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Objectives <p>To evaluate the effectiveness of chronological age (CA), sex, and fractal dimension (FD) values in classifying skeletal maturation stages using multinomial logistic regression analysis.</p> Materials and methods <p>Lateral cephalometric radiographs and hand-wrist radiographs (HWRs) of 923 individuals (409 boys and 514 girls) aged 7–18 years were analyzed. Nine regions of interest located in the C2, C3, and C4 vertebral bodies were selected for the fractal analysis. Skeletal maturation stages were determined using Fishman’s skeletal maturity indicator (SMI) method and categorized into accelerating (<i>n</i> = 201; 141 boys and 60 girls), high (<i>n</i> = 334; 165 boys and 169 girls), and decreasing (<i>n</i> = 388; 103 boys and 285 girls) growth velocity groups. Multinomial logistic regression was used to evaluate the associations of CA, sex, and FD values with maturation group membership. Relative risk ratios (RRRs) and 95% confidence intervals (CIs) were calculated to assess the effects of CA, sex, and FD values on maturation stage classification.</p> Results <p>The full model was statistically significant compared with the intercept-only model and achieved an overall apparent classification accuracy of 77.8%. The age-and-sex-only model had a Nagelkerke R² of 0.768 and an accuracy of 77.2%, whereas the full model including FD variables had a Nagelkerke R² of 0.779 and an accuracy of 77.8%. These results indicate that FD measurements provided a modest additional contribution beyond CA and sex. CA and sex were the most stable predictors. Among FD variables, C2 anterior FD showed a significant overall effect, while C4 medial and C4 posterior FD showed more limited, category-specific associations.</p> Conclusion <p>CA and sex were the primary predictors of maturation group membership. FD values from selected cervical vertebral regions may provide supplementary information, but their contribution was modest and should be interpreted cautiously until externally validated.</p> Clinical relevance <p>Cervical vertebral fractal analysis may provide supplementary information for skeletal maturation assessment when combined with chronological age and sex; however, external validation is required.</p>

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Linking vertebral trabecular structure to growth rate: clinical and developmental insights

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月11日

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  • Merve Gonca,
  • Mehmet Fatih Sert,
  • Dilara Nil Günaçar,
  • Taha Emre Köse,
  • Büşra Beşer Gül,
  • Samet Uygun

摘要

Objectives

To evaluate the effectiveness of chronological age (CA), sex, and fractal dimension (FD) values in classifying skeletal maturation stages using multinomial logistic regression analysis.

Materials and methods

Lateral cephalometric radiographs and hand-wrist radiographs (HWRs) of 923 individuals (409 boys and 514 girls) aged 7–18 years were analyzed. Nine regions of interest located in the C2, C3, and C4 vertebral bodies were selected for the fractal analysis. Skeletal maturation stages were determined using Fishman’s skeletal maturity indicator (SMI) method and categorized into accelerating (n = 201; 141 boys and 60 girls), high (n = 334; 165 boys and 169 girls), and decreasing (n = 388; 103 boys and 285 girls) growth velocity groups. Multinomial logistic regression was used to evaluate the associations of CA, sex, and FD values with maturation group membership. Relative risk ratios (RRRs) and 95% confidence intervals (CIs) were calculated to assess the effects of CA, sex, and FD values on maturation stage classification.

Results

The full model was statistically significant compared with the intercept-only model and achieved an overall apparent classification accuracy of 77.8%. The age-and-sex-only model had a Nagelkerke R² of 0.768 and an accuracy of 77.2%, whereas the full model including FD variables had a Nagelkerke R² of 0.779 and an accuracy of 77.8%. These results indicate that FD measurements provided a modest additional contribution beyond CA and sex. CA and sex were the most stable predictors. Among FD variables, C2 anterior FD showed a significant overall effect, while C4 medial and C4 posterior FD showed more limited, category-specific associations.

Conclusion

CA and sex were the primary predictors of maturation group membership. FD values from selected cervical vertebral regions may provide supplementary information, but their contribution was modest and should be interpreted cautiously until externally validated.

Clinical relevance

Cervical vertebral fractal analysis may provide supplementary information for skeletal maturation assessment when combined with chronological age and sex; however, external validation is required.