Hand-wrist Radiographs Research Articles

A machine learning approach for age prediction based on trigeminal landmarks

ObjectiveThe aim of this study was to estimate the chronological age (CA) of a growing individual using a new machine learning approach on Cone Beam Computed Tomography (CBCT). Materials and methodsThe dataset included 48 CBCT and hand-wrist radiographs of growing individuals. 12 landmarks related to trigeminal trajectories were plotted on each CBCT and principal component analysis was applied for dimensionality reduction. The estimated CA was obtained using a decision tree. Finally, a genetic algorithm was implemented to select the best set of landmarks that would optimize the estimation. The age was also assessed following Greulich and Pyle's (GP) method on hand-wrist radiographs. The results (GP and Machine Learning) were then compared to the true CA. ResultsAmong the 12 landmarks, the genetic algorithm selected 7 optimal features, and 12 principal components out of 36. The best results for age prediction were obtained by a combination of genetic algorithm, principal component analysis, and regression tree where the Mean Squared Error (MSE) and Mean Absolute Error (MAE) were respectively 1.29 and 0.92. These outcomes showed improved accuracy compared to those of the hand-wrist method (MSE = 2.038 and MAE = 1.775). ConclusionsA numerical application on a dataset of CBCT showed that the proposed machine learning method achieved an improved accuracy compared to conventional methods and had satisfying performance in assessing age for forensic purposes. Validation of the presented method on a larger and more diverse sample would pave the way for future applications in forensic science as a tool for age prediction.

Children's bone age development is delayed with increasing altitude: a multicenter study.

To investigate the bone age (BA) characteristics of children living at high-altitude regions and determine the impact of altitude on the development of BA. From June 2014 to July 2022, 1,318 children with left hand-wrist radiographs were retrospectively enrolled from three different geographical altitudes (Beijing 43.5 m above sea level [asl], Lhasa 3650 m asl, and Nagqu 4500 m asl). The predicted age difference (PAD), defined as the difference between BA and chronologic age (CA), was considered the indicator for delayed or advanced growth. The PAD of children from the three regions in total and according to different age groups, genders, and ethnicities were compared. The linear regression model was used to assess the effect of altitude on PAD. A total of 1284 children (CA: 12.00 [6.45, 15.72] years; male: 837/1284, 65.2%) were included in the study with 407 from Beijing, 491 from Lhasa, and 386 from Nagqu. The PAD for Beijing, Lhasa, and Nagqu were 0.1 [-0.30, 0.65], -0.40 [-1.20, 0.27], and -1.42 [-2.32, -0.51] years, respectively. A linear regression analysis showed that altitude significantly contributed to PAD (compared to Beijing, Lhasa coefficient = -0.57, P < 0.001; Nagqu coefficient = -1.55, P < 0.001). High altitude might be an independent contributor to the delayed BA development of children. The impact of altitude on BA development was revealed for the first time, highlighting the necessity of considering the altitude of the area when evaluating BA development for children residing in high-altitude regions.

The impact of HIV infection on skeletal maturity in peripubertal children in Zimbabwe: a cross-sectional study

IntroductionHIV infection and its treatment compromises skeletal development (growth and maturation). Skeletal maturity is assessed as bone age (BA) on hand and wrist radiographs. BA younger than chronological age (CA) indicates delayed development. We conducted a cross-sectional study to determine differences between BA and CA (i.e., skeletal maturity deviation [SMD]), and risk factors associated with SMD in peripubertal children with and without HIV established on antiretroviral therapy (ART) including use of tenofovir disoproxil fumarate (TDF).MethodsChildren with HIV taking ART for at least two years and a comparison group of HIV-negative children, aged 8–16 years and frequency-matched by age and sex, were recruited from HIV clinics and local schools in the same catchment area, in Harare, Zimbabwe. BA was assessed from non-dominant hand-wrist radiographs using the Tanner Whitehouse 3 method. Negative SMD values correspond to delayed development, i.e., BA younger than CA. Multivariable linear regression models determined factors associated with SMD overall, and in children with HIV.ResultsIn total, 534 participants (54% males) were included; by design CA was similar in males and females, whether living with or without HIV. Mean (SD) SMD was more negative in CWH than in HIV-negative children in both males [-1.4(1.4) vs. -0.4(1.1) years] and females [-1.1(1.3) vs. -0.0(1.2) years]. HIV infection and weight-for-age Z-score<-2 were associated with more negative SMD in both males and females after adjusting for socio-economic status, orphanhood, pubertal stage, and calcium intake. Age at ART initiation was associated with SMD in both males and females with those starting ART later more delayed: starting ART aged 4–8 years 1.14 (-1.84, -0.43), or over 8 years 1.47 (-2.30, -0.65) (p-value for trend < 0.001). Similar non-significant trends were seen in males. TDF exposure TDF exposure whether < 4years or ≥ 4 years was not associated with delayed development.ConclusionPerinatally-acquired HIV infection and being underweight were independently associated with delayed skeletal maturation in both males and females. Starting ART later was independently associated with skeletal maturation delay in CWH. Given the known effects of delayed development on later health, it is important to find interventions to ensure healthy weight gain through early years and in CWH to initiate ART as early as possible.

