Department of Radiology, Örebro University, Örebro, Sweden.
Department of Clinical Sciences, Lund University, Lund, Sweden.
Eur Radiol. 2017 Feb;27(2):491-497. doi: 10.1007/s00330-016-4392-5. Epub 2016 May 31.
Thoracic spine radiography becomes more difficult with age. Tomosynthesis is a low-dose tomographic extension of radiography which may facilitate thoracic spine evaluation. This study assessed the added value of tomosynthesis in imaging of the thoracic spine in the elderly.
Four observers compared the image quality of 50 consecutive thoracic spine radiography and tomosynthesis data sets from 48 patients (median age 67 years, range 55-92 years) on a number of image quality criteria. Observer variation was determined by free-marginal multirater kappa. The conversion factor and effective dose were determined from the dose-area product values.
For all observers significantly more vertebrae were seen with tomosynthesis than with radiography (mean 12.4/9.3, P < 0.001) as well as significantly more fractures (mean 0.9/0.7, P = 0.017). The image quality score for tomosynthesis was significantly higher than for radiography, for all evaluated structures. Tomosynthesis took longer to evaluate than radiography. Despite this, all observers scored a clear preference for tomosynthesis. Observer agreement was substantial (mean κ = 0.73, range 0.51-0.94). The calibration or conversion factor was 0.11 mSv/(Gy cm) for the combined examination. The resulting effective dose was 0.87 mSv.
Tomosynthesis can increase the detection rate of thoracic vertebral fractures in the elderly, at low added radiation dose.
• Tomosynthesis helps evaluate the thoracic spine in the elderly. • Observer agreement for thoracic spine tomosynthesis was substantial (mean κ = 0.73). • Significantly more vertebrae and significantly more fractures were seen with tomosynthesis. • Tomosynthesis took longer to evaluate than radiography. • There was a clear preference among all observers for tomosynthesis over radiography.
随着年龄的增长，胸椎的放射摄影变得更加困难。断层合成是放射摄影的一种低剂量断层扩展，可促进胸椎评估。本研究评估了断层合成在老年患者胸椎成像中的附加价值。
四位观察者根据多项图像质量标准，对 48 名患者（中位数年龄 67 岁，范围 55-92 岁）的 50 例连续胸椎放射摄影和断层合成数据集进行了图像质量比较。观察者变异性通过自由边际多评价者 κ 确定。转换系数和有效剂量由剂量面积乘积值确定。
对于所有观察者，断层合成比放射摄影能看到更多的椎骨（平均 12.4/9.3，P<0.001），也能看到更多的骨折（平均 0.9/0.7，P=0.017）。对于所有评估结构，断层合成的图像质量评分均明显高于放射摄影。断层合成的评估时间明显长于放射摄影，但所有观察者都明显更倾向于断层合成。观察者之间的一致性很高（平均κ=0.73，范围 0.51-0.94）。组合检查的校准或转换系数为 0.11 mSv/（Gy cm）。有效剂量为 0.87 mSv。
断层合成可以在低附加辐射剂量下提高老年患者胸椎骨折的检出率。
断层合成有助于评估老年患者的胸椎。
胸椎断层合成的观察者一致性很高（平均κ=0.73）。
断层合成能看到更多的椎体和更多的骨折。
断层合成的评估时间比放射摄影长。
所有观察者都明显更喜欢断层合成而非放射摄影。
