW3 Height Prediction More Accurate than TW2? Preliminary Data

Background/Aims: Skeletal maturation is considered a reliable variable in evaluating the ‘tempo’ of growth. It is important in the diagnosis of endocrinological diseases, in chronic diseases, in hormonal therapy follow-up and in computing height prediction for prognostic and therapeutic purposes. It is also used when chronological age is not available for minors without known birth dates. There are different methods to evaluate skeletal maturation and height prediction. The Tanner-Whitehouse (TW) method 2 (TW2) has been considered to be the most useful method so far, and has recently been updated with modified height prediction equations (TW2-Mark II). TW3 is the newest method. The aim of this study is to evaluate whether TW3 is more accurate in the assessment of height prediction than TW2-Mark II in a sample of healthy north Italian subjects. Methods: Anthropometrical data were collected as part of a survey in 1977–1978 in Turin. The sample involved 1,384 healthy children. The children, now adults, have been traced and recalled to measure their final height in order to test height prediction reliability. At present, we have collected 118 adult heights. Results: According to the TW2 method 40% of the males had a height prediction error larger than ± residual SD (4.1 cm), and with TW3 this was 32.9%. The female height prediction error with TW2 was larger than ± residual SD (3.6 cm) in 29.2% of girls, and the same value was found with TW3. Conclusion: According to our preliminary data, TW3 does not represent any real progress.

An accurate method of predicting mandibular growth potential based on bone maturity.

Mandibular growth prediction provides important information for planning treatment and for evaluating occlusal stability after treatment. At present, several methods can predict mandibular growth, but it is not clear which method is the most accurate. This study compared the predictive error of several methods by using skeletal maturity indicators. Twenty-two longitudinal cephalograms and hand-wrist radiographs of female subjects (average initial age, 8.3 years; final age, 18.4 years) were collected to construct the prediction formula. Another 22 female subjects (initial age, 10.8 years; final age, 18.6 years) were examined to compare differences between the predicted values and the actual values. Mandibular total length (condylion-gnathion) at the final stage can be accurately predicted by (1) the ossification events of the third middle phalanx and the radius, (2) the growth potential method, (3) the growth percentage method, (4) the multiple regression method, and (5) the growth chart method. Bone age as a parameter was calculated by both the Tanner-Whitehouse 2 (TW2) method and the computer-aided skeletal maturity assessment system (CASMAS) that we developed. The average error between the predicted length of condylion to gnathion and the actual length at the final stage for each method was (1) 3.0 mm; (2) 2.1 mm (TW2), 2.4 mm (CASMAS); (3) 2.3 mm (TW2), 2.6 mm (CASMAS); (4) 4.3 mm (TW2), 4.9 mm (CASMAS); and (5) 3.6 mm (TW2), 3.7 mm (CASMAS). The growth potential method and the growth percentage method were the most accurate predictors of mandibular growth potential.

Growth of primary school children: a validation of the 1990 references and their use in growth monitoring

AIMSTo determine whether the British 1990 growth charts are valid for cross sectional and longitudinal use in primary school children.METHODSA total of 694 children aged 7–10 years from 10 Leeds...

Computer-aided estimation of skeletal age and comparison with bone age evaluations by the method of Greulich-Pyle and Tanner-Whitehouse.

Bone age (BA) is usually estimated using the atlas of Greulich-Pyle (GP) or Tanner-Whitehouse (TW) and depends on the individual experience of the investigator. A computer-aided method, computer-assisted skeletal age scores (CASAS), based on the TW2-radius, ulna, short bones (RUS) method has been created to increase reliability and validity. We compared the results of the three different methods (CASAS, GP, TW2) in three groups of children with Turner s syndrome (TS), growth hormone deficiency (GHD), and familial short stature (FSS). The practicability and reliability of CASAS was investigated and the results compared with those obtained by the other methods. Each method was applied by one investigator, with up to six consecutive BA estimations per subject being carried out in 5 patients with TS, 6 with GHD and 18 with FSS. Using CASAS, individual bone evaluations had to be repeated once in 7.3 % and twice in 2.7 % of all probands on request of the computer system because of doubtful results. Manual interventions by the investigator were necessary in 12.3 % of evaluations in TS, 8.5 % in GHD and 9.0 % in FSS. The frequency of a warning insert, indicating uncertainty of CASAS, was also higher in TS than in GHD and FSS (19.0 % vs. 15.0 % and 13.0 %). The majority of external corrections for CASAS were necessary for evaluations of the fifth finger and the thumb. On three occasions with TS the progress of BA determined by CASAS demonstrated a regressive course with age. CASAS and manual TW2 BA data were comparable and generally higher than BA data obtained by GP (mean + 1.1 years). In conclusion, CASAS represents a useful method for analysing skeletal age and seems to increase reliability by rating on a continuous scale. However, difficulties with abnormally shaped bones restricts its use in some pathologic conditions.

