使用 DXA 椎体骨折评估评估椎体压缩性骨折时，双侧侧卧位片是否有必要？
Are bilateral decubitus views necessary in assessing for vertebral compression fractures using DXA vertebral fracture assessment?
机构信息
Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung and Chang Gung University, 222 Maijin Road, Keelung, Taiwan.
Keelung Osteoporosis Prevention and Treatment Center, Keelung, Taiwan.
出版信息
Osteoporos Int. 2017 Aug;28(8):2377-2382. doi: 10.1007/s00198-017-4040-1. Epub 2017 May 9.
UNLABELLED
The purpose of this study is to assess the differences in VFA diagnostic accuracy when using bilateral decubitus views and whether diagnostic accuracy is affected by scoliosis. Our findings show that the current practice of performing only one side is valid; however, bilateral views can improve specificity in scoliosis.
INTRODUCTION
The diagnostic accuracy of vertebral fracture assessment (VFA) can be influenced by poor patient position and scoliosis. This study aims to assess the differences in VFA diagnostic accuracy for right and left lateral decubitus views and the effect of scoliosis.
METHODS
One hundred fourteen postmenopausal women received right and left lateral thoracolumbar spine dual-energy VFA and radiography. Cobb angles were measured from the posteroanterior absorptiometry image, and lumbar spine radiography was the standard reference for vertebral fracture and also provides the levels investigated. McNemar's test was used to compare accuracy between the two decubitus position and Fisher's exact test was used for patients with and without scoliosis.
RESULTS
Forty-two vertebral fractures (VFs) were identified. There was no significant difference in sensitivity (p = 0.125) or specificity (p = 0.866) between the left lateral decubitus (64.3, 97.2%) and right lateral decubitus (76.2, 91.1%), respectively, views. Scoliotic patients had a significantly worse specificity (92.7 vs 98.1%, p = 0.003) than patients without scoliosis; however, a combination of both decubitus positions significantly improved specificity (p < 0.001).
CONCLUSION
Right and left side lateral decubitus views have excellent agreement with radiography and similar diagnostic accuracy in the detection of VFs. Thus, the current practice of performing only one side is valid. With scoliosis, bilateral decubitus views can improve the specificity of detecting VF; however, this would increase radiation dose.
目的
本研究旨在评估使用双侧卧位和脊柱侧凸对 VFA 诊断准确性的影响。结果：114 例绝经后妇女接受右侧和左侧胸腰椎侧位双能 VFA 和 X 线摄影。从后前位吸收计量图像测量 Cobb 角，腰椎 X 线摄影为椎体骨折的标准参考，也提供了研究的水平。采用 McNemar 检验比较两种卧位的准确性，采用 Fisher 确切概率法比较有无脊柱侧凸患者的准确性。结果：42 例椎体骨折（VFs）。左侧（64.3%，97.2%）和右侧（76.2%，91.1%）卧位之间的敏感性（p=0.125）或特异性（p=0.866）无显著差异。脊柱侧凸患者的特异性明显较差（92.7%对 98.1%，p=0.003），但双侧卧位联合可显著提高特异性（p<0.001）。结论：右侧和左侧侧卧位与 X 线摄影具有良好的一致性，在检测 VF 方面具有相似的诊断准确性。因此，目前只做一侧的做法是有效的。在存在脊柱侧凸的情况下，双侧卧位可以提高检测 VF 的特异性，但会增加辐射剂量。
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