Evaluation and Correlation of Salivary Bone-Specific Alkaline Phosphatase Level with Skeletal Age

Background: This study aimed to measure bone-specific alkaline phosphatase (B-ALP) levels in saliva and determine how they relate to different stages of skeletal development, as assessed by hand-wrist X-rays using the Hagg and Taranger method. Since orthodontic treatment is closely linked to an individual’s growth, the development of the jaws, face, and overall body, and how they affect the alignment of teeth, the suggestion to use biomarkers to evaluate an individual’s skeletal maturity has emerged as a promising approach. Unlike traditional radiographic methods, which are subjective and based on morphology, biomarkers provide objective indicators related to the patient’s physiology, and they do not involve radiation exposure or magnification errors. The main goal of this study was to measure B-ALP levels in saliva and examine their correlation with varying degrees of skeletal maturity. In a positive correlation, the total ALP present in saliva could be a valuable biological indicator in growing patients. Methods: Thirty patients were randomly selected for the study based on the inclusion criteria: Age of the individual: 9‒19 years, with good general health and no nutritional issues. A sample of unstimulated whole saliva was collected using a passive drooling method to estimate levels of the bone alkaline phosphatase using an enzyme-linked immunosorbent assay (ELISA) kit. After saliva collection, hand-wrist radiographs were immediately obtained and manually traced onto 50-micron-thick lead acetate tracing sheets using an 0.5-mm lead pencil. The hand-wrist radiographs were then categorized into five groups, which involved analyzing the morphology of the hand-wrist radiographs: group SO (prepubertal), group S (pubertal onset), group MP3G (peak pubertal), group DP3 (pubertal deceleration), and group RJ (growth completion). Results: There were significant differences between the B-ALP levels between different skeletal ages. The salivary B-ALP values of the group MP3 were significantly higher than those of groups SO and RJ. The mean salivary B-ALP levels consistently increased from the group SO to the group MP3, followed by a gradual decrease. Conclusion: Salivary alkaline phosphatase activity was significantly higher during the peak pubertal period (group MP3) compared to both the pre-peak (group SO) and post-peak (group RJ) values. This finding suggests that salivary bone alkaline phosphatase can be used as an additional indicator alongside conventional skeletal maturation indicators to assess pubertal development.

Skeletal Growth Status Agreement in a Group of Thai Children and Adolescents: A Comparative Analysis of Fishman's Skeletal Maturation and Baccetti's Cervical Vertebral Maturation Indices

This study aimed to determine the agreement of skeletal maturation (SM) assessed by hand-wrist radiographs and cervical vertebral maturation (CVM) assessed by lateral cephalometric radiographs. It also explored the feasibility of using CVM as an alternative to hand-wrist radiographs among Thai children and adolescents. The samples comprised 95 males and 67 females from Thailand, aged 7–17 years. A total of 162 hand-wrist radiographs and lateral cephalometric radiographs were included. Two experienced oral radiologists independently assessed SM (using Fishman’s method) and CVM (using Baccetti’s method); a third referee observer resolved any discrepancies. The correlation and agreement between the methods were evaluated. The results found a substantial agreement (weighted kappa = 0.594) between SM and CVM. The interobserver discrepancy in categorizing SM stages was mostly found at stage 5, while the most common discrepancy for CVM was at stage 6. A significant positive correlation (Spearman’s correlation coefficient = 0.677, P &lt; 0.001) indicated a moderate to strong association between SM and CVM. The substantial agreement and moderate to strong correlation between CVM and SM highlighted the feasibility of using CVM to assess skeletal growth. However, to ensure reliability, it was necessary to precisely evaluate the appearance of the capping of the epiphyseal plate for SM and the distinction between a rectangular and square cervical spine shape at C3 and C4 for CVM differentiation. Keywords: Cervical spine, Hand, Radiographic evaluation, Orthodontics

