Evaluation of the Skeletal Maturation of Cervical Vertebrae with Magnetic Resonance Imaging: a pilot study

  • Camila Chaparin Baldin
  • Marjorie Kitt
  • André Luiz Ferreira Costa
  • Clarissa Lin Yasuda
  • Fernando Cendes
  • Ana Carla Raphaelli Nahás-Scocate


Aims: The objective of the present study was to assess the skeletal maturation by means of three-dimensional models of the cervical vertebrae generated through segmentation of the magnetic resonance (MR) images by using medical software. Methods: Twenty MR images of the skull of male and female individuals aged between 8 and 22 years old were selected. Assessment of the images was performed by using the ITK-SNAP software, consisting of three steps: 1) vertebral segmentation; 2) three-dimensional reconstruction; and 3) classification of skeletal maturation. Two specialists in orthodontics and two specialists in dentomaxillofacial radiology assessed the images. Results: Analysis of reproducibility and repeatability were performed by using the RR method, with paired t-test also being applied to the repeatability factor together with Lin’s concordance coefficient. The significance level was set at 5%. It was found that there was no difference in the inter-rater reliability (P-value = 0.625), but without statistical repeatability. Conclusions: New tools, as 3D reconstruction software, enabled us to build an effective and friendly 3D-reconstruction system for classification of the skeletal maturation stages of cervical vertebrae.


