Pak C Y, Ho A, Poindexter J, Peterson R, Sakhaee K
Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center at Dallas 75235-8885, USA.
Bone. 1996 Apr;18(4):349-53. doi: 10.1016/8756-3282(96)00007-5.
The value of quantitative morphometry in detection of new spinal fractures was assessed in serial radiographs from 83 patients with osteoporosis. From vertebral landmarks on lateral spine radiographs, a computer program allowed calculation of vertebral heights and area. By comparing vertebral dimensions in the two sets of films, incident spinal fractures could be quantitated based either on the minimum criteria of 15% reduction in vertebral height (CM2) or a fall in height and area of 20% and 10% (CM1). The results of quantitative morphometry were compared with those of the consensus and individual readings of visual detection by three experienced investigators in the same paired sets of spinal films. For incident new fractures, the visual consensus method (V-C) showed a very good agreement with individual visual detection (kappa of 0.794 to 0.916) as well as with CM1 (kappa of 0.821). However, there was a poor agreement between the results of consensus reading and of detection by CM2 (kappa of 0.341), due to excessive number of fractures identified by CM2, but not by the visual method. For incident recurrent fractures, there was a poor agreement between V-C and individual visual detection, and between V-C and quantitative morphometry (kappa of 0.306 to 0.496). It was due to severe compression fractures at baseline, which caused further changes in vertebral dimensions difficult to measure accurately by either visual or quantitative morphometry. Thus, if the visual detection of fractures by a consensus of experienced investigators is considered as the "gold standard," quantitative morphometry, based on minimum reduction in vertebral height of 20% accompanied by a minimum decline in area of 10%, provides an objective detection of incident new spinal fractures but not of recurrent fractures.
对83例骨质疏松症患者的系列X线片进行分析，评估定量形态测量法在检测新发脊柱骨折中的价值。通过脊柱侧位X线片上的椎体标志，计算机程序可计算椎体高度和面积。通过比较两组X线片上的椎体尺寸，可根据椎体高度至少降低15%（CM2）或高度和面积分别降低20%和10%（CM1）的最低标准对新发脊柱骨折进行定量。将定量形态测量结果与三位经验丰富的研究人员对同一组脊柱X线片进行视觉检测的共识及个人读数结果进行比较。对于新发骨折，视觉共识法（V-C）与个人视觉检测（kappa值为0.794至0.916）以及与CM1（kappa值为0.821）显示出非常好的一致性。然而，共识读数结果与CM2检测结果之间的一致性较差（kappa值为0.341），这是因为CM2识别出的骨折数量过多，而视觉方法未识别出这些骨折。对于复发性骨折，V-C与个人视觉检测之间以及V-C与定量形态测量之间的一致性较差（kappa值为0.306至0.496）。这是由于基线时存在严重压缩性骨折，导致椎体尺寸进一步变化，难以通过视觉或定量形态测量准确测量。因此，如果将经验丰富的研究人员达成共识的骨折视觉检测视为“金标准”，那么基于椎体高度至少降低20%且面积至少降低10%的定量形态测量法可客观检测新发脊柱骨折，但不能检测复发性骨折。
