title: Cervical vertebral maturation as a biologic indicator of skeletal maturity.
abstract: OBJECTIVE
  To identify and review the literature regarding the reliability of cervical vertebrae maturation (CVM) staging to predict the pubertal spurt.
  
  
  METHODS
  The selection criteria included cross-sectional and longitudinal descriptive studies in humans that evaluated qualitatively or quantitatively the accuracy and reproducibility of the CVM method on lateral cephalometric radiographs, as well as the correlation with a standard method established by hand-wrist radiographs.
  
  
  RESULTS
  The searches retrieved 343 unique citations. Twenty-three studies met the inclusion criteria. Six articles had moderate to high scores, while 17 of 23 had low scores. Analysis also showed a moderate to high statistically significant correlation between CVM and hand-wrist maturation methods. There was a moderate to high reproducibility of the CVM method, and only one specific study investigated the accuracy of the CVM index in detecting peak pubertal growth.
  
  
  CONCLUSIONS
  This systematic review has shown that the studies on CVM method for radiographic assessment of skeletal maturation stages suffer from serious methodological failures. Better-designed studies with adequate accuracy, reproducibility, and correlation analysis, including studies with appropriate sensitivity-specificity analysis, should be performed.
authors.affiliation: Federal University of Rio de Janeiro, Brazil. rodrigo_cesar_santiago@hotmail.com
authors.forename: Rodrigo César
authors.initials: RC
authors.lastname: Santiago
authors.forename: Luiz Felipe
authors.initials: LF
authors.lastname: de Miranda Costa
authors.forename: Robert Willer Farinazzo
authors.initials: RW
authors.lastname: Vitral
authors.forename: Marcelo Reis
authors.initials: MR
authors.lastname: Fraga
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Bolognese
authors.forename: Lucianne Cople
authors.initials: LC
authors.lastname: Maia
mesh_terms: D000293:Adolescent; D041923:Adolescent Development / Q000502:physiology; D000365:Age Determination by Skeleton / Q000379:methods*; D001846:Bone Development / Q000502:physiology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000254:growth & development*; D002648:Child; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015203:Reproducibility of Results; D014953:Wrist / Q000000981:diagnostic imaging*