Deep learning approaches for quantitative and qualitative assessment of cervical vertebral maturation staging systems

To investigate the potential of artificial intelligence (AI) in Cervical Vertebral Maturation (CVM) staging, we developed and compared AI-based qualitative CVM and AI-based quantitative QCVM methods. A dataset of 3,600 lateral cephalometric images from 6 medical centers was divided into training, validation, and testing sets in an 8:1:1 ratio. The QCVM approach categorized images into six stages (QCVM I-IV) based on measurements from 13 cervical vertebral landmarks, while the qualitative method identified six stages (CS1-CS6) through morphological assessment of three cervical vertebrae. Statistical analyses evaluated the methods' performance, including the Pearson correlation coefficient, mean square error (MSE), success detection rate (SDR), precision-recall metrics, and the F1 score. For landmark prediction, our AI model demonstrated remarkable performance, achieving an SDR (error threshold of ≤ 1.0 mm) of 97.14% and with the mean prediction error across thirteen landmarks ranging narrowly from 0.17 to 0.55 mm. Based on the AI-predicted landmarks, the cervical vertebral measurements showed strong agreement with orthodontists, as indicated by a Pearson correlation coefficient of 0.98 and an MSE of 0.004. Besides, the CVM method attained an overall classification accuracy of 71.11%, while the QCVM method showed a higher accuracy of 78.33%. These findings suggest that the AI-based quantitative QCVM method offers superior performance, with higher agreement rates and classification accuracy compared to the AI-based qualitative CVM approach, indicating the fully automated QCVM model could give orthodontists a powerful tool to enhance cervical vertebral maturation staging.