Accuracy of Ultrasound in Bone Age Estimation in Iraqi Short-stature Children

Background Bone age assessment represents an important step in the management of children with Isolated Growth Hormone Deficiency (IGHD). This study examined the usefulness of Ultrasound (US) in the assessment of bone age in a sample of Iraqi children with IGHD as compared to radiography as a reference. Additionally, it verified if patient gender and growth hormone therapy have an impact on US accuracy. Methods An observational cross-sectional study recruited children with isolated growth hormone deficiency who were diagnosed and followed at the Alresafa Specialized Center for Endocrinology and Diabetes, Baghdad, Iraq, over 6 months. Children with IGHD from Iraqi nationality were recruited, while children from other nationalities or having multiple hormonal deficiencies, syndromic features, and parent refused participation were excluded. For each patient, a bone age assessment was conducted using two methods: US and TW2 hand-wrist radiographs at the same visit by the same radiologist. Results A total of 116 children were included. The chronological age of recruited children was 7 to 17 years, with a mean of 13.01 ± 2.78 years. There were 67 males (57.9%) with a male-to-female ratio of 1.37:1. The patient's gender did not affect the US accuracy; there was a non-significant difference in the bone age estimated by the US and conventional radiograph for both male and female patients, ( p -value = 0.087, 0.308) respectively. Those who received growth hormone therapy and those who did not for both male and female patients ( p -value = 0.071,0.243), respectively. There was a strong positive correlation between the means of bone age assessed by ultrasound (US) and conventional radiography for both males and females, with correlation coefficients of r = 0.788 and r = 0.703, respectively. Conclusion Ultrasound may serve as a valid replacement for radiography in the assessment of bone age in children with short stature caused by a growth hormone deficiency, irrespective of the gender and treatment received. Thus, it may overcome radiography drawbacks for children who need sequential bone age assessment.