Radiology Approach of Precocious Puberty: A Review on Different Available Imaging Modalities

Diagnosis and management of precocious puberty are challenging. The two main classes of precocious puberty are Central Precocious Puberty (CPP) and Peripheral Precocious Puberty (PPP), which should be differentiated from normal pubertal variants. Radiology plays an essential role in the diagnosis and management of precocious puberty. We reviewed available studies in the case of different radiology modalities to find the role of these methods in precocious puberty assessment. We found that bone age assessment can be the initial step in the diagnosis of precocious puberty; however, a normal bone age cannot rule out precocious puberty in a deterministic manner. The use of pelvic ultrasound can further help the approach to precocious puberty. Moreover, suspected female and male cases of congenital adrenal hyperplasia should be evaluated with adrenal sonography. Testis and mammary ultrasound assessments are usually conducted in asymmetrical changes. Still, breast ultrasound staging may be helpful in even the diagnosis of precocious puberty. Brain magnetic resonance imaging is another modality used in CPP cases. The role of artificial intelligence is a neglected part, which is partly covered by BoneXpert software. Future studies should focus on scoring methods based on bone age as well as breast and pelvic (ovary and uterus) ultrasound assessments in diagnosing female precocious puberty cases and distinguishing the patients from normal pubertal variants.