Kim N, Rowe B H, Raymond G, Jen H, Colman I, Jackson S A, Siminoski K G, Chahal A M, Folk D, Majumdar S R
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada.
AJR Am J Roentgenol. 2004 Feb;182(2):297-300. doi: 10.2214/ajr.182.2.1820297.
Osteoporosis is underdiagnosed and therefore undertreated. We determined the potential usefulness of chest radiography for detecting clinically important vertebral fractures by performing semiquantitative reviews and quantitative digital morphometry on 100 routine chest radiographs taken in the emergency department and comparing the yield of these independent reviews with official radiology reports.
One hundred randomly selected chest radiographs of patients 60 years or older who presented to the emergency department of a tertiary care hospital were evaluated. Radiographs were selected without knowledge of the presenting complaint and were independently reviewed by two board-certified radiologists and a radiology resident. A validated semiquantitative method was used to assess lateral chest radiographs for vertebral fracture. In addition, quantitative digital morphometry was undertaken. A clinically important vertebral fracture was defined as one that was at least moderate to severe (loss of height >or=> 25%).
Mean age of the population was 75 years, 47% were women, and 46% were admitted to the hospital. According to the reference radiologist, prevalence of moderate to severe vertebral fractures was 22%. Simple agreement was 87-88% among reviewers; kappa values were moderate (0.56-0.58). The greatest agreement was between the reference standard radiologist and quantitative digital morphometry (89% agreement; kappa = 0.67). Only 55% (12/22) of vertebral fractures we identified were mentioned in the official radiology reports.
Chest radiography has potential as a screening tool for revealing previously undiagnosed vertebral fractures, although in this study only half of moderate to severe fractures that we identified were mentioned in official reports.
骨质疏松症存在诊断不足的情况，因此治疗也不充分。我们通过对在急诊科拍摄的100份常规胸部X线片进行半定量评估和定量数字形态测量，并将这些独立评估的结果与官方放射学报告进行比较，来确定胸部X线检查在检测具有临床重要性的椎体骨折方面的潜在效用。
对一家三级护理医院急诊科收治的100例60岁及以上患者的随机选择的胸部X线片进行评估。在不知道患者就诊主诉的情况下选择X线片，并由两名获得委员会认证的放射科医生和一名放射科住院医师进行独立评估。使用一种经过验证的半定量方法评估胸部侧位X线片是否存在椎体骨折。此外，还进行了定量数字形态测量。具有临床重要性的椎体骨折定义为至少为中度至重度（高度丢失>或=25%）。
研究人群的平均年龄为75岁，47%为女性，46%住院。根据参考放射科医生的判断，中度至重度椎体骨折的患病率为22%。评估者之间的简单一致性为87 - 88%；kappa值为中等（0.56 - 0.58）。参考标准放射科医生与定量数字形态测量之间的一致性最高（一致性为89%；kappa = 0.67）。我们识别出的椎体骨折中，官方放射学报告仅提及了55%（12/22）。
胸部X线检查有潜力作为一种筛查工具来发现先前未诊断出的椎体骨折，尽管在本研究中，官方报告仅提及了我们识别出的中度至重度骨折中的一半。