Validation of methods for predicting adult stature in Turkish girls.

The original or revised methods for prediction of adult stature of Tanner-Whitehouse (TW), Roche-Wainer-Thissen (RWT), and Bayley-Pinneau (BP) were validated in a mixed longitudinal study of Turkish girls, 9-14 years of age. Comparison of 727 estimations of 102 girls showed that the RWT'93 revision is an improvement over the original method by reducing the standard deviation, and absolute median and mean of residuals. The TW'83 (3v) method, by dropping the variable midparent stature, was reduced in accuracy before age 12. The addition of the previous annual increment in stature improved the predictions, while further addition of the increment in skeletal age did not. In relation to overall accuracy and reliability, BP (0.75) and TW'75 (0.73) had the highest R2 values, while RWT'75 had the lowest (0.55). Regarding individual consistency of multiple predictions, the RWT methods ranked best and TW'83 relatively poorest. Systematic errors found in Turkish girls were similar to those found in French, Swiss, and Finnish girls. © 1995 Wiley-Liss, Inc.

Assessment of bone ages by the Tanner-Whitehouse method using a computer-aided system.

A computer-aided system to estimate bone age based on Fourier analysis was assessed by reference to the original radiographs used to produce the Tanner-Whitehouse 2 (TW2) standards for the radius, ulna and short finger bones. The computer-aided system involved matching a template of each bone to the scanned image of the radiograph. The computer then generated a stage of bone maturity, individual and total bone scores and a value for bone age. The bone ages assessed by the computer-aided system were no different from the original TW2 reference values, indicating the applicability of the system. The system was used to assess the bone ages of tall Dutch girls, and the results obtained were compared with more traditional assessments made by an experienced rater. For the radiographs from the tall girls, there was good agreement for individual bones between this method and the traditional assessment by the rater, but less agreement for the total 13-bone score and bone age.

Bone Age Maturation in Children with Non-Endocrine Short Stature (NESS) -Comparison between Tanner-Whitehouse 2 (TW2) Original Method and Standardized TW2 Method for Japanese Children

Bone Age Maturation in Children with Non-Endocrine Short Stature (NESS) -Comparison between Tanner-Whitehouse 2 (TW2) Original Method and Standardized TW2 Method for Japanese Children

PREDICTORS OF FINAL HEIGHT (FH) AFTER GROWTH HORMONE (GH) THERAPY IN PERIPUBERTAL SHORT CHILDREN

Seventy three peripubertal children (49 M, 24F) were studied. Height was <2 SD for age and gender, growth velocity was <4.5 cm/year, bone age was more than 2 SD below mean for age and GH response to provocative tests (PT) was <10 mcg/L in 12 children (group GHD). PT was >10 mcg/L in 61 children of which 31 subjects (group T) were treated with GH 0.75 u/kg/week for 2-5 years, until FH was attained. 20 (group C) were untreated children who were followed until cessation of growth and served as controls. The Tanner-whitehouse (TW) and the Bayley-Pinneau (BP) predictions (in SDS) were highly correlated with FH in treated groups (r=0.747 and r=0.646, p<0.02). The TW and BP methods over estimated FH in treated groups by 3.6 and 3 cm. The untreated group was shorter by 0.7 EDS than the treated groups. Neither protreatment height velocity nor GH measurements by physiologic or pharmacologic tests were correlated with FH. The main effect of GH was observed during the first year of treatment in group T when height velocity was significantly higher in the than in the untreated (9.3±2.1 vs 5.3±1.1 respectively, p<0.001) FH of group G and T were similar. The high cost of the treatment in group T should be weighted against the results.

Reduction of body height in tall girls by estrogen treatment

Twenty-six girls with constitutional tall stature were treated with 0.5 mg ethinyloestradiol daily po and 10 mg norethisteronacetate from day 21 to 25 of the cycle for 1.4 +/- 0.4 years. Height, weight, bone age according to Greulich-Pyle (GP) and Tanner (RUS), height predictions according to Bayley Pinneau (BP) and Tanner Whitehouse (TW) were recorded at the onset of therapy, at the end of treatment and 7.4 years later. The mean chronological age at start of treatment was 12.6 +/- 1.1 years, bone age (GP) 12.4 +/- 0.7 years, (RUS) 13.5 +/- 0.7 years. The initial height prediction according to BP was 186.2 +/- 4.1 cm, which was 3.5 cm higher than the prognosis according to Tanner Whitehouse. Depending on the method used for height prediction, the height reduction by treatment was 4.6 +/- 3.0 cm (BP) or 1.4 +/- 2.2 cm (TW), respectively. The reduction of predicted height was more pronounced in girls with a bone age (GP) < 12.5 years at the initiation of therapy (n = 13), than in girls with a bone age > or = 12.5 years (n = 13). Final height was measured 7.4 years after the end of treatment. Chronological age: 21.3 +/- 3.7 years, final height 181.8 +/- 3.7 cm. Mean final height after therapy was 7.7 cm above target height, or, after allowance for the secular trend, 3.8 cm above target height. Body weight, recorded in centiles of body mass index, increased from the 38.5 +/- 26 to the 58.1 +/- 22 centile, weight gain was more pronounced in younger girls. At follow up investigation 18/19 girls, who answered a questionnaire, had a positive view of the previous treatment.

