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Sardella C, Urbani C, Marconcini G, Cappellani D, Manetti L, De Liperi A, Romei C, Morganti R, Marcocci C, Bogazzi F. Conventional X-rays in the diagnosis and follow-up of vertebral fractures in patients with acromegaly: a real-life study. J Endocrinol Invest 2024; 47:325-334. [PMID: 37668886 DOI: 10.1007/s40618-023-02148-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/28/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To explore the role of conventional X-ray imaging in detecting vertebral fractures (VFs) in patients with acromegaly, both at diagnosis of disease and at the last clinical visit. The risk factors for VFs were also evaluated. DESIGN AND METHODS A retrospective cohort study was conducted on 60 consecutive patients with acromegaly, in a tertiary referral centre. Thoracolumbar spine radiography (X-spine) was performed at the last clinical visit during the follow-up in order to detect VFs. Routine chest radiograph, performed as a part of the general evaluation at diagnosis of acromegaly, were retrospectively analysed to screen for baseline VFs. RESULTS At diagnosis of acromegaly, chest X-ray revealed that 10 (17%) patients had VFs. Of the 50 patients without VFs at diagnosis of acromegaly, 33 (66%) remained unfractured at the last clinical visit (median [IQR] time, 144 [96-192] months after the diagnosis of acromegaly), whereas 17 (34%) had VFs. Overall, 22 patients (37%) had novel VFs detected on X-spine including five patients with previous VFs. Risk factor for incident VFs was the presence of hypogonadism at diagnosis of acromegaly (p = 0.016). CONCLUSIONS In acromegaly patients, conventional X-rays can detect vertebral fractures early at diagnosis of acromegaly. They can also reveal incident VFs, which may occur several years later even in patients without VFs at diagnosis, above all in relation to hypogonadism.
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Affiliation(s)
- C Sardella
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy.
| | - C Urbani
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - G Marconcini
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - D Cappellani
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - L Manetti
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - A De Liperi
- 2nd Radiology Unit, Radiology Department, Pisa University Hospital, 56124, Pisa, Italy
| | - C Romei
- 2nd Radiology Unit, Radiology Department, Pisa University Hospital, 56124, Pisa, Italy
| | - R Morganti
- Section of Statistics, Pisa University Hospital, 56126, Pisa, Italy
| | - C Marcocci
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
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Serum Periostin Level and Genetic Polymorphisms Are Associated with Vertebral Fracture in Chinese Postmenopausal Women. Genes (Basel) 2022; 13:genes13030439. [PMID: 35327993 PMCID: PMC8949046 DOI: 10.3390/genes13030439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 01/27/2023] Open
Abstract
Purposes: In order to investigate the association between serum periostin levels and the variation of its encoding gene POSTN and the prevalence of vertebral fractures and bone mineral density (BMD) in Chinese postmenopausal women, an association study was performed. Materials and Methods: 385 postmenopausal women were recruited. For participants without a history of vertebral fracture, lateral X-rays of the spine covering the fourth thoracic spine to the fifth lumbar spine were performed to detect any asymptomatic vertebral fractures. Ten tag-single nucleotide polymorphisms (SNP) of POSTN were genotyped. Serum periostin levels, biochemical parameters, and BMD were measured individually. Results: rs9603226 was significantly associated with vertebral fractures. Compared to allele G, the minor allele A carriers of rs9603226 had a 1.722-fold higher prevalence of vertebral fracture (p = 0.037). rs3923854 was significantly associated with the serum periostin level. G/G genotype of rs3923854 had a higher serum periostin level than C/C and C/G (67.26 ± 19.90 ng/mL vs. 54.57 ± 21.44 ng/mL and 54.34 ± 18.23 ng/mL). Furthermore, there was a negative correlation between the serum level of periostin and BMD at trochanter and total hip. Conclusion: Our study suggested that genetic variation of POSTN could be a predicting factor for the risk of vertebral fractures. The serum level of periostin could be a potential biochemical parameter for osteoporosis in Chinese postmenopausal women.