The Addition of Hand-specific Skeletal Maturity Parameters Does Not Improve Skeletal Maturity Estimation Accuracy of the Modified Fels Wrist System.

The Modified Fels Wrist system is potentially the most accurate clinically accessible skeletal maturity system utilizing hand or wrist radiographs. During development, parameters distal to the metacarpals were excluded. We attempted to further optimize the Modified Fels wrist system through the inclusion of hand parameters distal to the metacarpals. Forty-three new anteroposterior (AP) hand radiographic parameters were identified from the Fels and Greulich and Pyle (GP) skeletal maturity systems. Twelve parameters were eliminated from further evaluation for poor correlation with skeletal maturity, poor reliability, and lack of relevance in the peripubertal years. In addition to the 8 previously described Modified Fels Wrist parameters, 31 hand radiographic parameters were evaluated on serial peripubertal AP hand radiographs to identify the ones most important for accurately estimating skeletal age. This process produced a "Modified Fels hand-wrist" model; its performance was compared with (1) GP only; (2) Sanders Hand (SH) only; (3) age, sex, and GP; (4) age, sex, and SH; and (5) Modified Fels Wrist system. Three hundred seventy-two radiographs from 42 girls and 38 boys were included. Of the 39 radiographic parameters that underwent full evaluation, 9 remained in the combined Modified Fels Hand-Wrist system in addition to chronological age and sex. Four parameters are wrist specific, and the remaining 5 are hand specific. The Hand-Wrist system outperformed both GP and SH in estimating skeletal maturity ( P <0.001). When compared with the Modified Fels Wrist system, the Modified Fels Hand-Wrist system performed similarly regarding skeletal maturity estimation (0.36±0.32 vs. 0.34±0.26, P =0.59) but had an increased (worse) rate of outlier predictions >1 year discrepant from true skeletal maturity (4.9% vs. 1.9%, P =0.01). The addition of hand parameters to the existing Modified Fels Wrist system did not improve skeletal maturity estimation accuracy and worsened the rate of outlier estimations. When an AP hand-wrist radiograph is available, the existing Modified Fels wrist system is best for skeletal maturity estimation. Level III.

Determination of growth and developmental stages in hand-wrist radiographs : Can fractal analysis in combination with artificial intelligence be used?

The goal of this work was to assess the classification of maturation stage using artificial intelligence (AI) classifiers. Hand-wrist radiographs (HWRs) from 1067 individuals aged between 7and 18years were included. Fifteen regions of interest were selected for fractal dimension (FD) analysis. Five predictive models with different inputs were created (model1: only FD; model2: FD and Chapman sesamoid stage; model3: FD, age, and sex; model4: FD, Chapman sesamoid stage, age, and sex; model5: Chapman sesamoid stage, age, and sex). The target diagnoses were accelerating growth velocity, very high growth velocity, and decreasing growth velocity. Four AI algorithms were applied: multilayer perceptron (MLP), support vector machine (SVM), gradient boosting machine (GBM) and C5.0 decision tree classifier. All AI algorithms except for C5.0 yielded similar overall predictive accuracies for the five models. In order from lowest to highest, the predictive accuracies of the models were as follows: model1 < model3 < model2 < model5 < model4. The highest overall F1 score, which was used instead of accuracy especially for models with unbalanced data, was obtained for models1,2, and3 based on SVM, for model4 based on MLP, and for model5 based on C5.0. Adding Chapman sesamoid stage, chronologic age, and sex as additional inputs to the FD values significantly increased the F1 score. Applying FD analysis to HWRs is not sufficient to predict maturation stage in growing patients but can be considered agrowth rate prediction method if combined with the Chapman sesamoid stage, age, and sex.