FELS, Greulich-Pyle, and Tanner-Whitehouse bone age assessments in a group of Italian children and adolescents.

Assessments of skeletal maturity are usually made from handwrist radiographs, using either the method of Greulich-Pyle (GP) or Tanner-Whitehouse (TW). Recently the FELS method has been developed, and it represents a potentially valuable approach to skeletal age assessment. The present study evaluates the accuracy and precision of FELS skeletal age assessments compared with ratings by the GP and TW methods in a group of Italian children and adolescents. The hand-wrist radiographs of subjects (171 males and 156 females 1 to 17 years) referred to the "Istituto di Puericultura e Medicina Neonatale" of the University of Genoa in Italy between 1985 and 1990 were assessed according to each method. Two independent observers rated the radiographs and one observer reassessed them after 6 months or more. GP estimates rather closely match chronological age; TW ratings tend to overestimate chronological age by 7-9 months around puberty, mainly in boys; and the FELS method tends to overestimate chronological age by amounts that increase with chronological age. The degree of precision of skeletal age assessments is within the usually accepted limits. Higher levels of repeatability and reproducibility are apparent for the FELS estimates than for GP and TW assessments. Thus, skeletal maturity is likely to be adequately interpreted by the FELS method as well as by the more commonly used GP and TW systems in Italian children and adolescents. © 1992 Wiley-Liss, Inc.

Prediction of Final Height in Turner's SyndromeA Comparative Study

Various methods are used for prediction of final height in girls with Turner's syndrome (TS), but their accuracy has not been systematically investigated or compared. We have compared predictions of final height made with the most commonly used methods in 20 Turner girls at ages 9.5-18 years. Growth standards based on growth and final height of 78 Danish Turner women were used for calculation of standard deviation scores (SDS). In order to provide the necessary basis for "index of potential height" (IPH) method, bone age development was determined from 74 X-rays of 38 untreated Turner girls aged 5.2-19 years. This method was further modified and improved for use in TS. Prediction methods based only on height and chronological age (CA) showed little difference from methods including bone age. The IPH method in our modification was more accurate than those of Bayley-Pinneau and Tanner. At younger ages the IPH method showed better results when using Tanner-Whitehouse 2 (TW2) bone age than when using Greulich-Pyle bone age. Accuracy of predictions were considerably improved by combining methods with and without allowance for bone age. Combinations including the IPH method based on TW2 bone age appeared to be the most accurate. Predictions of final height in Turner's syndrome should therefore be made by combining the IPH method and one of the methods based on height and CA.

Assessment of Skeletal Maturity and Prediction of Adult Height (TW2 Method)

This book describes the Tanner-Whitehouse (TW) approach to bone age determination and presents the new TW2 standards. Drs Tanner, Whitehouse and co-workers are at the Department of Growth and Development, Institute of Child Health, University of London, and the Hospital for Sick Children in London. This new book includes a much clearer description of their method for the evaluation of bone age than in the previously published TW1 standards. Several other significant improvements have been made since the previous study. First of all, the publication gives both line and radiographic illustrations of the various stages of development for each of the bones. It also presents separate standards for boys and girls that recognize systematic differences between the sexes and the fact that girls are not simply more mature boys. Probably the most useful addition to the book is the separate standards for the carpals and the tubular bones. The tubular

Tanner‐Whitehouse and Greulich‐Pyle skeletal age velocity comparisons

AbstractLongitudinal velocity measurements of Tanner‐Whitehouse (TW) and Greulich‐Pyle (GP) skeletal ages have been determined for 233 Hong Kong Chinese orphanage children. When skeletal age is compared to chronological age (CA) the resulting ratio TW/CA or GP/CA has been titled a Tanner. Tanner values range from 0.74 to 1.26 for the GP/CA calculations and from 0.73 to 1.45 for the TW/CA calculations. The mean Tanner value was much higher for TW velocities (X = 1.19). Age to age variability in velocity is large by either system and generally girls vary more than boys.