Surgical and Radiologic Anatomy

, Volume 41, Issue 3, pp 281–286 | Cite as

MDCT evaluation of sternal development

  • Ekim GumelerEmail author
  • Erhan Akpinar
  • Orhan Macit Ariyurek
Original Article


Background and purpose

Sternal ossification starts in utero, and continues throughout puberty in various patterns. In this study, our objective was to evaluate the correlation of ossification with age and to determine whether age can be predicted.

Materials and methods

Individuals younger than 30 years old without congenital anomalies, chronic disease, and history of long-term chemotherapy who had chest CT imaging with a slice thickness < 3 mm were retrospectively reviewed. Data of ossification centers, horizontal and vertical fusion were collected. Spearman correlation test and ROC analysis were performed to correlate age with fusion. Kruskal–Wallis test was used to perform gender wise comparisons. Sensitivity, specificity, positive predictive value and negative predictive value of cut-off points, estimated according to ROC analysis, were calculated.


Segmented ossification centers were more common in males, with significant difference in third and fourth mesosternal ossification centers (p < 0.05). Females had more vertical fusion at each level (p < 0.05). Spearman correlation test showed significant correlation between age and horizontal and vertical fusion for both genders. ROC analysis was performed and cut-off values were estimated. Sensitivity was very high (84.6–100%) but specificity was low (43.3–79.9%) for horizontal fusion. Sensitivity of vertical fusion (64.8–100%) was similar but specificity was higher (74.7–100%).


Horizontal and vertical fusions of sternal ossification centers correlate with age significantly. Vertical fusion might be a better indicator of age with higher sensitivity and specificity, while horizontal fusion has lower accuracy. Large-scale studies should be conducted to confirm our results.


MDCT Sternal development Age 


Author contributions

EG: project development, data collection, data analysis, and manuscript writing. EA: data analysis and manuscript editing. OMA: project development and data analysis.


No funding.

Compliance with ethical stadards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Andren L, Hall P (1961) Diminished segmentation or premature ossification of the sternum in congenital heart disease. Br Heart J 23:140–142CrossRefGoogle Scholar
  2. 2.
    Ashley GT (1956) The relationship between the pattern of ossification and the definitive shape of the mesosternum in man. J Anat 90:87–105Google Scholar
  3. 3.
    Bath LF, Crofton PM, Evans AE, Ranke MB, Elmlinger MW, Kelnar CJ, Wallace WH (2004) Bone turnover and growth during and after chemotherapy in children with solid tumors. Pediatr Res 55:224–230. CrossRefGoogle Scholar
  4. 4.
    Bayarogullari H, Yengil E, Davran R, Aglagul E, Karazincir S, Balci A (2014) Evaluation of the postnatal development of the sternum and sternal variations using multidetector CT. Diagn Interv Radiol 20:82–89. Google Scholar
  5. 5.
    Carlson B (2013) Integumentary, skeletal and muscular systems. In: Human embryology and developmental biology 5th revised edition. Elsevier Health Sciences, LondonGoogle Scholar
  6. 6.
    Crofton PM, Ahmed SF, Wade JC, Stephen R, Elmlinger MW, Ranke MB, Kelnar CJ, Wallace WH (1998) Effects of intensive chemotherapy on bone and collagen turnover and the growth hormone axis in children with acute lymphoblastic leukemia. J Clin Endocrinol Metab 83:3121–3129. Google Scholar
  7. 7.
    Dean C, Etienne D, Hindson D, Matusz P, Tubbs RS, Loukas M (2012) Pectus excavatum (funnel chest): a historical and current prospective. Surg Radiol Anat 34:573–579. CrossRefGoogle Scholar
  8. 8.
    Delgado J, Jaimes C, Gwal K, Jaramillo D, Ho-Fung V (2014) Sternal development in the pediatric population: evaluation using computed tomography. Pediatr Radiol 44:425–433. CrossRefGoogle Scholar
  9. 9.
    Demirkaya M, Sevinir B, Saglam H (2011) Time-dependent alterations in growth and bone health parameters evaluated at different posttreatment periods in pediatric oncology patients. Pediatr Hematol Oncol 28:588–599. CrossRefGoogle Scholar
  10. 10.
    Fischer KC, White RI, Jordan CE, Dorst JP, Neil CA (1973) Sternal abnormalities in patients with congenital heart disease. Am J Roentgenol Radium Ther Nucl Med 119:530–538CrossRefGoogle Scholar
  11. 11.
    Gray H (2005) Anatomy of the human body. Elsevier, EdinburghGoogle Scholar
  12. 12.
    Paraskevas GK, Tzika M, Natsis K (2016) Double sternal foramina in a dried sternum: a rare normal variant and its radiologic assessment. Surg Radiol Anat 38:991–993. CrossRefGoogle Scholar
  13. 13.
    Paulino AC, Simon JH, Zhen W, Wen BC (2000) Long-term effects in children treated with radiotherapy for head and neck rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 48:1489–1495CrossRefGoogle Scholar
  14. 14.
    Riach IC (1967) Ossification in the sternum as a means of assessing skeletal age. J Clin Pathol 20:589–590CrossRefGoogle Scholar
  15. 15.
    Saccheri P, Sabbadini G, Toso F et al (2012) A keyhole-shaped sternal defect in an ancient human skeleton. Surg Radiol Anat 34:965–968CrossRefGoogle Scholar
  16. 16.
    Sandoz B, Badina A, Laporte S, Lambot K, Mitton D, Skalli W (2013) Quantitative geometric analysis of rib, costal cartilage and sternum from childhood to teenagehood. Med Biol Eng Comput 51:971–979. CrossRefGoogle Scholar
  17. 17.
    Stark P, Jaramillo D (1986) CT of the sternum. Am J Roentgenol 147:72–77. CrossRefGoogle Scholar
  18. 18.
    Steiner RM, Kricun M, Shapiro J (1976) Absent mesosternum in congenital heart disease. Am J Roentgenol 127:923–925. CrossRefGoogle Scholar
  19. 19.
    White RI, Jordan CE, Fischer KC, Lampton L, Neil CA, Dorst JP (1972) Skeletal changes associated with adolescent congenital heart disease. Am J Roentgenol Radium Ther Nucl Med 116:531–538CrossRefGoogle Scholar
  20. 20.
    Xie YZ, Wang BJ, Yun JS, Chung GH, Ma ZB, Li XJ, Kim IS, Chai OH, Han EH, Kim HT, Song CH (2014) Morphology of the human xiphoid process: dissection and radiography of cadavers and MDCT of patients. Surg Radiol Anat 36:209–217. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiology, School of MedicineHacettepe UniversityAnkaraTurkey

Personalised recommendations