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Huang M, Hung VWY, Li TK, Law SW, Wang Y, Chen S, Qin L. Performance of HR-pQCT, DXA, and FRAX in the discrimination of asymptomatic vertebral fracture in postmenopausal Chinese women. Arch Osteoporos 2021; 16:125. [PMID: 34480663 PMCID: PMC8418592 DOI: 10.1007/s11657-021-00939-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Volumetric bone density (vBMD) and trabecular microarchitecture measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) can discriminate the patients with high risk of asymptomatic vertebral fracture (VF) in postmenopausal Chinese women. These findings suggested that HR-pQCT could provide additional information on bone quality of the patients with asymptomatic VF. INTRODUCTION Although there were several studies using HR-pQCT to investigate asymptomatic VF, it remains uncertain if HR-pQCT parameters can discriminate asymptomatic VF patients, especially in Chinese population. The purpose of this study was to investigate whether bone quality measured by HR-pQCT could discriminate asymptomatic VF independent of hip areal bone mineral density (aBMD) measured by dual-energy x-ray absorptiometry (DXA) and fracture risks evaluated using built-in Fracture Risk Assessment Tool (FRAXBMD). METHODS This is a nested case-control study. One hundred seventy-five ambulatory Chinese postmenopausal women aged 60-79 years were retrieved from Normative Reference Standards (NRS) cohort in Hong Kong. DXA was used to identify VF from lateral spine images (VFA) using Genant's semi-quantitative method. Major osteoporotic fracture risk was calculated using FRAX tool. HR-pQCT was used to assess vBMD, microarchitecture, and estimated strength at both distal radius and tibia. Comparison of HR-pQCT parameters between asymptomatic VF and control was performed using covariance analysis. Logistic regression analysis was performed for calculating the adjusted odds ratio (OR) with 95% confidence intervals (CI) of fracture status as per SD decrease in HR-pQCT parameters. RESULTS Women with asymptomatic VF were older than those of the control in our NRS cohort. Nevertheless, after adjusted for covariance, asymptomatic VF showed significantly lower trabecular vBMD (Tb.vBMD) at radius but higher SMI at tibia as compared with those of the control. Tb.vBMD at radius yielded the highest value of area under the curve (AUC) as compared with total hip aBMD and FRAXBMD. However, no significant difference was found among each other. CONCLUSION Tb.vBMD at the radius and SMI at the tibia provided by HR-pQCT can discriminate asymptomatic VF independent of hip aBMD and FRAXBMD by DXA in postmenopausal women.
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Affiliation(s)
- Meiling Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Vivian Wing-Yin Hung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Tsz Kiu Li
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Sheung Wai Law
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Shangjie Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Department of Rehabilitation, Shenzhen Baoan Hospital Affiliated to Southern Medical University, Shenzhen, China.
| | - Ling Qin
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.
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Acromegaly is associated with vertebral deformations but not vertebral fractures: Results of a cross-sectional monocentric study. Joint Bone Spine 2020; 87:618-624. [PMID: 32428690 DOI: 10.1016/j.jbspin.2020.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/30/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Patients with acromegaly appear to be at increased risk of vertebral fractures despite normal bone mineral density. We investigated the prevalence of vertebral fractures in a cohort of acromegalic patients under 80 years of age. METHODS Monocentric cross-sectional study performed at Nantes University Hospital from 1988 to 2018. Fifty patients (18 females, 32 males) with a median age of 52.3 years (range: 27-78) were included. Radiological vertebral fractures were evaluated on conventional lumbar and thoracic spine radiographs using Genant's semiquantitative fracture assessment. We studied qualitative abnormalities of the spine using three criteria: osteophytes, disc-space narrowing and wedge-shaped vertebrae. We analysed bone mineral density and endocrine status. RESULTS Three patients (6%) had a vertebral fracture: one grade 1 and two grade 2 according to Genant's assessment, with two osteoporotic and one osteopenic patients. They had no unsubstituted pituitary deficiency. Considering the frank deformations (osteophyte or disc narrowing≥grade 2 or wedge-shaped), the thoracic spine was deformed in 22 patients (44%) and the lumbar spine in 21 patients (42%). CONCLUSION Acromegalic patients had a low prevalence of vertebral fractures but had a significant amount of vertebral deformations. We speculate that this high prevalence of frank deformations could explain the previously reported high prevalence of vertebral fractures.
