Ultrasound-based area ossification ratios for pediatric radiographic bone age: Development and internal…

Cohort studyEuropean journal of radiology· Aug 2026

Ultrasound-based area ossification ratios for pediatric radiographic bone age: Development and internal validation of a radiation-free nomogram.

Yongzhi Deng, Lu Qiang, Tailong Wang … Yudan Li

Pediatric RadiologyCohort studyDiagnosisQ1IF 4.0

Ultrasound nomogram cut bone age prediction error over 60% in discordant maturation

Ultrasound-based area ossification ratios for pediatric radiographic bone age: Development and internal validation of a radiation-free nomogram.

Yongzhi Deng … Yudan Li

European journal of radiology · Aug 2026 · Q1 in Radiology

Purpose

This study developed and internally validated a radiation-free nomogram based on multi-site two-dimensional ultrasound area ossification ratios (ORs) to assess Zhonghua-05 (RUS-CHN) radiographic bone age and predicted adult height (predicted adult height), evaluating its incremental value over chronological age.

Methods

In this single-center prospective study (August 2024 ∼ December 2025), 1,053 children aged 3-15 years were randomized into training and validation sets (7:3).

n = 1,053 children

Results

over 60%

in these harder cases, ultrasound prediction error dropped by more than half

n = 1,053 children

More results

Ultrasound OR measurements showed excellent reproducibility (ICC > 0.88).

In the validation set, the nomogram predicted RUS-CHN bone age with a mean absolute error (mean absolute error) of 2.94 months (RMSE = 3.67 months, R 2 = 0.989).

The secondary model for predicted adult height achieved an mean absolute error of 0.63 cm.

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Conclusion · 1 of 3

Multi-site ultrasound area ORs provide a highly reproducible, radiation-free index of skeletal maturity.

Conclusion · 2 of 3

As an internally validated, standard-specific research tool, the nomogram estimated RUS-CHN radiographic bone age and corrected age-anchoring bias in children with discordant maturation.

Conclusion · 3 of 3

Because its numeric calibration is specific to the RUS-CHN standard, external multicenter and longitudinal validation is required before clinical use.

Ultrasound-based area ossification ratios for pediatric radiographic bone age: Development and internal validation of a radiation-free nomogram.

Ultrasound-based area ossification ratios for pediatric radiographic bone age: Development and internal validation of a radiation-free nomogram.

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