Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, Santiago, Chile 8330077.
Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, Santiago, Chile 8330077.
Spine J. 2018 Nov;18(11):2074-2080. doi: 10.1016/j.spinee.2018.04.024. Epub 2018 Apr 27.
Differentiating osteoporotic vertebral fractures (OVFs) from metastatic vertebral fractures (MVFs) is an important clinical challenge. A novel magnetic resonance imaging (MRI)-based score (the META score) was described, aiming to differentiate OVF from MVF. This score showed an almost perfect agreement by the group developing it, but an independent agreement evaluation is pending.
We aimed to perform an independent inter- and intraobserver agreement evaluation of the META score and to test the score's capability of differentiating OVF from MVF.
This is an agreement study of the META score.
Sixty-four patients with confirmed OVF or MVF were assessed by six independent evaluators (three spine surgeons and three fellowship-trained radiologists) using the META score. We used the intraclass correlation coefficient (ICC) to determine the overall inter-and intraobserver agreement, and the kappa statistic (κ) to express the agreement for each individual score criterion. The score accuracy was determined by calculating the area under the receiver operating characteristic curve. Finally, we used κ to evaluate the agreement among raters to determine whether the fracture was OVF or MVF.
The overall interobserver agreement was poor [ICC=0.10 (0.02-0.20)]; spine surgeons [ICC=0.75 (0.66-0.83)] had better agreement than radiologists did [ICC=0.05 (-0.08 to 0.21)]. The intraobserver agreement was poor [ICC=0.17 (0.01-0.32)]; both spine surgeons [ICC=0.21 (0.05-0.41)] and radiologists had a poor agreement [ICC=0.03 (-0.29 to 0.27)]. The agreement for each specific criterion varied from κ=0.24 to κ=0.60. The area under the receiver operating characteristic curve was 0.58 (0.64 for spine surgeons and 0.52 for radiologists, p<.01).
The interobserver agreement using the META score was adequate for spine surgeons but not for other potential users (radiologists); the intraobserver agreement was poor. Further studies are thus necessary before the use of this score is recommended.
区分骨质疏松性椎体骨折（OVF）和转移性椎体骨折（MVF）是一项重要的临床挑战。一种新的基于磁共振成像（MRI）的评分（META 评分）被描述出来，旨在区分 OVF 和 MVF。该评分在开发它的小组中显示出几乎完美的一致性，但独立的一致性评估仍在进行中。
我们旨在对 META 评分进行独立的观察者间和观察者内一致性评估，并测试该评分区分 OVF 和 MVF 的能力。
这是一项关于 META 评分的一致性研究。
64 例经证实的 OVF 或 MVF 患者由 6 名独立评估者（3 名脊柱外科医生和 3 名 fellowship培训的放射科医生）使用 META 评分进行评估。我们使用组内相关系数（ICC）来确定整体观察者间和观察者内的一致性，并使用kappa 统计量（κ）来表示每个单独评分标准的一致性。通过计算受试者工作特征曲线下的面积来确定评分的准确性。最后，我们使用κ来评估评分者之间的一致性，以确定骨折是 OVF 还是 MVF。
整体观察者间的一致性较差[ICC=0.10（0.02-0.20）]；脊柱外科医生[ICC=0.75（0.66-0.83）]的一致性优于放射科医生[ICC=0.05（-0.08 至 0.21）]。观察者内的一致性也较差[ICC=0.17（0.01-0.32）]；脊柱外科医生[ICC=0.21（0.05-0.41）]和放射科医生的一致性均较差[ICC=0.03（-0.29 至 0.27）]。每个具体标准的一致性范围为κ=0.24 至 κ=0.60。受试者工作特征曲线下的面积为 0.58（脊柱外科医生为 0.64，放射科医生为 0.52，p<.01）。
使用 META 评分的观察者间一致性对于脊柱外科医生来说是足够的，但对于其他潜在使用者（放射科医生）来说则不够；观察者内的一致性较差。因此，在推荐使用该评分之前，还需要进一步的研究。