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Robinson ME, Trejo P, Palomo T, Glorieux FH, Rauch F. Osteogenesis Imperfecta: Skeletal Outcomes After Bisphosphonate Discontinuation at Final Height. J Bone Miner Res 2019; 34:2198-2204. [PMID: 31356699 DOI: 10.1002/jbmr.3833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/14/2019] [Accepted: 07/18/2019] [Indexed: 11/09/2022]
Abstract
Intravenous cyclical bisphosphonates are widely used to treat children with moderate to severe osteogenesis imperfecta (OI). Bisphosphonates are often discontinued when growth is completed, but subsequent skeletal changes have not been studied in detail. We assessed 31 patients (22 females) with OI who had started intravenous bisphosphonates (either pamidronate or zoledronic acid) before 13 years of age, were treated for at least 2 years (range 4.7-15.7 years), and discontinued treatment after completion of growth, when their age ranged from 13.4 to 20.0 years (mean 16.4 years). At 4 years after treatment discontinuation, lumbar spine areal bone mineral density (BMD) had increased by 4% (p < 0.05). Peripheral quantitative computed tomography of the radius showed a decrease in trabecular volumetric BMD at the distal metaphysis of 19% but an increase in cortical volumetric BMD of 4% (p < 0.05 for both). None of the patients sustained a new vertebral compression fracture during follow-up. The proportion of patients with new long-bone fractures was higher in the 2 years before treatment discontinuation than in the last 2 years of follow-up (42% and 16%, respectively; p < 0.05). © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
| | - Pamela Trejo
- Shriners Hospital for Children, Montreal, Canada
| | - Telma Palomo
- Shriners Hospital for Children, Montreal, Canada
| | | | - Frank Rauch
- Shriners Hospital for Children, Montreal, Canada
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Alqahtani FF, Messina F, Offiah AC. Are semi-automated software program designed for adults accurate for the identification of vertebral fractures in children? Eur Radiol 2019; 29:6780-6789. [PMID: 31119416 PMCID: PMC6828619 DOI: 10.1007/s00330-019-06250-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 11/05/2022]
Abstract
Objectives To assess whether diagnostic accuracy of morphometric vertebral fracture (VF) diagnosis in children can be improved using AVERT™ (a 33-point semi-automated program developed for VF diagnosis in adults) compared with SpineAnalyzer™ (a 6-point program), which has previously been shown to be of insufficient accuracy. Materials and methods Lateral spine radiographs (XR) and dual-energy X-ray absorptiometry (DXA) scans of 50 children and young people were analysed by two observers using two different programs (AVERT™ and SpineAnalyzer™). Diagnostic accuracy (sensitivity, specificity, false-negative (FN) and false-positive rates (FP)) was calculated by comparing with a previously established consensus arrived at by three experienced paediatric musculoskeletal radiologists, using a simplified algorithm-based qualitative scoring system. Observer agreement was calculated using Cohen’s kappa. Results For XR, overall sensitivity, specificity, FP and FN rates using AVERT™ were 36%, 95%, 5% and 64% respectively and 26%, 98%, 2% and 75% respectively, using SpineAnalyzer™. For DXA, overall sensitivity, specificity, FP and FN rates using AVERT™ were 41%, 91%, 9% and 59% respectively and 31%, 96%, 4% and 69% respectively, using SpineAnalyzer. Reliability (kappa) ranged from 0.34 to 0.37 (95%CI, 0.26–0.46) for AVERT™ and from 0.26 to 0.31 (95%CI, 0.16–0.44) for SpineAnalyzer™. Inter- and intra-observer agreement ranged from 0.41 to 0.47 for AVERT™ and from 0.50 to 0.79 for SpineAnalyzer™. Conclusion AVERT™ has slightly higher accuracy but lower observer reliability for the representation of vertebral morphometry in children when compared with SpineAnalyzer™. However, neither software program is satisfactorily reliable for VF diagnosis in children. Key Points • SpineAnalyzer™ and AVERT™ have low diagnostic accuracy and observer agreement when compared to three paediatric radiologists’ readings for the diagnosis of vertebral fractures (VF) in children. • Neither AVERT™ nor SpineAnalyzer™ is satisfactorily reliable for VF diagnosis in children. • Development of specific paediatric software and normative values (incorporating age-related physiological variation in children) is required.
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Affiliation(s)
- Fawaz F Alqahtani
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Medical School, University of Sheffield, Street Building, Western Bank, Sheffield, S10 2TH, UK. .,Department of Radiological Sciences, College of Applied Medical Sciences, Najran University, Najran, Kingdom of Saudi Arabia.