To Evaluate Correlation Between Cervical Vertebral Maturation Stages and Third Molar Maturation Stages in North Maharashtrian Population

Introduction Assessment of growth is crucial in the diagnosis and treatment planning in orthodontics. Skeletal development can be assessed by using hand-wrist radiographs and lateral cephalograms. The advantage of the panoramic radiograph over hand wrist radiograph is that patient exposure is reduced following the ALARA principle. Aim The aim of this study was to investigate the correlation between third molar calcification stages and skeletal maturity using the CVM stages in North Maharashtrian population. Methods Dental panoramic and lateral cephalograms of subjects ranged in age from 9 to 20 years were selected. Demirjians method was used to assess the dental maturation stages of third molars on both the sides. Hassel and Farman classification was used for classifying into cervical vertebral maturation indicator stages. The collected data were statistically analyzed. Result There was a statistically significant correlation between cervical maturation stages and third molar calcification stages in North Maharashtrian population.

Estimation of Salivary Bone Specific Alkaline Phosphatase as a Biomarker for Assessing Skeletal Maturity Indicator

ABSTRACT Background: Evaluation of skeletal maturation plays a substantial role in selection of orthodontic treatment strategies. Recently, new noninvasive methods of assessing biological mediators have been introduced to assess skeletal maturity. There is a marked rise in the value of these mediators during pubertal growth spurts. When these mediators emerge as the assessment tool for skeletal maturity determination, it can reduce radiation exposure and beneficial to the patient. Hence, the goal of this study is to validate the calculation of salivary alkaline phosphatase (ALP) as a noninvasive skeletal maturity indicator by estimating the Bone Alkaline Phosphatase (B-ALP) level in whole unstimulated saliva at different stages of skeletal maturity and correlating B-ALP level with different stages of skeletal development using cervical vertebral maturation index (CVMI) and hand-wrist MP3 (third finger middle phalanx). Materials and Methods: The test group included 90 subjects aged between 8 and 18 years requiring orthodontic treatment. The salivary samples were collected and examined by ALP kit following the manufacturer’s instructions and assessed using photo-spectrometer at 405 nm. The skeletal age was assessed using handwrist radiographs; skeletal age was determined by modified MP3 staging. Lateral cephalograms of each individual were also collected and tracing done for assessing skeletal age with CVM staging. The collected data were analyzed statistically with analysis of variance for intergroup comparison of ALP levels and Kruskal–Wallis test for intergroup comparison of CVM and MP3 stages. Results and Conclusion: Salivary ALP activity during the peak pubertal period was markedly increased when compared to pre- and post-peak values. Salivary ALP activity was in correlation with the cervical vertebral maturation and MP3 stages showing peak values at the pubertal stages. Thus, salivary B-ALP can serve as a noninvasive method of skeletal maturity assessment as an adjunct to conventional skeletal maturity indicators.

Comparative analysis of deep-learning-based bone age estimation between whole lateral cephalometric and the cervical vertebral region in children.

Bone age determination in individuals is important for the diagnosis and treatment of growing children. This study aimed to develop a deep-learning model for bone age estimation using lateral cephalometric radiographs (LCRs) and regions of interest (ROIs) in growing children and evaluate its performance. This retrospective study included 1050 patients aged 4-18 years who underwent LCR and hand-wrist radiography on the same day at Pusan National University Dental Hospital and Ulsan University Hospital between January 2014 and June 2023. Two pretrained convolutional neural networks, InceptionResNet-v2 and NasNet-Large, were employed to develop a deep-learning model for bone age estimation. The LCRs and ROIs, which were designated as the cervical vertebrae areas, were labeled according to the patient's bone age. Bone age was collected from the same patient's hand-wrist radiograph. Deep-learning models trained with five-fold cross-validation were tested using internal and external validations. The LCR-trained model outperformed the ROI-trained models. In addition, visualization of each deep learning model using the gradient-weighted regression activation mapping technique revealed a difference in focus in bone age estimation. The findings of this comparative study are significant because they demonstrate the feasibility of bone age estimation via deep learning with craniofacial bones and dentition, in addition to the cervical vertebrae on the LCR of growing children.

