Staging hand-wrist and cervical vertebrae images: a comparison of reproducibility

The aim of this study was to compare the reproducibility of skeletal maturation assessments by raters with similar orthodontic experience using hand-wrist (HW) and cervical vertebral maturation (CVM) methods.

HW and lateral cephalometric radiographs from 15 subjects (8 males and 7 females; ages, 9-16 years) were selected randomly. HW skeletal maturation was evaluated by the method of Greulich and Pyle, and CVM staging was evaluated by the method of Baccetti et al. Six orthodontic residents evaluated all images at three time periods: T₁, initial evaluation; T₂, re-evaluation after 7 days and T₃, final evaluation after 5 weeks. Intra- and interexaminer reproducibility was evaluated with the intraclass correlation coefficient; the limits of agreement (LoA) were determined by using the Bland-Altman method.

The intraexaminer reliability assessed by intraclass correlation coefficient was scored as good for both of methods (T₁-T₂-T₃ HW = 0.89 and CVM = 0.80; T₁-T₂ HW = 0.87 and CVM = 0.77; T₂-T₃ HW0 = 0.90 and CVM = 0.81), as well as the interexaminer evaluation, with the exception of HW-T₁, which scored excellent (0.92). The width of LoA from Bland-Altman plot of cervical vertebra method was narrower (CVM T₁-T₂: -2.3 and +1.8; CVM T₂-T₃: -2.0 and +2.0) than the HW method (HW T₁-T₂: -3.9 and +4.8; HW T₂-T₃: -4.0 and +3.5).

Both HW and CVM methods presented good reproducibility for intra- and interexaminer correlation assessments. The small LoA indicated that the CVM is a reproducible method.