| | - Fabrizio Messina
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Amaka C Offiah
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Medical School, University of Sheffield, Street Building, Western Bank, Sheffield, S10 2TH, UK.,Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Glinkowski WM, Narloch J. CT-scout based, semi-automated vertebral morphometry after digital image enhancement. Eur J Radiol 2017; 94:195-200. [PMID: 28712699 DOI: 10.1016/j.ejrad.2017.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Radiographic diagnosis of osteoporotic vertebral fracture is necessary to reduce its substantial associated morbidity. Computed tomography (CT) scout has recently been demonstrated as a reliable technique for vertebral fracture diagnosis. Software assistance may help to overcome some limitations of that diagnostics. We aimed to evaluate whether digital image enhancement improved the capacity of one of the existing software to detect fractures semi-automatically. METHODS CT scanograms of patients suffering from osteoporosis, with or without vertebral fractures were analyzed. The original set of CT scanograms were triplicated and digitally modified to improve edge detection using three different techniques: SHARPENING, UNSHARP MASKING, and CONVOLUTION. RESULTS The manual morphometric analysis identified 1485 vertebrae, 200 of which were classified as fractured. Unadjusted morphometry (AUTOMATED with no digital enhancement) found 63 fractures, 33 of which were true positive (i.e., it correctly identified 52% of the fractures); SHARPENING detected 57 fractures (30 true positives, 53%); UNSHARP MASKING yielded 30 (13 true positives, 43%); and CONVOLUTION found 24 fractures (9 true positives, 38%). The intra-reader reliability for height ratios did not significantly improve with image enhancement (kappa ranged 0.22-0.41 for adjusted measurements and 0.16-0.38 for unadjusted). Similarly, the inter-reader agreement for prevalent fractures did not significantly improve with image enhancement (kappa 0.29-0.56 and -0.01 to 0.23 for adjusted and unadjusted measurements, respectively). CONCLUSIONS Our results suggest that digital image enhancement does not improve software-assisted vertebral fracture detection by CT scout.
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Affiliation(s)
- Wojciech M Glinkowski
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland; Centre of Excellence "TeleOrto" for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Medical University of Warsaw, Warsaw, Poland; Department of Orthopaedics and Traumatology of the Locomotor System, Baby Jesus Clinical Hospital, Warsaw, Poland
| | - Jerzy Narloch
- Chair and Department of Orthopaedics and Traumatology of the Locomotor System, Medical University of Warsaw, Lindley'a 4, 02-005 Warsaw, Poland.
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Diagnosis of vertebral fractures in children: is a simplified algorithm-based qualitative technique reliable? Pediatr Radiol 2016; 46:680-8. [PMID: 26902300 PMCID: PMC4841845 DOI: 10.1007/s00247-015-3537-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/03/2015] [Accepted: 12/30/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Identification of osteoporotic vertebral fractures allows treatment opportunity reducing future risk. There is no agreed standardised method for diagnosing paediatric vertebral fractures. OBJECTIVE To evaluate the precision of a modified adult algorithm-based qualitative (ABQ) technique, applicable to children with primary or secondary osteoporosis. MATERIALS AND METHODS Three radiologists independently assessed lateral spine radiographs of 50 children with suspected reduction in bone mineral density using a modified ABQ scoring system and following simplification to include only clinically relevant parameters, a simplified ABQ score. A final consensus of all observers using simplified ABQ was performed as a reference standard for fracture characterisation. Kappa was calculated for interobserver agreement of the components of both scoring systems and intraobserver agreement of simplified ABQ based on a second read of 29 randomly selected images. RESULTS Interobserver Kappa for modified ABQ scoring for fracture detection, severity and shape ranged from 0.34 to 0.49 Kappa for abnormal endplate and position assessment was 0.27 to 0.38. Inter- and intraobserver Kappa for simplified ABQ scoring for fracture detection and grade ranged from 0.37 to 0.46 and 0.45 to 0.56, respectively. Inter- and intraobserver Kappa for affected endplate ranged from 0.31 to 0.41 and 0.45 to 0.51, respectively. Subjectively, observers' felt simplified ABQ was easier and less time-consuming. CONCLUSION Observer reliability of modified and simplified ABQ was similar, with slight to moderate agreement for fracture detection and grade/severity. Due to subjective preference for simplified ABQ, we suggest its use as a semi-objective measure of diagnosing paediatric vertebral fractures.
