Menarche marks a major turning point in female development and usually signals that there is only limited height growth left. However, remaining growth varies widely from girl to girl, making clinical decisions difficult. Traditional methods such as the Greulich–Pyle and Bayle–Pineau approaches rely heavily on hand-wrist bone age, even though final stature is strongly linked to lower limb development. The knee, particularly the distal femur and proximal tibia, may better reflect ongoing development because these regions articulate later than the hand and wrist. Manual reading also introduces observer variation. Because of these challenges, there is a need for intensive research on more objective and accurate methods to predict final height after menstruation.
Researchers at Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, reported the study online Dec. 13, 2025 (DOI: 10.1007/s12519-025-01002-5) World Journal of Pediatrics. The team analyzed 173 Chinese girls seen within three months of menstruation and developed a predictive model that combined height at the time of menstruation, father’s height, Greulich-Pyle bone age and radiomic scores obtained from images of the left knee. Their goal was to improve prediction of final height at a stage when decisions about potential intervention are particularly time-sensitive.
To build the model, the researchers extracted radiomic features from digital radiographs of the left knee, focusing on the distal femur and proximal tibia. These features capture image patterns related to size, brightness, and texture that are not easily visible in routine clinical readings. After feature screening and regression analysis, the distal femur score emerged as a useful imaging marker, whereas the tibial score did not significantly correlate with final height. In this group, girls’ height increased by an average of 8.94 cm after menstruation. The best performing equation explained approximately 73% of the variation in final height and outperformed conventional methods in five-fold cross-validation. Its prediction errors were narrow, with a root mean square error of about 2.01 cm and strong Bland–Altman agreement, whereas the older approach resulted in larger residuals and more systematic bias.
“This study points toward a more practical way of reading growth potential at menarche: not by relying solely on a familiar atlas, but by combining clinical judgment with imaging signals hidden from the knee. This preserves information about distal femur maturation that may be missed in standard assessment, making predictions of final height more stable, more objective, and potentially more useful when families and physicians must quickly decide whether intervention is still worthwhile.”
These findings may help pediatric endocrinology move toward more personalized predictive tools for girls entering the final stages of development. Because digital radiography of the knee is much more practical than magnetic resonance imaging in outpatient care, the model may be easier to translate into routine clinics. It can also reduce subjectivity in bone age interpretation, especially when expert readers are limited. The authors say the study was based on a single-center Chinese cohort and still needs extensive external validation. Nevertheless, work shows that radiomics can transform ordinary radiographs into rich decision tools for growth assessment and adolescent care.
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