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

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.

Comparison among three standards of TW2 to skeletal age determination in children with central precocious puberty / 法医学杂志

OBJECTIVE@#To discuss the diagnostic value of English, Chinese and Japanese standards of TW2 to skeletal age assessment of children with central precocious puberty (CPP), then to confirm the normal thresholds.@*METHODS@#Sixty one children as patient group were definitely assured CPP. The control group had 67 children. Among them, 61 were normal children, another 6 children as a special control group. Left hand-wrist X-ray radiographs were retrospectively analyzed by two doctors separately and their skeletal ages were assessed with the three standards of TW2 method. The differences between skeletal age and chronological age were analyzed with ROC in SPSS 13.0.@*RESULTS@#(1) The skeletal age results showed kappa value is 0.776 deduced by two clinical doctors(u = 16.128, P < 0.05). (2) There were no statistic differences for the areas under ROC curves among three methods. (3) d > or = 1.15 years in TW2, d > or = 1.25 years in TW2-CHN and d > or = 0.65 years in TW2-JP were more susceptive and specific points.@*CONCLUSION@#TW2, TW2-CHN and TW2-JP provided a higher value for the diagnosis of skeletal age in unhealthy children, and TW2-CHN is highest value for Chinese children.

TW systems in estimation of carpal bone age and their potential applications in diagnosis of idiopathic precocious puberty in Chinese girls / 法医学杂志

OBJECTIVE@#To compare three assessment methods (TW2, TW2CH, and TW3) for carpal bone age and their potential applications in diagnosis of idiopathic precocious puberty (IPP) in Chinese girls.@*METHODS@#Fifty-five (55) girls with IPP and 83 normal girls as control group were selected in this study. The X-ray films of the left hand-wrist taken at their first visit were analyzed retrospectively. Three assessment methods were used to estimate the carpal bone age with single-blinded method and percentiles were set at 5 different decision thresholds (1)>97th percentile, (2)>90 th percentile, (3)>75th percentile, (4)>50 th percentile, and (5)< or =50th percentile.@*RESULTS@#All of the three methods showed similar high sensitivity and specificity at the threshold above 90th percentile.@*CONCLUSION@#Our data indicate that all of the three methods for estimation of the carpal bone age are useful in diagnosis of IPP. TW2CH and TW3 methods appear to be superior to TW2 method.

New formula to objectively evaluate skeletal maturation using lateral cephalometric radiographs

The aim of this study was to establish two new formulas for objectively evaluating skeletal maturation of cervical vertebrae in female and male Brazilian subjects using lateral cephalometric radiographs. The sample included 128 girls and 110 boys, aged 7.0 to 15.9 years, from the files of the Oral Radiology Clinic, Piracicaba Dental School, University of Campinas (Unicamp), SP, Brazil. The cervical vertebral bodies of C3 and C4 were traced and measured and regression formulas were developed in order to determine cervical vertebral bone age. Another sample of lateral teleradiographs and hand-wrist radiographs of 55 girls and 54 boys (aged 7.0 to 15.9 years) was used to verify the reliability of the developed regression formulas, as compared with bone age assessed using the Tanner et al.15 (2001) Method (TW3) in hand-wrist radiographs. The analysis of both the boys’ and girls’ data (ANOVA) showed no statistical difference between cervical vertebral bone age, bone age, and chronological age, indicating that these formulas can be used in this population (p = 0.5721 and p = 0.6007 for girls and boys, respectively). Female cervical vertebral bodies of C3 and C4 increased in an accelerated manner from 10 to 13 years. Analysis of the male sample showed that C3 measurements increased in an accelerated manner from 12 to 15 years. The C4 measurements, however, did not increase at all. Using cervical vertebral bone age it is possible to evaluate skeletal maturation objectively in cephalometric radiographs.

O objetivo deste estudo foi estabelecer dois novos métodos para meninas e meninos brasileiros, no intuito de determinar de forma objetiva a maturação esquelética das vértebras cervicais em radiografias cefalométricas laterais. Foram selecionados 128 meninas e 110 meninos, com faixa etária variando entre 7 e 15,9 anos, pertencentes à Clínica de Radiologia da Faculdade de Odontologia de Piracicaba da Universidade de Campinas (Unicamp). Os corpos da terceira e quarta vértebras cervicais foram traçados e medidos e fórmulas de regressão foram criadas no intuito de se estabelecer a idade óssea das vértebras cervicais. Uma outra amostra composta por telerradiografias em normal lateral e radiografias carpais de 55 meninas e 54 meninos com a mesma faixa etária foi utilizada para verificar a confiabilidade das fórmulas criadas, em comparação à idade óssea determinada pelo método de Tanner et al.15 (2001) (TW3) em radiografias carpais. A análise da amostra feminina e masculina (ANOVA) revelou não haver diferença estatística significativa entre idade óssea da vértebra cervical, idade esquelética e idade cronológica, indicando que as fórmulas desenvolvidas podem ser utilizadas nesta população (p = 0,5721 e p = 0,6007 para meninas e meninos, respectivamente). Os corpos da terceira e quarta vértebras cervicais aumentaram de forma acelerada dos 10 aos 13 anos nas meninas. A análise da amostra masculina revelou aumento acelerado de C3 dos 12 aos 15 anos. A vértebra C4, no entanto, não aumentou em tamanho. Utilizando a idade óssea de vértebras cervicais, é possível avaliar a maturidade esquelética de forma objetiva em radiografias cefalométricas laterais.