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Overuse and Underuse of Antiosteoporotic Treatments According to Highly Influential Osteoporosis Guidelines: A Population-Based Cross-Sectional Study in Spain. PLoS One 2015; 10:e0135475. [PMID: 26317872 PMCID: PMC4552751 DOI: 10.1371/journal.pone.0135475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/23/2015] [Indexed: 11/19/2022] Open
Abstract
Inappropriate prescribing of antiosteoporotic medications has been observed; however, the joint study of both overuse and underuse has barely been attempted. Spain, with its high utilization rates, constitutes a good example to assess differences in over and under use according to diverse highly-influential osteoporosis guidelines (HIOG) worldwide. We used data of a population-based cross-sectional study including 824 post-menopausal women ≥50 years old living in the city of Valencia, Spain and aimed to estimate the percentage of women eligible for treatment, and the proportion of overuse and underuse of antiosteoporotic treatment according to HIOG. The prevalence of antiosteoporotic treatment in postmenopausal women ≥ 50 in Valencia was 20.9% (95%CI:17.6–24.4). The type of antiosteoporotic drugs prescribed varied greatly depending on the medical specialty responsible of the initial prescription. When applying the HIOG, the percentage of women 50 and over who should be treated varied from less than 9% to over 44%. In real terms, from the approximately eight million women of 50 years old and over in Spain, the number eligible for treatment would range from 0.7 to 3.8 million, depending on the guideline used. A huge proportion of inappropriate treatments was found when applying these guidelines to the Spanish population, combining a high overuse (42–78% depending on the guideline used) and underuse (7–41%). In conclusion, we found that the pharmacological management of osteoporosis in women of 50 and over in this population combines an important overuse and, to a lesser extent, underuse, although the level of inappropriateness varied strikingly depending on the CPG used. It seems urgent to reduce treatment overuse without neglecting underuse, as is urgent an attempt to reach wider agreement worldwide regarding osteoporosis management, in order to facilitate appropriate treatment and development of policies to reduce effectively treatment inappropriateness.
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Performance of statistical models of shape and appearance for semiautomatic segmentations of spinal vertebrae T4-L4 on digitized vertebral fracture assessment images. Spine J 2015; 15:1248-54. [PMID: 25684060 DOI: 10.1016/j.spinee.2015.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 01/08/2015] [Accepted: 02/06/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Despite its clinical importance, accurate identification of vertebral fractures is problematic and time-consuming. There is a recognized need to improve the detection of vertebral fractures so that appropriate high-risk patients can be selected to initiate clinically beneficial therapeutic interventions. PURPOSE To develop and evaluate semiautomatic algorithms for detailed annotation of vertebral bodies from T4 to L4 in digitized lateral spinal dual-energy X-ray absorptiometry (DXA) vertebral fracture assessment (VFA) images. STUDY DESIGN Using lateral spinal DXA VFA images from subjects imaged at University Hospital fracture liaison service, image algorithms were developed for semiautomatic detailed annotation of vertebral bodies from T4 to L4. PATIENT SAMPLE Two hundred one women aged 50 years or older with nonvertebral fractures. OUTCOME MEASURES Algorithm accuracy and precision. METHODS Statistical models of vertebral shape and appearance from T4 to L4 were constructed using VFA images from 130 subjects. The resulting models form a part of an algorithm for performing semiautomatic detailed annotation of vertebral bodies from T4 to L4. Algorithm accuracy and precision were evaluated on a test-set of 71 independent images. RESULTS Overall accuracy was 0.72 mm (3.00% of vertebral height) and overall precision was 0.26 mm (1.11%) for point-to-line distance. Accuracy and precision were best on normal vertebrae (0.65 mm [2.67%] and 0.21 mm [0.90%], respectively) and mild fractures (0.78 mm [3.18%] and 0.32 mm [1.39%], respectively), but accuracy and precision errors were higher for moderate (1.07 mm [4.66%] and 0.48 mm [2.15%], respectively) and severe fractures (2.07 mm [9.65%] and 1.10 mm [5.09%], respectively). Accuracy and precision results for the algorithm were comparable with other reported results in the literature. CONCLUSIONS This semiautomatic image analysis had high overall accuracy and precision on normal vertebrae and mild fractures, but performed less well in moderate and severe fractures. It is, therefore, a useful tool to identify normality of vertebral shape and to identify mild fractures.