Estimation of Serum Parathyroid Hormone Related Protein in the Assessment of Pubertal Growth Spurt in Skeletal Class II Malocclusion Subjects.

Introduction: Accurate measurement of skeletal maturity is critical to the optimal treatment timing of skeletal jaw discrepancies. Skeletal maturity can be assessed by several radiologic biologic indicators such as orthopantomograph, middle phalanx of third finger (MP3), hand-wrist radiograph and cervical vertebral maturation indicators (CVMI), but since they are highly subjective techniques to identify peak mandibular growth, a quest for a reliable non-radiologic biologic marker was deemed necessary. Parathyroid Hormone related Protein (PTHrP) was chosen to assess the skeletal maturity as its evidence was scarce in literature. Materials and Methods: The sample consisted of 80 skeletal Class II malocclusion subjects, males (n= 38), females (n=42), aged 11–18 years. The cervical stage of each subject was assessed with a lateral cephalogram. Two mL blood was obtained by venipuncture. Serum PTHrP was quantitatively assessed by ELISA-Sandwich principle using Elabscience, ELISA kit. Results: Mean PTHrP serum levels in males witnessed an increase in CS3 &amp; in females in CS2 followed by CS5, exhibiting a pubertal trend in males and a pre-pubertal trend in females. Mean PTHrP serum levels in the four intervals of cervical staging showed an increase in CS2 through to CS4 in males and in CS2-CS3 in females, showing an increase of this biomarker in the pre and pubertal stages in both the sexes. Conclusions: PTHrP mean serum levels was found to be increased in early rather than in the later stages of puberty in both males and females leading to the speculation that PTHrP could serve as a potential biomarker to assess the pubertal growth spurt.

Correlation of Serum Insulin-Like Growth Factor-1 and Hand Wrist Radiographs as Skeletal Maturity Indicators: an Ex-Vivo Study

Introduction: Conventional Hand and Wrist radiographs, have certain drawbacks of exposing orthodontic patients to unnecessary radiation hazards and subjectivity to errors. Serum insulin-like growth factor 1 (IGF-1) levels have been reported to increase until the pubertal peak in literature. The present study aims to assess the relationship between serum IGF-1 and skeletal maturity indicators Materials and Methods: Lateral cephalograms of 60 patients were assigned SMI stage according to Fishman’s classification system. The serum IGF-1 levels of the patients were also evaluated. Correlation between the serum IGF-1 levels, age of the patient, and their SMI stage was analyzed. Results: Pearson's coefficient of correlation revealed a non-significant weak positive correlation (p=0.69; &gt;0.05) between age and IGF-1 levels, and a non-significant weak negative correlation (p =0.52; &gt;0.05) between SMI stages and IGF-1 levels. Results of the ANOVA test indicated that there was no significant difference between mean IGF-1 levels across the different age groups and eleven SMI groups. However, there was a significant difference noted in the mean IGF-1 levels and the restructured SMI categories and groups. Conclusion: The moderate correlation between age and serum IGF-1 fluctuations during puberty underscores the hormone's pivotal role in adolescent growth. This positions serum IGF-1 as a potentially specific and reliable marker for assessing mandibular growth modifications, offering a radiation-free alternative to conventional radiographic methods

Biomarkers in Body Fluids as Indicators of Skeletal Maturity: A Systematic Review and Meta-analysis.

