Grados Franck, Fechtenbaum Jacques, Flipon Elisabeth, Kolta Sami, Roux Christian, Fardellone Patrice
INSERM, ERI12, Faculté de Médecine et de Pharmacie, 1 rue des Louvels 80037 Amiens, France; Service de Rhumatologie, Hôpital Nord, CHU Amiens, 80 054 Amiens Cedex 1, France.
Joint Bone Spine. 2009 May;76(3):241-7. doi: 10.1016/j.jbspin.2008.07.017. Epub 2009 Feb 3.
Reproducible methods for the radiological assessment of osteoporotic vertebral fractures, defined based on accurate criteria, are needed in everyday practice and in therapeutic trials and epidemiological studies.
To describe and to evaluate methods for osteoporotic vertebral fracture assessment based on standard radiographs or dual-energy X-ray absorptiometry (DXA) and to determine the role for each method in clinical practice, therapeutic trials, and epidemiological studies.
A review written by a rheumatologist based on his clinical experience and on a literature review was submitted to four experts. Studies in English or French published between 1975 and February 2008 were retrieved from Medline using the keywords vertebral fracture, osteoporosis, vertebral deformity, and vertebral fracture assessment.
One hundred forty-nine articles were selected and read in their full-text version. There was no consensus regarding the definition of osteoporotic vertebral fractures. The following methods were evaluated: visual assessment, Genant's semi-quantitative assessment, Jiang's algorithm-based qualitative method, morphometric radiography, and DXA of the spine. In everyday practice, Genant's semi-quantitative assessment on standard radiographs may provide useful information on the severity and prognosis of osteoporosis. DXA done for bone mineral density measurement may detect vertebral fractures in asymptomatic patients. Assessment of standard radiographs remains the reference standard for diagnosing vertebral fractures in patients with suggestive symptoms (e.g., pain in the thoracic or lumbar spine, height loss, or thoracic kyphosis). For therapeutic trials and epidemiological studies, Genant's semi-quantitative assessment used by a trained and experienced observer is the preferred method, based on its good reproducibility and ability to differentiate fractures from other deformities. However, thousands of radiographs may be needed, making routine interpretation by an expert impractical. A visual semi-quantitative method may be used to separate normal radiographs from radiographs showing possible or obvious fractures, which can then be read by an expert. Alternatively, radiomorphometric indices can be determined on digitized radiographs in combination with a semi-quantitative assessment, with discordant cases being reviewed by an expert. We do not recommend Jiang's method at present, as it is still undergoing validation.
在日常实践、治疗试验和流行病学研究中，需要基于准确标准的可重复的骨质疏松性椎体骨折放射学评估方法。
描述并评估基于标准X线片或双能X线吸收测定法（DXA）的骨质疏松性椎体骨折评估方法，并确定每种方法在临床实践、治疗试验和流行病学研究中的作用。
一位风湿病学家基于其临床经验和文献综述撰写的一篇综述提交给了四位专家。使用关键词“椎体骨折”“骨质疏松症”“椎体畸形”和“椎体骨折评估”从Medline检索1975年至2008年2月发表的英文或法文研究。
挑选了149篇文章并阅读了全文。关于骨质疏松性椎体骨折的定义尚无共识。评估了以下方法：视觉评估、Genant半定量评估、基于蒋氏算法的定性方法、形态计量X线摄影和脊柱DXA。在日常实践中，标准X线片上的Genant半定量评估可为骨质疏松症的严重程度和预后提供有用信息。为测量骨密度而进行的DXA可检测无症状患者的椎体骨折。标准X线片评估仍然是诊断有提示性症状（如胸或腰椎疼痛、身高降低或胸椎后凸）患者椎体骨折的参考标准。对于治疗试验和流行病学研究，由训练有素且经验丰富的观察者使用的Genant半定量评估是首选方法，因其具有良好的可重复性以及区分骨折与其他畸形的能力。然而，可能需要数千张X线片，这使得由专家进行常规解读不切实际。可使用视觉半定量方法将正常X线片与显示可能或明显骨折的X线片区分开，然后由专家进行解读。或者，可以结合半定量评估在数字化X线片上确定放射形态计量指数，不一致的病例由专家进行复查。目前我们不推荐蒋氏方法，因为它仍在验证中。
