Computer-assisted analysis of cervical vertebral bone age using cephalometric radiographs in Brazilian subjects

Abstract

The aims of this study were to develop a computerized program for objectively evaluating skeletal maturation on cephalometric radiographs, and to apply the new method to Brazilian subjects. The samples were taken from the patient files of Oral Radiological Clinics from the North, Northeast, Midwest and South regions of the country. A total of 717 subjects aged 7.0 to 15.9 years who had lateral cephalometric radiographs and hand-wrist radiographs were selected. A cervical vertebral computerized analysis was created in the Radiocef Studio 2 computer software for digital cephalometric analysis, and cervical vertebral bone age was calculated using the formulas developed by Caldas et al.17 (2007). Hand-wrist bone age was evaluated by the TW3 method. Analysis of variance (ANOVA) and the Tukey test were used to compare cervical vertebral bone age, hand-wrist bone age and chronological age (P < 0.05). No significant difference was found between cervical vertebral bone age and chronological age in all regions studied. When analyzing bone age, it was possible to observe a statistically significant difference between cervical vertebral bone age and hand-wrist bone age for female and male subjects in the North and Northeast regions, as well as for male subjects in the Midwest region. No significant difference was observed between bone age and chronological age in all regions except for male subjects in the North and female subjects in the Northeast. Using cervical vertebral bone age, it might be possible to evaluate skeletal maturation in an objective manner using cephalometric radiographs.

A practical formula for determining growth

“…Therefore, our formula seems to be sufficient to detect skeletal maturation age precisely for both genders. However, Caldas et al (17) encountered significant differences between vertebral and hand-wrist bone ages for boys, which was in contrast with our findings. That study was performed in Brazil, which has numerous geographic territories with their own distinct characteristics.…”

“…Age estimation using cervical vertebrae has been increasingly used to assess skeletal maturation instead of the hand-wrist bone age in recent years (1,(6)(7)(8)(12)(13)(14)(15)(16)(17)(18). Scoring the developmental stages of twenty bones in the hand and wrist region could be noted as a time-consuming endeavor.…”

“…Although a correlation between the changes in cervical vertebrae and growth was reported (12,13,15), the reproducibility of skeletal age evaluation based on similarity between the radiographs and the defined images was found to be disappointingly low (26). Mito et al (16) and Caldas et al (17,18) suggested using methods depending on formulas instead of radiograph similarity for achieving objective results. Therefore, in this study, a formula was developed to easily and objectively calculate the cervical vertebral age.…”

“…We used a single formula with different gender coefficients, as gender-dependent differences with regard to the timing of morphologic changes in cervical vertebral bodies were reported to be significant (17). Moreover, a recent meta-analysis reported that skeletal maturation evaluation performed by cervical vertebrae is positively correlated with carpal calculation methods, showing higher correlation for female gender than for the male (28).…”

“…However, this method is limited by the subjective evaluation of growth, because it mainly depends on finding similarity between the radiographs of the subjects and the defined images. Therefore, Mito et al (16) derived a formula for cervical vertebral bone age in girls, and Caldas et al (17,18) developed two formulas in Brazilian subjects to determine reliability. Although these studies have simplified the maturation prediction process, to our knowledge, no previous studies have evaluated a single formula for both genders in Caucasian subjects.…”