Raspe H, Raspe A, Holzmann M, Leidig G, Scheidt-Nave C, Felsenberg D, Banzer D, Matthis C
Institut für Sozialmedizin, Medizinische Universität zu Lübeck.
Med Klin (Munich). 1998 Mar 15;93 Suppl 2:34-40. doi: 10.1007/BF03041997.
Radiologically identified vertebral deformities, e.g. wedge-, fish-, or crush-vertebrae are not always a consequence of local osteoporosis. Other frequent pathomechanisms include Morbus Scheuermann, degenerative changes, overt trauma, and congenital dysplasia. This requires differential diagnosis of vertebral deformities. Radiological classification criteria have to satisfy various methodological requirements to ensure reliability of the results.
Inter-rater reliability of more than 30 radiological findings was assessed in 4 German centres of the European Vertebral Osteoporosis Study (EVOS). One hundred randomly selected EVOS cases from the West-Berlin population, each contributing 2 lateral X-rays from the thoracic and lumbar spine respectively, were independently evaluated by 7 observers. All observers were medical doctors, 4 of them heads or members of clinical radiological departments. Thus each observer read 200 radiographs. Radiological alterations in the form and structure of 13 vertebrale which were considered to be relevant for the differential diagnosis of osteoporosis were recorded in a standardized documentation form. Additionally global judgements (e. g. "osteoporotic spine" yes/no) were required. To quantify agreement Fleiss' kappa (kappa) for nominal data and multiple observers was used.
经放射学检查发现的椎体畸形，如楔形、鱼椎形或压缩性椎体，并非总是由局部骨质疏松症导致。其他常见的发病机制包括休曼氏病、退行性改变、明显外伤和先天性发育异常。这就需要对椎体畸形进行鉴别诊断。放射学分类标准必须满足各种方法学要求，以确保结果的可靠性。
在欧洲椎体骨质疏松症研究（EVOS）的4个德国中心评估了30多项放射学检查结果的观察者间可靠性。从西柏林人群中随机选取100例EVOS病例，每人分别提供胸椎和腰椎的2张侧位X线片，由7名观察者独立评估。所有观察者均为医生，其中4人是临床放射科的主任或成员。因此，每位观察者阅读200张X线片。以标准化记录表格记录13个椎体在形态和结构上被认为与骨质疏松症鉴别诊断相关的放射学改变。此外，还需要做出总体判断（如“骨质疏松性脊柱”是/否）。为了量化一致性，对于名义数据和多名观察者的情况，使用了弗莱iss卡方检验（kappa）。
