Background: Childhood and adolescence constitute a critical period for craniofacial growth. Understanding its developmental patterns is essential for clinical decision-making in orthodontics and maxillofacial surgery. Traditional cephalometric analysis relies on manual landmarking, which oversimplifies complex morphology and introduces subjectivity. Although deep learning, a key artificial intelligence (AI) technology, has demonstrated remarkable performance in image analysis and classification, most methods still depend on manual annotations during training, perpetuating subjectivity and limiting model generalizability and robustness on large datasets. This hinders the development of objective, comprehensive methods to quantify craniofacial growth that account for its multi-tissue complexity. Methods: To address these limitations, this study developed an end-to-end deep learning framework based on lateral cephalometric radiographs from 41,625 individuals aged 4–18 years. Without relying on manual annotations, the model is designed to autonomously extract dynamic imaging features associated with continuous age intervals in craniofacial development and further discern features related to sexual dimorphism. Gradient-weighted Class Activation Mapping (Grad-CAM) was employed to visualize the learned features, generating population-averaged saliency maps that highlight age-related and sex-related patterns. Furthermore, we introduced two novel quantitative metrics, the Age-related Saliency Index (ASI) and the Sex-related Saliency Index (SSI), to evaluate the significance of developmental and dimorphic characteristics in key craniofacial regions. Results: Age-related saliency maps extended the focus from external contours to internal anatomical details of the bones, intuitively visualizing the relative importance of multiple bone regions during dynamic development, with the ASI providing a quantitative prioritization of these regions. The Sex-related Saliency Index (SSI) quantified the dynamic evolution of sexual dimorphism, demonstrating that early-stage differences were widely distributed across cranial bones and gradually became concentrated in the mandibular region by adulthood. Conclusions: This study established an end-to-end deep learning framework for analyzing large-scale lateral cephalometric radiographs. By generating age- and sex-related average saliency maps and their corresponding quantitative indices, we visualized and quantified the spatiotemporal growth dynamics and sexual dimorphism across distinct craniofacial skeletal regions throughout development. These findings not only validate established developmental theories but also provide novel insights into the coordinated growth patterns of craniofacial bones and sex-specific radiological characteristics, offering clinicians objective quantitative references for assessing developmental stages and guiding the timing of interventions targeting specific craniofacial regions.
Hu et al. (Fri,) studied this question.