This review aimed to critically appraise the evidence for biomarkers in blood serum, gingival crevicular fluid (GCF), saliva, and urine in comparison with standard radiographic indices for skeletal maturation assessment. A thorough literature search in multiple databases was conducted for biomarkers in body fluids for skeletal maturation assessed with cervical vertebrae in lateral cephalograms or on hand-wrist radiographs. Different combinations including free text, MeSH terms, and Boolean operators were used. Two researchers used strict inclusion and exclusion criteria to screen title, abstract, and full text, and used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 instrument for risk of bias assessment of individual studies. Meta-analysis was performed on eligible studies using RevMan 5 software. A total of 344 articles were screened, of which 33 met the inclusion criteria and quality assessment. The skeletal maturity indicators included insulin-like growth factors (IGF-1), alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BALP), dehydroepiandrosterone sulfate (DHEAS), vitamin D binding protein (DBP), parathormone-related protein (PTHrP), osteocalcin, metalloproteins, and serotransferrin (TF) along with different metabolites. At puberty, a significant rise was seen in IGF-1, DBP, ALP, osteocalcin, TF, and BALP. However, the serum DHEAS and PTHrP increased from pre-pubertal to post-pubertal stages. Due to the data heterogeneity, a meta-analysis could be performed on seven studies in total on IGF-1 in serum and blood. Of these, five were included for data in males and six in females, and four studies on IGF-1 in serum and blood. A significant difference in IGF-1 levels was seen between stages of peak pubertal growth spurt (CS3 and CS4) and decelerating pubertal growth (CS5) compared with growth initiation stage (CS2). Pubertal growth spurts were correlated with peak serum IGF-1 and BALP in both sexes individually. Peak ALP levels in GCF were correlated with the pubertal spurt in a combined sample of males and females. Standard biofluid collection protocols and homogeneity in sampling and methodology are strongly recommended for future research.

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

BackgroundTo investigate whether fractal dimension (FD) measurements from hand-wrist radiographs and lateral cephalometric radiographs are correlated with each other and with skeletal maturation stages.MethodsIn this retrospective study conducted on hand-wrist and lateral cephalometric radiographs obtained from patients between 2017 and 2023, hand-wrist maturation stages (HWMS) and cervical vertebral maturation stages (CVMS) of 144 subjects (6 to 17 years of age) were assessed radiographically. The participants were divided into nine groups (n = 16 each) based on HWMS. Fractal analysis was performed on the radiographs of the radius, the middle finger phalanges (proximal, medial and distal), and the cervical vertebral bodies (C2, C3, C4). Mean and standard deviation values, Spearman’s and Pearson correlation analyses, one-way ANOVA, Kruskal-Wallis H tests and Mann-Whitney-U test were used to evaluate the data.ResultsPositive correlations were found between the FD values of the radius and HWMS or CVMS (r = .559, P = .001, r = .528 P = .001 respectively). The FD values of the radius were positively correlated with those of all cervical vertebrae (C2, C3, C4), proximal and medial phalanges as well as age. FD values measured from the proximal phalanx, medial phalanx and radius showed significant differences among both HWMS and CVMS (P < .05). HWMS was strongly correlated with CVMS (r = .929, P = .001). Age was strongly correlated with HWMS (r = .795, P = .001) and CVMS (r = .756, P = .001). There was a significant difference in terms of age distribution among HWMS and CVMS (P < .05).ConclusionsFD measurements on hand-wrist radiographs can provide useful information for the assessment of skeletal maturation stage. Especially, FD measurements from the radius are important and more reliable to predict skeletal maturation stage.

Correlation of skeletal age by Greulich-Pyle atlas, physiological age by body development index, and dental age by London Atlas and modified Demirjian’s technique in children and adolescents of an Eastern Indian population

BackgroundForensic age estimation using multiple maturity indicators necessitates investigation of correlation between various techniques. This study intended to compare and evaluate the correlation between skeletal age using Greulich-Pyle atlas, dental age by Acharya’s modification of Demirjian’s technique and London Atlas method of Tooth Development, and age estimated by body developmental index with chronological age. Orthopantomograms and left hand-wrist radiographs of one hundred seventy-four subjects (64 males and 70 females) in the age group of 8–20 years were evaluated by age estimation methods. Physical parameters including height, weight, biacromial breadth, and biliospinale breadth were measured. The data were entered in the SPSS software (Version 27.0). Comparison between age estimation methods was done using Student’s t-test for paired samples. Unpaired t-test was utilized for gender-wise comparison of age. Pearson’s correlation coefficient was calculated to assess correlation between the various methods.ResultsSignificant mean differences were noted between the chronological age and all the age estimation methods when Greulich-Pyle atlas method (− 0.43), modified Demirjian’s method (− 0.31), London Atlas Method (− 0.62), and body developmental index (− 0.51) were employed respectively. Inter-group comparison between all methods yielded no significant differences except for modified Demirjian’s method and London Atlas method (mean difference = 0.31). All the age estimation techniques showed strong correlation with chronological age; the best was provided by the Greulich-Pyle method (r = 0.92).ConclusionAll the assessed age estimation techniques show strong correlation with chronological age. Acharya’s modified Demirjian’s method (dental age) and Greulich-Pyle atlas method (skeletal age) showed good accuracy and strong correlation with chronological age, suggesting that these methods can be used simultaneously and/or interchangeably for age assessment in children and adolescents of Eastern Indian population.

