Grigoryan Mikayel, Guermazi Ali, Roemer Frank W, Delmas Pierre D, Genant Harry K
Osteoporosis and Arthritis Research Group, Department of Radiology, University of California San Francisco, 350 Parnassus Avenue, 94117, San Francisco, CA, USA.
Eur Spine J. 2003 Oct;12 Suppl 2(Suppl 2):S104-12. doi: 10.1007/s00586-003-0613-0. Epub 2003 Sep 11.
Vertebral fractures are the hallmark of osteoporosis, and occur with a higher incidence earlier in life than any other type of osteoporotic fractures. It has been shown that both symptomatic and asymptomatic vertebral fractures are associated with increased morbidity and mortality. Morbidity associated with these fractures includes decreased physical function and social isolation, which have a significant impact on the patient's overall quality of life. Since the majority of vertebral fractures do not come to clinical attention, radiographic diagnosis is considered to be the best way to identify and confirm the presence of osteoporotic vertebral fractures in clinical practice. Traditionally, conventional lateral radiographs of the thoracolumbar spine have been visually evaluated by radiologists or clinicians to identify vertebral fractures. The two most widely used methods to determine the severity of such fractures in clinical research are the semiquantitative assessment of vertebral deformities, which is based on visual evaluation, and the quantitative approach, which is based on different morphometric criteria. In our practice for osteoporosis evaluation we use the Genant semiquantitative approach: an accurate and reproducible method tested and applied in many clinical studies. The newest generation of fan-beam DXA systems delivering "high-resolution" lateral spine images offers a potential practical alternative to radiographs for clinical vertebral fracture analysis. The advantages of using DXA over conventional radiographic devices are its minimal radiation exposure and high-speed image acquisition. It also allows combined evaluation of vertebral fracture status and bone mass density, which could become a standard for patient evaluation in osteoporosis. The disadvantage of DXA use is that upper thoracic vertebrae cannot be evaluated in a substantial number of patients due to poor imaging quality. We truly believe that the that there is a major role for radiologists and clinicians alike to carefully assess and diagnose vertebral fractures using standardized grading schemes such as the one outlined in this review. Quantitative morphometry is useful in the context of epidemiological studies and clinical drug trials; however, the studies would be flawed if quantitative morphometry were to be performed in isolation without additional adjudication by a trained and highly experienced radiologist or clinician.
椎体骨折是骨质疏松症的标志，其在生命早期的发生率高于任何其他类型的骨质疏松性骨折。研究表明，有症状和无症状的椎体骨折均与发病率和死亡率增加相关。与这些骨折相关的发病率包括身体功能下降和社会隔离，这对患者的整体生活质量有重大影响。由于大多数椎体骨折未引起临床关注，因此在临床实践中，X线诊断被认为是识别和确认骨质疏松性椎体骨折存在的最佳方法。传统上，放射科医生或临床医生通过对胸腰椎的传统侧位X线片进行视觉评估来识别椎体骨折。在临床研究中，用于确定此类骨折严重程度的两种最广泛使用的方法是基于视觉评估的椎体畸形半定量评估和基于不同形态学标准的定量方法。在我们评估骨质疏松症的实践中，我们使用Genant半定量方法：这是一种在许多临床研究中经过测试和应用的准确且可重复的方法。新一代提供“高分辨率”脊柱侧位图像的扇形束双能X线吸收仪（DXA）系统为临床椎体骨折分析提供了一种潜在的实用替代X线片的方法。与传统X线设备相比，使用DXA的优点是辐射暴露最小且图像采集速度快。它还允许对椎体骨折状态和骨密度进行联合评估，这可能成为骨质疏松症患者评估的标准。使用DXA的缺点是由于成像质量差，相当数量的患者无法评估上胸椎。我们坚信，放射科医生和临床医生都有重要作用，应使用标准化分级方案（如本综述中概述的方案）仔细评估和诊断椎体骨折。定量形态学在流行病学研究和临床药物试验中很有用；然而，如果在没有经过培训且经验丰富的放射科医生或临床医生进行额外判定的情况下单独进行定量形态学研究，这些研究将存在缺陷。
