Wu C Y, Li J, Jergas M, Genant H K
Department of Radiology, University of California San Francisco 94143-0628, USA.
Osteoporos Int. 1995;5(5):354-70. doi: 10.1007/BF01622258.
To compare visual semiquantitative (SQ) reading and quantitative morphometry (QM) for assessing prevalent and incident vertebral fractures, radiographs of the thoracolumbar spine were evaluated in 400 (only baseline films) and 335 (baseline and follow-up films) postmenopausal women with osteopenia as defined by a T-score of less than 2 SD below young normals. QM was performed using different cutoff thresholds, and the SQ reading was performed by three radiologists independently. A joint consensus reading of the radiographs by all participating radiologists was used as a reference standard. Our results indicate that the concordance within SQ methods is excellent, and it is higher than that between SQ and QM regardless of the cutoff criteria used. This finding was consistent for the diagnosis of prevalent as well as incident vertebral fractures. For prevalent fractures the use of the 2.5 SD cutoff criterion provided the highest concordance with the consensus reading and with the radiologists' reading, thereby providing high sensitivity (70.23%) with moderate specificity (98.76%) relative to the consensus reading when compared with the 3 SD or 4 SD cutoff criteria. For the diagnosis of incident vertebral fractures the best agreement between our consensus reading and QM was found for an absolute reduction of 6 mm and for a combination of relative and absolute reduction of 15% and 3 mm in vertebral height. The respective sensitivities and specificities for the two criteria were 51%/99.9% and 75.4%/98.9%, respectively. Even though the consensus reading may favor the reader's evaluation over QM, the assessment of prevalent and incident fractures using QM alone may not be sufficiently reliable for detection of vertebral fractures in epidemiological studies and clinical trials. It should be performed principally in conjunction with a trained radiologist or a highly experienced clinician.
为比较视觉半定量（SQ）读数法和定量形态测量法（QM）在评估现患和新发椎体骨折方面的效果，我们对400名（仅包括基线影像）和335名（包括基线和随访影像）绝经后骨质疏松症女性的胸腰椎X线片进行了评估，这些女性的T值低于年轻正常人群2个标准差。采用不同的截断阈值进行QM，由三名放射科医生独立进行SQ读数。所有参与的放射科医生对X线片进行联合一致读数，并将其作为参考标准。我们的结果表明，SQ方法内部的一致性非常好，且无论使用何种截断标准，其一致性都高于SQ与QM之间的一致性。这一发现对于现患和新发椎体骨折的诊断均一致。对于现患骨折，使用2.5个标准差的截断标准与一致读数以及放射科医生的读数一致性最高，相对于一致读数，与3个标准差或4个标准差的截断标准相比，其敏感性较高（70.23%），特异性中等（98.76%）。对于新发椎体骨折的诊断，我们发现当椎体高度绝对减少6毫米以及相对和绝对减少分别为15%和3毫米时，一致读数与QM之间的一致性最佳。这两个标准各自的敏感性和特异性分别为51%/99.9%和75.4%/98.9%。尽管一致读数可能比QM更有利于读者的评估，但在流行病学研究和临床试验中，仅使用QM评估现患和新发骨折对于检测椎体骨折可能不够可靠。它主要应与训练有素的放射科医生或经验丰富的临床医生联合进行。
