Evaluating sternum development and ossification through computed tomography images: a comparative analysis across age and sex
, 2, 3, 2, 4
Abstract
Background: The development of the sternum begins during the intrauterine life and continues until the age of 25 years. However, specific information on the ages at which the development sternum completed remains limited. The aim of this study was to identify the cut-off ages for ossification and fusion of the sternal parts and segments, specifically the manubrium, sternal body and its segments, in both sexes.
Materials and methods: Computed tomography images of the thorax for 480 individuals (215 females and 265 males) from 0 to 25 years of age were analysed to determine the number of ossification centres in the sternal parts. A receiver operating characteristic (ROC) analysis was used to evaluate the ossification and fusion of the sternum segments for the ages at which ossification and fusion occurred for both sexes.
Results: The ROC analysis results indicated that the sternal body showed the most significant age-related ossification in both sexes. The optimal cut-off ages for ossification of the manubrium and sternal body were 4 and 15 years for females and 5 and 15, years for males, respectively (p = 0.001). Age significantly influenced the fusion of the sternum segments. The S1–S2 fusion had the highest area under the curve.
Conclusions: The results of this study emphasise the importance of age in sternum ossification and fusion. Age-specific ossification patterns were most pronounced in the sternal body. The ROC analysis provided the critical age cut-off points for the developmental stages of the sternum in both sexes.
Keywords: sternumossificationfusiondevelopmentage
References
- Akin K, Kosehan D, Topcu A, et al. Anatomic evaluation of the xiphoid process with 64-row multidetector computed tomography. Skeletal Radiol. 2011; 40(4): 447–452.
- Badhe PV, Shukla AD, Mhatre P, et al. Age estimation based on CT chest analysis of ossification of the xiphisternal joint in a living population aged 35–50 in a tertiary setup. Cureus. 2023; 15(4): e38160.
- Bayaroğulları H, Yengil E, Davran R, et al. Evaluation of the postnatal development of the sternum and sternal variations using multidetector CT. Diagn Interv Radiol. 2014; 20(1): 82–89.
- Bolatlı G, Doğan NÜ, Koplay M, et al. Evaluation of sternal morphology according to age and sex in multidedector computerized tomography. Anatomy. 2020; 14(1): 29–38.
- Cui X, Li RG, Ma DT. A safe area for sternal puncture in children: an MSCT study based on sternal development. Surg Radiol Anat. 2022; 44(1): 105–115.
- Delgado J, Jaimes C, Gwal K, et al. Sternal development in the pediatric population: evaluation using computed tomography. Pediatr Radiol. 2014; 44(4): 425–433.
- Gkantsinikoudis N, Chaniotakis C, Gkasdaris G, et al. Morphological approach of the sternal foramen: an anatomic study and a short review of the literature. Folia Morphol. 2017; 76(3): 484–490.
- Gumeler E, Akpinar E, Ariyurek OM. MDCT evaluation of sternal development. Surg Radiol Anat. 2019; 41(3): 281–286.
- Khartade HK, Shrivastava S, Shedge R, et al. Anthropometry of the sternum: an autopsy-based study for sex determination. Med Leg J. 2024; 92(1): 27–33.
- Manoharan C, Dhanalakshmi V, Thangam D, et al. Estimation of age from human sternum-an autopsy study. Indian J Forensic Community Med. 2016; 3(2): 128.
- Monum T, Makino Y, Prasitwattanaseree S, et al. Age estimation from ossification of sternum and true ribs using 3D post-mortem CT images in a Japanese population. Leg Med (Tokyo). 2020; 43: 101663.
- O'Neal ML, Dwornik JJ, Ganey TM, et al. Postnatal development of the human sternum. J Pediatr Orthop. 1998; 18(3): 398–405.
- Ogden JA, Conlogue GJ, Bronson ML, et al. Radiology of postnatal skeletal development. II. The manubrium and sternum. Skeletal Radiol. 1979; 4(4): 189–195.
- Paraskevas GK, Tzika M, Natsis K. Double sternal foramina in a dried sternum: a rare normal variant and its radiologic assessment. Surg Radiol Anat. 2016; 38(8): 991–993.
- Rodríguez-Vázquez JF, Verdugo-López S, Garrido JM, et al. Morphogenesis of the manubrium of sternum in human embryos: a new concept. Anat Rec (Hoboken). 2013; 296(2): 279–289.
- Sahu M, Tripathy P, Mohanty M, et al. Age estimation from sternum of eastern Indian population: Autopsy based study. Indian J Forensic Community Med. 2022; 9(2): 59–64.
- Sandoz B, Badina A, Laporte S, et al. Quantitative geometric analysis of rib, costal cartilage and sternum from childhood to teenagehood. Med Biol Eng Comput. 2013; 51(9): 971–979.
- Wattamwar K, Levin TL. Delayed sternal ossification in congenital heart disease: incidence using computed tomography. Pediatr Radiol. 2021; 51(9): 1676–1681.
- Weaver AA, Schoell SL, Nguyen CM, et al. Morphometric analysis of variation in the sternum with sex and age. J Morphol. 2014; 275(11): 1284–1299.
