Evaluation of the compatibility of C2, C3, and C4 fractal dimension values with hand-wrist and cervical vertebra maturation methods in determining skeletal maturation

Abstract

Objectives: To examine the correlation between the fractal dimension (FD) values of cervical vertebrae (C2, C3, and C4) and hand-wrist maturation (HWM) and cervical vertebra maturation (CVM) methods. In addition, the correlation between the pubertal growth spurt (PGS) and FD values was examined. Methods: The lateral cephalometric and hand-wrist radiographs of 120 subjects (61 females and 59 males) aged 8–18 years with a mean age of 13 years, were evaluated retrospectively. The CVM stages were determined in accordance with Hassel-Farman’s modification of Lamparski criteria. The HWM stages were determined in accordance with Björk and Grave-Brown criteria. Both HWM and CVM stages were divided into two according to PGS. Fractal analysis of cervical vertebrae was performed according to the White-Rudolph method. The relationships between HWM stages, CVM stages and other variables were evaluated by Spearman’s rank-order correlation coefficient. The relationships between FD values, chronological age, and divided stages were evaluated by the Pearson correlation coefficient. The Mann–Whitney U test was used to compare the FD values of two divided stages. Results: There were positive and statistically significant positive correlations between chronological age and both HWM and CVM stages. There was a positive and statistically significant correlation between CVM and HWM stages. In females and total, there were negative and statistically significant correlations between C4 FD values and divided HWM stages, and the differences between C4 FD values of divided HWM stages were also statistically significant. In total, there was a negative and statistically significant correlation between C4 FD values and divided CVM stages, and the difference between C4 FD values of divided CVM stages was also statistically significant. Conclusion: The negative correlations found between C4 FD values and divided HWM and CVM stages suggest the fractal analysis of cervical vertebrae, especially of C4, may be used as an objective tool for evaluating the PGS.

Assessment of correlation between hand-wrist maturation and cervical vertebral maturation: a fractal analysis study

“…In addition, a moderate correlation was found between C3 and C4 FD values. As opposed to the current study, no statistically significant correlations were found between FD values of the cervical vertebrae (C2, C3, C4) and chronological age, HWMS or CVMS in a study by Pamukçu et al investigating the correlation of FD measurements from the cervical vertebrae with HWMS and CVMS on radiographs of 120 subjects [ 13 ]. However, again in contrast to the current study, when HWMS and CVMS were divided into two groups according to pubertal growth spurt (PGS) as pre-PGS and post-PGS, significant negative correlations were found between C4 FD values and HWMS or CVMS both in females and in the entire sample in the same study.…”

“…Based on this finding, the authors suggested that the C4 FD value can be used as an objective tool to predict skeletal maturation stage and especially pubertal growth spurt. The limited sample size, the absence of testing for intra-observer agreement and uneven distributions of sex and patients among the stages may have accounted for the different results reported by Pamukçu et al [ 13 ].…”

“…Consequently, the cervical vertebral maturation (CVM) staging on lateral cephalometric radiographs has been introduced as an alternative to the HWM method [ 11 , 12 ]. Previous studies have shown that the hand-wrist maturation stages (HWMS) and cervical vertebral maturation stages (CVMS) are strongly correlated [ 13 – 16 ]. Also, it has been reported that the CVM method reliably predicts pubertal growth, and is highly consistent with the HWM method in predicting skeletal maturation in adolescence [ 17 , 18 ].…”

“…Fractal analysis is a method used to determine the complexity of the shapes or structural patterns within the bone, which is numerically expressed as fractal dimension (FD) [ 19 ]. Information about the 3D structure of the bone can be obtained through two-dimensional images, and fractal analysis enables detection of details that may be missed on radiographs [ 4 , 13 , 20 ]. Changes in the trabecular bone pattern have been demonstrated in several studies using fractal analysis [ 21 – 23 ].…”

Mapping an intelligent algorithm for predicting female adolescents’ cervical vertebrae maturation stage with high recall and accuracy

“…Females are more advanced than males in skeletal maturation. The growth spurt of female adolescents commenced four months earlier and extended for an additional four months compared to males [ 26 ]. A disparity between chronological age and skeletal maturity arises, particularly among females, at puberty initiation owing to the secretion of gonadotropin-releasing (GnRH) and sex hormones [ 27 ].…”