Correlation between Serum IGF-1, IGFBP-3 Levels, and Hand-Wrist Radiographs in Determining Skeletal Maturity

The aim of this study was to assess the correlation between serum levels of insulinlike growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), and hand-wrist radiographs using a skeletal maturity indicator (SMI) and the middle phalanx of the third finger (MP3). Hand-wrist radiographs and blood samples from 205 patients aged 7 - 17 years were retrospectively analyzed by two dentists using the SMI stages, MP3 stages, and serum IGF-1 and IGFBP-3 levels. Serum IGF-1 levels were highest at the SMI 6 - 8 and MP3 - G stage and lowest at the SMI 1 - 3 and MP3 - F stage (&lt;i&gt;p&lt;/i&gt; &lt; 0.0001). Serum IGFBP-3 levels were highest at the SMI 9 - 10 and MP3 - I stage and lowest at the SMI 1 - 3 and MP3 - FG stage (&lt;i&gt;p&lt;/i&gt; = 0.010, 0.030). As a result of Pearson correlation analysis, a relatively high correlation was found between skeletal maturity using the SMI and MP3 stages and serum IGF-1 levels (&lt;i&gt;r&lt;/i&gt; = 0.698, 0.622, &lt;i&gt;p&lt;/i&gt; &lt; 0.0001). According to the results of this study, serum IGF-1 levels can be used as an auxiliary measure to evaluate the skeletal maturity of children and adolescents in dentistry. The range from the mean serum IGF-1 level of 472 µg/L in SMI 6 stage to the mean IGF-1 level of 510.63 µg/L in MP3 G stage could be considered as the peak height velocity in clinical practice.

Preece-Baines 1 model validation for cross-sectional data in male soccer players according to maturity status.

The aim of the present study was to compare the Preece-Baines 1 (PB1) model fit between longitudinal and cross-sectional data in male soccer players and to adjust the height growth curve by maturity status. A final sample of 57 male Portuguese soccer players from professional soccer academies was included. Longitudinal height records were measured between 8 and 17 times in each subject from 2-8 years to 14-17 years. Additionally, longitudinal height records were used as cross-sectional data along with 1087 cross-sectional height records taken from 602 Portuguese soccer players. Skeletal age was estimated by Tanner-Whitehouse III method from a left hand-wrist radiograph. Age at peak height velocity (PHV) was estimated by PB1 model for longitudinal and cross-sectional data and by maturity status. No significant differences were found between all the longitudinal estimates of 57 players and the random cross-sectional samples for, S1 parameter and for growth velocity at PHV, at TO, and for age at PHV. The age at PHV in early, on-time, and late maturers were 12.26, 12.9, and 13.58 years, respectively. PB1 adjusted the height growth of Portuguese male soccer players from cross-sectional data, obtaining an estimate PHV very similar to that found from longitudinal data. A maturity time difference of ≈0.6 years was found between the age at PHV of on-time, early, and on-time and late maturity state.

Assessment of Skeletal Age using Hand-Wrist Radiographs Following BJORK System Sample Size - Prospective Study.

The planning of effective orthodontic therapy greatly benefits from an understanding of the skeletal maturation and stage of growth of the patients seeking orthodontic treatment. However, the patient's various craniofacial structures have varying levels of growth potential. The patient is exposed to additional radiation when hand-wrist radiographs are regularly used to forecast growth. As an alternative, cervical vertebrae in the lateral cephalograph have been suggested. When arranging orthodontic treatment for growing children, it is important to take into account the pubertal growth spurt, which is a crucial time in therapy. Finding out how much growth a patient with skeletal discrepancy would experience during adolescence is one of the key goals of conducting a hand and wrist radiograph.

