Interobserver variation in the detection of osteopenia by radiography and comparison with dual X-ray absorptiometry of the lumbar spine

In 100 patients (20 male, 80 female) radiographs of the lumbar spine were obtained in both planes, anteroposterior and lateral. Nine readers independently and without specific criteria or training assessed the radiographs for presence of osteopenia in the form of a binary decision. A posteroanterior dual x-ray absorptiometry (PA DXA) measurement of the lumbar spine was performed in all patients using the Hologic QDR 1000 bone densitometer. A bone mineral density (BMD) of 0.83 g/ cm2 (T-score about 2 SD and 2.5 SD lower than BMD in normal young female and male subjects respectively) was used as a threshold for the diagnosis of osteopenia. Complete agreement amongst the 9 readers was achieved in 43 patients. In 26 more patients at least 8 readers agreed, κ-coefficients for interobserver variation ranged from 0.458 to 0.691 for reader pairs. For agreement between the observer ratings and the DXA results, κ-coefficients ranging between 0.347 and 0.555 were found. The vast majority of readers agreed in the diagnosis of osteopenia in cases where the BMD was less than 0.73 g/cm2. Where the BMD was between 0.73 and 1.03 g/cm2 a substantial disagreement was found between reader evaluation and DXA measurement, and also amongst the readers. We conclude from our results that osteopenia can reliably be detected from lumbar spine radiographs by all readers only after a substantial amount of BMD is lost. On the other hand, a diagnosis based solely on PA DXA measurement of the spine may also lack accuracy, due to a substantial influence of degenerative changes of the lumbar spine and aortic calcification. Therefore, spine radiographs remain an important cornerstone in the detection and differential diagnosis of osteopenia.

[1]  E. Lachmann,et al.  The Roentgen Diagnosis of Osteoporosis and Its Limitations1 , 1936 .

[2]  Ardran Gm,et al.  Bone destruction not demonstrable by radiography. , 1951 .

[3]  G. Ardran.  Bone destruction not demonstrable by radiography. , 1951, The British journal of radiology.

[4]  P. Virtama.  Uneven distribution of bone minerals and covering effect of non-mineralized tissue as reasons for impaired detectability of bone density from roentgenograms. , 1960, Annales medicinae internae Fenniae.

[5]  B E NORDIN,et al.  The radiological diagnosis of osteoporosis: a new approach. , 1960, Clinical radiology.

[6]  P. Virtama,et al.  RELATIVE DENSITY OF THE VERTEBRAL END-PLATES AS AN ESTIMATE OF OSTEOPOROSIS. , 1965, The British journal of radiology.

[7]  F. Doyle,et al.  An assessment of radiological criteria used in the study of spinal osteoporosis. , 1967, The British journal of radiology.

[8]  W. E. Dotter,et al.  Densitometric and visual observations of spinal radiographs. , 1969, Geriatrics.

[9]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[10]  V M Haughton,et al.  The effect of clinical bias on the interpretation of myelography and spinal computed tomography. , 1982, Radiology.

[11]  William M. Park,et al.  Observer variation in skeletal radiology , 1983, Skeletal radiology.

[12]  D A Revicki,et al.  Relationship between body mass indices and measures of body adiposity. , 1986, American journal of public health.

[13]  H. Kopera.  [Prophylaxis and treatment of osteoporosis]. , 1989, Klinische Wochenschrift.

[14]  D. Sartoris,et al.  Detection of thoracolumbar vertebral body destruction with lateral spine radiography. Part II: Clinical investigation with computed tomography. , 1990, Investigative radiology.

[15]  D. Sartoris,et al.  Detection of thoracolumbar vertebral body destruction with lateral spine radiography. Part I: Investigation in cadavers. , 1990, Investigative Radiology.

[16]  D A Bloch,et al.  Plain radiographs can be useful in estimating lumbar bone density. , 1990, The Journal of rheumatology.

[17]  Harry K. Genant,et al.  A comparison of morphometric definitions of vertebral fracture , 1991 .

[18]  S. Cummings,et al.  A comparison of morphometric definitions of vertebral fracture , 1991, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[19]  K Engelke,et al.  Noninvasive measurements of bone mass, structure, and strength: current methods and experimental techniques. , 1991, AJR. American journal of roentgenology.

[20]  S. Williamson,et al.  Osteoporosis: diagnosis by plain chest film versus dual photon bone densitometry , 2004, Skeletal Radiology.

[21]  Observer variation in the detection of osteopenia , 2004, Skeletal Radiology.

[22]  A. DeSmet,et al.  The effect of overlying calcification on lumbar bone densitometry , 1992, Calcified Tissue International.

[23]  W. Dorda,et al.  Clinical relevance of radiologic examination of the skeleton and bone density measurements in osteoporosis of old age , 1981, Skeletal Radiology.

[24]  H. Kopera,et al.  Briefe an die Redaktion , 1989, Klinische Wochenschrift.