1. Wong RW, Alkhal HA, Rabie AB. Use of cervical vertebral maturation to determine skeletal age. Am J Orthod Dentofacial Orthop. 2009 Oct;136(4):484.e1-6; discussion 484-5.
doi: 10.1016/j.ajodo.2007.08.033.
2. Crawford B, Kim DG, Moon ES, Johnson E, Fields HW, Palomo JM, et al. Cervical vertebral bone mineral density changes in adolescents during orthodontic treatment. Am J Orthod Dentofacial Orthop. 2014 Aug;146(2):183-9. doi: 10.1016/j.ajodo.2014.04.019.
3. Linhares RV, Matta Mde O, Lima JR, Dantas PM, Costa MB, Fernandes Filho J. [Effects of sexual maturation on body composition, dermatoglyphics, somatotype and basic physical qualities of adolescents]. Arq Bras Endocrinol Metabol. 2009;53(1):47-54. portuguese.
4. Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop. 1995 Jan;107(1):58-66.
5. Baccetti T, Franchi L, De Toffol L, Ghiozzi B, Cozza P. The diagnostic performance of chronologic age in the assessment of skeletal maturity. Prog Orthod. 2006;7(2):176-88.
6. Kucukkeles N, Acar A, Biren S, Arun T. Comparisons between cervical vertebrae and hand-wrist maturation for the assessment of skeletal maturity. J Clin Pediatr Dent. 1999 Fall;24(1):47-52.
7. Fishman LS. Radiographic evaluation of skeletal maturation. A clinically oriented method based on hand-wrist lms. Angle Orthod. 1982 Apr;52(2):88-112.
8. Flores-Mir C, Burgess CA, Champney M, Jensen RJ, Pitcher MR, Major PW. Correlation of skeletal maturation stages determined by cervical vertebrae and hand-wrist evaluations. Angle Orthod. 2006 Jan;76(1):1-5.
9. Danaei SM, Karamifar A, Sardarian A, Shahidi S, Karamifar H, Alipour A, et al. Measuring agreement between cervical vertebrae and hand-wrist maturation in determining skeletal age: reassessing
the theory in patients with short stature. Am J Orthod Dentofacial Orthop. 2014 Sep;146(3):294-8. doi: 10.1016/j.ajodo.2014.05.023.
10. Santiago RC, Cunha AR, Junior GC, Fernandes N, Campos MJ, Costa LF, et al. New software for cervical vertebral geometry assessment and its relationship to skeletal maturation--a pilot study. Dentomaxillofac Radiol. 2014;43(2):20130238. doi: 10.1259/dmfr.20130238.
11. Franchi L, Baccetti T, McNamara JA, Jr. Mandibular growth as related to cervical vertebral maturation and body height. Am J Orthod Dentofacial Orthop. 2000 Sep;118(3):335-40.
12. Baccetti T, Franchi L, McNamara JA, Jr. An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod. 2002 Aug;72(4):316-23.
13. Caldas Mde P, Ambrosano GM, Haiter Neto F. New formula to objectively evaluate skeletal maturation using lateral cephalometric radiographs. Braz Oral Res. 2007 Oct-Dec;21(4):330-5.
14. Nestman TS, Marshall SD, Qian F, Holton N, Franciscus RG, Southard TE. Cervical vertebrae maturation method morphologic criteria: poor reproducibility. Am J Orthod Dentofacial Orthop. 2011 Aug;140(2):182-8. doi: 10.1016/j.ajodo.2011.04.013.
15. Mendelson DS, Rubin DL. Imaging informatics: essential tools for the delivery of imaging services. Acad Radiol. 2013 Oct;20(10):1195-212. doi: 10.1016/j.acra.2013.07.006.
16. Doi K. Computer-aided diagnosis in medical imaging: historical review, current status and future potential. Comput Med Imaging Graph. 2007 Jun-Jul;31(4-5):198-211.
17. Costa AL, Yasuda CL, Appenzeller S, Lopes SL, Cendes F. Comparison of conventional MRI and 3D reconstruction model for evaluation of temporomandibular joint. Surg Radiol Anat. 2008 Nov;30(8):663-7. doi: 10.1007/s00276-008-0400-z.
18. Chang G, Honig S, Brown R, Deniz CM, Egol KA, Babb JS, et al. Finite element analysis applied to 3-T MR imaging of proximal femur microarchitecture: lower bone strength in patients
with fragility fractures compared with control subjects. Radiology. 2014 Aug;272(2):464-74. doi: 10.1148/radiol.14131926.
19. Cevidanes LH, Gomes LR, Jung BT, Gomes MR, Ruellas AC, Goncalves JR, et al.
3D superimposition and understanding temporomandibular joint arthritis. Orthod Craniofac Res. 2015 Apr;18 Suppl 1:18-28. doi: 10.1111/ocr.12070.
20. Schilling J, Gomes LC, Benavides E, Nguyen T, Paniagua B, Styner M, et al. Regional 3D superimposition to assess temporomandibular joint condylar morphology. Dentomaxillofac Radiol. 2014;43(1):20130273. doi: 10.1259/dmfr.20130273.
21. Alhadidi A, Cevidanes LH, Paniagua B, Cook R, Festy F, Tyndall D. 3D quanti cation of mandibular asymmetry using the SPHARM-PDM tool box. Int J Comput Assist Radiol Surg. 2012 Mar;7(2):265-71. doi: 10.1007/s11548-011-0665-2.
22. White SC. Computer-aided differential diagnosis of oral radiographic lesions. Dentomaxillofac Radiol. 1989 May;18(2):53-9.
23. Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, et al. User-guided 3D active contour segmentation of anatomical structures: signi cantly improved e ciency and reliability. Neuroimage. 2006;31(3):1116-8.
24. Yasuda CL, Costa AL, Franca M, Jr., Pereira FR, Tedeschi H, de Oliveira E, et al. Postcraniotomy temporalis muscle atrophy: a clinical, magnetic resonance imaging volumetry and electromyographic investigation. J Orofac Pain. 2010 Fall;24(4):391-7.
25. Gandini P, Mancini M, Andreani F. A comparison of hand-wrist bone and cervical vertebral analyses in measuring skeletal maturation. Angle Orthod. 2006 Nov;76(6):984-9.
26. Patcas R, Signorelli L, Peltomaki T, Schatzle M. Is the use of the cervical vertebrae maturation method justi ed to determine skeletal age? A comparison of radiation dose of two strategies for skeletal age estimation. Eur J Orthod. 2013 Oct;35(5):604-9. doi: 10.1093/ejo/cjs043.
27. Mahajan S. Evaluation of skeletal maturation by comparing the hand wrist radiograph and cervical vertebrae as seen in lateral cephalogram. Indian J Dent Res. 2011 Mar-Apr;22(2):309-16. doi: 10.4103/0970-9290.84310.
How to Cite
BALDIN, Camila Chaparin et al. Evaluation of the Skeletal Maturation of Cervical Vertebrae with Magnetic Resonance Imaging: a pilot study. Brazilian Journal of Oral Sciences, [S.l.], p. e17060, oct. 2017. ISSN 1677-3225. Available at: <https://www.fop.unicamp.br/bjos/index.php/bjos/article/view/60>. Date accessed: 21 july 2019. doi: https://doi.org/10.20396/bjos.v16i1.8650501.
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