Jergas M, Uffmann M, Escher H, Schaffstein J, Nitzschke E, Köster O
Radiologische Universitätsklinik Ruhr-Universität am St. Josef-Hospital Bochum.
Z Orthop Ihre Grenzgeb. 1994 Mar-Apr;132(2):91-8. doi: 10.1055/s-2008-1039825.
Routine radiographs and PA dual x-ray absorptiometry (DXA) of the lumbar spine were performed in 253 patients. A T-score of -2SD (approximately 20% reduction from young normal bone mineral density (BMD)) as measured by DXA, was used as threshold for the diagnosis of osteopenia. A lumbar spine index (LSI) as proposed by Barnett and Nordin was assessed by one radiologist. The correlation between LSI and bone mineral density, measured by DXA, was poor, and our results indicate that osteopenic patients cannot be differentiated from non-osteopenic patients by LSI. 100 radiographs of the lumbar spine were evaluated by 9 observers in order to determine observer variation in the detection of osteopenia. A complete agreement between the readers for the diagnosis of osteopenia was achieved in 43 percent of all radiographs. DXA and observers agreed in 68 to 76 percent of all cases. For a decrease of BMD of more than 60 percent compared to young normal adults, as determined by DXA, all readers agreed in the diagnosis of osteopenia, whereas for higher BMD values the agreement between readers and DXA worsened. The inconsistency between DXA and observer agreement was greatest for patients with a BMD reduction between 10 and 20 percent. The mean values of the kappa-coefficients were 0.574 +/- 0.06 for interobserver variation and 0.437 +/- 0.06 for the agreement between readers and DXA-results. An only moderate kappa-coefficient of 0.573 for the intraobserver variation as determined in one reader was found.
对253例患者进行了腰椎的常规X线片和前后位双能X线吸收法（DXA）检查。DXA测量的T值为-2SD（比年轻正常骨密度（BMD）降低约20%），用作骨质减少诊断的阈值。由一名放射科医生评估了Barnett和Nordin提出的腰椎指数（LSI）。LSI与DXA测量的骨密度之间的相关性较差，我们的结果表明，无法通过LSI区分骨质减少患者和非骨质减少患者。9名观察者对100张腰椎X线片进行了评估，以确定观察者在骨质减少检测中的差异。在所有X线片中，43%的片子在骨质减少诊断上读者之间完全一致。DXA与观察者在所有病例中的一致率为68%至76%。对于DXA确定的与年轻正常成年人相比BMD降低超过60%的情况，所有读者在骨质减少诊断上意见一致，而对于更高的BMD值，读者与DXA之间的一致性变差。DXA与观察者一致性之间的不一致在BMD降低10%至20%的患者中最大。观察者间差异的kappa系数平均值为0.574±0.06，读者与DXA结果之间一致性的kappa系数为0.437±0.06。在一名读者中确定的观察者内差异的kappa系数仅为中等的0.573。
