基于算法的常见椎体骨折定性和半定量识别：不同读者、成像方式和诊断方法之间的一致性

Algorithm-based qualitative and semiquantitative identification of prevalent vertebral fracture: agreement between different readers, imaging modalities, and diagnostic approaches.

作者信息

Ferrar Lynne, Jiang Guirong, Schousboe John T, DeBold Charles R, Eastell Richard

机构信息

Academic Unit of Bone Metabolism, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, United Kingdom.

出版信息

J Bone Miner Res. 2008 Mar;23(3):417-24. doi: 10.1359/jbmr.071032.

DOI:10.1359/jbmr.071032

PMID:17967136

Abstract

UNLABELLED

We compared SQ and ABQ diagnosis of VF imaged by radiography and X-ray absorptiometry. Mild ABQ VF had stronger associations with osteoporosis than mild SQ VF. Interobserver agreement (radiographic diagnosis) was better for ABQ.

INTRODUCTION

Vertebral fracture (VF) assessment from images acquired by X-ray absorptiometry (VFA) is often based on a semiquantitative approach (SQ); prevalent VF is identified if vertebral height appears reduced by >20%. Algorithm-based qualitative definition of osteoporotic VF (ABQ) requires evidence of endplate depression, and there is no threshold for reduction in vertebral height. The aims of this study were to (1) compare the prevalence of VFs; (2) compare the characteristics of women with and without VFs; (3) compare interobserver agreement; and (4) compare agreement between methods and imaging modalities for ABQ and SQ definitions of VFs.

MATERIALS AND METHODS

Spine radiographs and absorptiometry images for 203 elderly women were assessed using ABQ (readers ABQ-1 and ABQ-2). These readings were compared with SQ assessments (readers SQ-1 and SQ-2) of the same images performed in a previous study. Agreement between readers and methods was assessed by kappa (kappa) statistics.

RESULTS

The prevalence of VF was 15-18% (radiography) and 12-24% (VFA) for ABQ and SQ, respectively. Women with ABQ or SQ fractures were older and had lower BMD than those without fracture (p < 0.01). Mild ABQ (but not SQ) VF was associated with low BMD. Kappa scores for interobserver agreement for radiography and VFA, respectively, were as follows: ABQ, kappa = 0.74 (95% CI, 0.60, 0.87) and 0.65 (95% CI, 0.48, 0.81); SQ, kappa = 0.53 (95% CI, 0.46, 0.60) and 0.51 (95% CI, 0.44, 0.58). For agreement between ABQ-1 and SQ-1, kappa = 0.55 (95% CI, 0.39, 0.72) for radiography and 0.41 (95% CI, 0.25, 0.58 for VFA.

CONCLUSIONS

The prevalence of radiographic VF identified by ABQ and SQ was similar, but on VFA was 50% higher for SQ. Mild ABQ VF was associated with low BMD. Interobserver agreement for radiographic diagnosis was significantly better for ABQ than for SQ. Agreement between ABQ and SQ was moderate.

摘要

未标注

我们比较了通过X线摄影和X线吸收法成像的室颤（VF）的半定量（SQ）和基于算法的定性（ABQ）诊断。轻度ABQ室颤与骨质疏松症的关联比轻度SQ室颤更强。观察者间一致性（X线摄影诊断）对于ABQ更好。

引言

通过X线吸收法（VFA）获取的图像进行椎体骨折（VF）评估通常基于半定量方法（SQ）；如果椎体高度降低超过20%，则认定存在普遍的VF。基于算法的骨质疏松性VF的定性定义（ABQ）需要终板凹陷的证据，且椎体高度降低没有阈值。本研究的目的是：（1）比较VF的患病率；（2）比较有和没有VF的女性的特征；（3）比较观察者间一致性；（4）比较ABQ和SQ定义的VF在方法和成像方式之间的一致性。

材料与方法

使用ABQ（读者ABQ - 1和ABQ - 2）评估203名老年女性的脊柱X线片和吸收法图像。将这些读数与先前研究中对相同图像进行的SQ评估（读者SQ - 1和SQ - 2）进行比较。通过kappa（κ）统计评估读者和方法之间的一致性。

结果

ABQ和SQ的VF患病率分别为15 - 18%（X线摄影）和12 - 24%（VFA）。有ABQ或SQ骨折的女性比没有骨折的女性年龄更大且骨密度更低（p < 0.01）。轻度ABQ（但不是SQ）室颤与低骨密度相关。X线摄影和VFA的观察者间一致性κ评分分别如下：ABQ，κ = 0.74（95%CI，0.60，0.87）和0.65（95%CI，0.48，0.81）；SQ，κ = 0.53（95%CI，0.46，0.60）和0.51（95%CI，0.44，0.58）。对于ABQ - 1和SQ - 1之间的一致性，X线摄影时κ = 0.55（95%CI，0.39，0.72），VFA时κ = 0.41（95%CI，0.25，0.58）。