Using artificial intelligence models to evaluate envisaged points initially: A pilot study.

The morphology of the finger bones in hand-wrist radiographs (HWRs) can be considered as a radiological skeletal maturity indicator, along with the other indicators. This study aims to validate the anatomical landmarks envisaged to be used for classification of the morphology of the phalanges, by developing classical neural network (NN) classifiers based on a sub-dataset of 136 HWRs. A web-based tool was developed and 22 anatomical landmarks were labeled on four region of interests (proximal (PP3), medial (MP3), distal (DP3) phalanges of the third and medial phalanx (MP5) of the fifth finger) and the epiphysis-diaphysis relationships were saved as "narrow,""equal,""capping" or "fusion" by three observers. In each region, 18 ratios and 15 angles were extracted using anatomical points. The data set is analyzed by developing two NN classifiers, without (NN-1) and with (NN-2) the 5-fold cross-validation. The performance of the models was evaluated with percentage of agreement, Cohen's (cκ) and Weighted (wκ) Kappa coefficients, precision, recall, F1-score and accuracy (statistically significance: p < 0.05). Method error was found to be in the range of cκ: 0.7-1. Overall classification performance of the models was changed between 82.14% and 89.29%. On average, performance of the NN-1 and NN-2 models were found to be 85.71% and 85.52%, respectively. The cκ and wκ of the NN-1 model were changed between -0.08 (p > 0.05) and 0.91 among regions. The average performance was found to be promising except the regions without adequate samples and the anatomical points are validated to be used in the future studies, initially.

Evaluation of two methods of bone age assessment in peripubertal children in Zimbabwe.

Bone age (BA) measurement in children is used to evaluate skeletal maturity and helps in the diagnosis of growth disorders in children. The two most used methods are Greulich and Pyle (GP), and Tanner and Whitehouse 3 (TW3), both based upon assessment of a hand-wrist radiograph. To our knowledge no study has compared and validated the two methods in sub-Saharan Africa (SSA), and only a few have determined BA despite it being a region where skeletal maturity is often impaired for example by HIV and malnutrition. This study aimed to compare BA as measured by two methods (GP and TW3) against chronological age (CA) and determine which method is most applicable in peripubertal children in Zimbabwe. We conducted a cross-sectional study of boys and girls who tested negative for HIV. Children and adolescents were recruited by stratified random sampling from six schools in Harare, Zimbabwe. Non-dominant hand-wrist radiographs were taken, and BA assessed manually using both GP and TW3. Paired sample Student t-tests were used to calculate the mean differences between BA and chronological age (CA) in boys and girls. Bland-Altman plots compared CA to BA as determined by both methods, and agreement between GP and TW3 BA. All radiographs were graded by a second radiographer and 20% of participants of each sex were randomly selected and re-graded by the first observer. Intraclass correlation coefficient assessed intra- and inter-rater reliability and coefficient of variation assessed precision. We recruited 252 children (111 [44%] girls) aged 8.0-16.5years. The boys and girls were of similar mean±SD CA (12.2±2.4 and 11.7±1.9years) and BA whether assessed by GP (11.5±2.8 and 11.5±2.1years) or TW3 (11.8±2.5 and 11.8±2.1years). In boys BA was lower than CA by 0.76years (95% CI: -0.95, -0.57) when using GP, and by 0.43years (95% CI: -0.61, -0.24) when using TW3. Among the girls there was no difference between BA and CA by either GP [-0.19years (95% CI: -0.40, 0.03)] or TW3 [0.07years (95% CI: -0.16, 0.29)]. In both boys and girls, there were no systematic differences between CA and TW3 BA across age groups whereas agreement improved between CA and GP BA as children got older. Inter-operator precision was 1.5% for TW3 and 3.7% for GP (n=252) and intra-operator precision was 1.5% for TW3 and 2.4% for GP (n=52). The TW3 BA method had better precision than GP and did not systematically differ from CA, meaning that TW3 is the preferred method of assessment of skeletal maturity in Zimbabwean children and adolescents. TW3 and GP methods do not agree for estimates of BA and therefore cannot be used interchangeably. The systematic differences in GP BA assessments over age means it is not appropriate for use in all age groups or stages of maturity in this population.