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Herrera A, Mateo J, Gil-Albarova J, Lobo-Escolar A, Artigas JM, López-Prats F, Mesa M, Ibarz E, Gracia L. Prevalence of osteoporotic vertebral fracture in Spanish women over age 45. Maturitas 2015; 80:288-95. [DOI: 10.1016/j.maturitas.2014.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/07/2014] [Indexed: 10/24/2022]
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Siminoski K, Lentle B, Matzinger MA, Shenouda N, Ward LM. Observer agreement in pediatric semiquantitative vertebral fracture diagnosis. Pediatr Radiol 2014; 44:457-66. [PMID: 24323185 PMCID: PMC3900460 DOI: 10.1007/s00247-013-2837-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/20/2013] [Accepted: 11/06/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Genant semiquantitative (GSQ) method has been a standard procedure for diagnosis of vertebral fractures in adults but has only recently been shown to be of clinical utility in children. Observer agreement using the GSQ method in this age group has not been described. OBJECTIVE To evaluate observer agreement on vertebral readability and vertebral fracture diagnosis using the GSQ method in pediatric vertebral morphometry. MATERIALS AND METHODS Spine radiographs of 186 children with acute lymphoblastic leukemia were evaluated independently by three radiologists using the same GSQ methodology as in adults. A subset of 100 radiographs was evaluated on two occasions. RESULTS An average of 4.7% of vertebrae were unreadable for the three radiologists. Intraobserver Cohen's kappa (κ) on readability ranged from 0.434 to 0.648 at the vertebral level and from 0.416 to 0.611 at the patient level, while interobserver κ for readability had a range of 0.330 to 0.504 at the vertebral level and 0.295 to 0.467 at the patient level. Intraobserver κ for the presence of vertebral fracture had a range of 0.529 to 0.726 at the vertebral level and was 0.528 to 0.767 at the patient level. Interobserver κ for fracture at the vertebral level ranged from 0.455 to 0.548 and from 0.433 to 0.486 at the patient level. CONCLUSION Most κ values for both intra- and interobserver agreement in applying the GSQ method to pediatric spine radiographs were in the moderate to substantial range, comparable to the performance of the technique in adult studies. The GSQ method should be considered for use in pediatric research and clinical practice.
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Affiliation(s)
- Kerry Siminoski
- Department of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, 6628-123 St., Edmonton, Canada, T6H 3T6,
| | - Brian Lentle
- Department of Radiology, BC Children’s Hospital, University of British Columbia 4500 Oak St, Vancouver, British Columbia, Canada V6H 3N1
| | - Mary-Ann Matzinger
- Department of Diagnostic Imaging, Children’s Hospital of Eastern Ontario, University of Ottawa 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1
| | - Nazih Shenouda
- Department of Diagnostic Imaging, Children’s Hospital of Eastern Ontario, University of Ottawa 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1
| | - Leanne M. Ward
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1
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Niimi R, Kono T, Nishihara A, Hasegawa M, Matsumine A, Kono T, Sudo A. Efficacy of the dynamic radiographs for diagnosing acute osteoporotic vertebral fractures. Osteoporos Int 2014; 25:605-12. [PMID: 23903955 DOI: 10.1007/s00198-013-2456-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED We investigated the efficacy of dynamic radiographs for diagnosing acute osteoporotic vertebral fractures (OVFs) compared with supine radiographs or sitting radiographs alone. Evaluation of the dynamic radiographs was superior to the other evaluations. Dynamic radiographs provide a convenient and useful method of diagnosing acute OVFs. INTRODUCTION Identifying acute OVFs on plain radiographs is difficult. We studied a new approach to identify acute OVFs on the basis of fracture mobility. METHODS We performed a retrospective radiographic analysis of 472 acute OVFs (<3 weeks after onset), which were diagnosed on the basis of magnetic resonance imaging of T5 through L5 (a total of 5,239 vertebrae). Supine lateral radiographs were compared with sitting lateral radiographs to determine the presence or absence of mobility. Vertebrae showing changes in the vertebral body height were diagnosed as acute OVFs. We analyzed the diagnostic accuracy on the basis of comparative supine and sitting lateral radiographs and compared it with that of radiographs obtained in the supine or the sitting position alone. RESULTS Of the 472 acute OVFs diagnosed, 313 (66 %) exhibited vertebral mobility on supine lateral and sitting lateral radiographs. Correct diagnoses of acute OVFs or no acute OVFs were made in 4,883 vertebrae. There were 159 unreadable OVFs (3 %), and 197 previous OVFs (4 %) were misdiagnosed as acute OVFs. The sensitivity was 66 % and the specificity was 96 %. Evaluation of the mobility of acute OVFs in the supine and the sitting position was superior to evaluation using radiographs in either the supine or the sitting position alone. CONCLUSIONS Dynamic radiographs provide a convenient way to identify acute OVFs.
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Affiliation(s)
- R Niimi
- Department of Orthopaedic Surgery, Tomidahama Hospital, 26-14, Tomidahamacho, Yokkaichi, Mie, 510-8008, Japan,
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