Identification of prevalent vertebral fractures using CT lateral scout views: a comparison of semi-automated quantitative vertebral morphometry and radiologist semi-quantitative grading

SummaryWe compared vertebral fracture assessment by semi-automated quantitative vertebral morphometry measurements with the conventional semi-quantitative (SQ) grading using lateral CT scout views. The semi-automated morphometry method showed good to excellent agreement with the visual SQ grading by radiologists for identification of vertebral fractures.IntroductionSemi-automated quantitative vertebral morphometry (QM) measurements may enhance management of osteoporosis patients by providing an efficient means to identify vertebral fractures (VFx). We compared identification of prevalent VFx by semi-automated QM to SQ grading.MethodsA non-radiologist performed semi-automated QM from CT lateral scout views in 200 subjects (102 men, 98 women, 65.8 ± 8.9 years) selected from the Framingham Heart Study Multidetector CT Study. VFx were classified in the QM approach based on using Genant's criteria for deformities, and compared with conventional SQ grading performed by experienced radiologists as the gold standard. The kappa (k) statistics, percent agreement (% Agree), sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) were computed.ResultsAmong 200 subjects, 57 had mild and 41 had moderate or severe VFx by visual SQ grading. Per-person analyses showed excellent agreement between the two methods, with k = 0.780. The % Agree ranged from 86.7% to 91.2%, the SE was 81.3%–96%, and the SP was 86.5%–92%. Among 2,588 vertebrae analyzed, 107 had mild and 49 had moderate or severe VFx by visual SQ grading. Per-vertebra analyses revealed good agreement, with k = 0.580. Agreement between the methods tended to be highest in L1-L4 region. Agreement and validity measures were higher when only moderate and severe fractures were included.ConclusionThe semi-automated quantitative vertebral morphometry measurements from CT lateral scout views provided good to excellent agreement with the standard SQ grading for assessment of prevalent vertebral fractures.

[1]  S. Cummings,et al.  A new approach to defining normal vertebral dimensions , 1991, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[2]  T. Abbott,et al.  Patients with Prior Fractures Have an Increased Risk of Future Fractures: A Summary of the Literature and Statistical Synthesis , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[3]  D. Kiel,et al.  Intra-and inter-reader reliability of semi-automated quantitative morphometry measurements and vertebral fracture assessment using lateral scout views from computed tomography , 2011, Osteoporosis International.

[4]  Udo Hoffmann,et al.  Pericardial Fat, Visceral Abdominal Fat, Cardiovascular Disease Risk Factors, and Vascular Calcification in a Community-Based Sample: The Framingham Heart Study , 2008, Circulation.

[5]  H. Genant,et al.  Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting , 2009, Osteoporosis International.

[6]  S. Gehlbach,et al.  Recognition of Vertebral Fracture in a Clinical Setting , 2000, Osteoporosis International.

[7]  J. Fleiss,et al.  The measurement of interrater agreement , 2004 .

[8]  R. Eastell,et al.  Comparison of methods for the visual identification of prevalent vertebral fracture in osteoporosis , 2004, Osteoporosis International.

[9]  Robert Epstein,et al.  Comparison of methods for defining prevalent vertebral deformities: The study of osteoporotic fractures , 1995, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[10]  Christian Roux,et al.  Vertebral Fracture Assessment: the 2007 ISCD Official Positions. , 2008, Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry.

[11]  J. Kanis,et al.  Vertebral Fracture Assessment (VFA) With a Densitometer Predicts Future Fractures in Elderly Women Unselected for Osteoporosis , 2008, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[12]  Martin Roberts,et al.  Vertebral Morphometry: Semiautomatic Determination of Detailed Shape From Dual-Energy X-ray Absorptiometry Images Using Active Appearance Models , 2006, Investigative radiology.

[13]  M. Roberts,et al.  Quantitative vertebral fracture detection on DXA images using shape and appearance models. , 2007, Academic radiology.

[14]  B. Wolffenbuttel,et al.  Vertebral fracture assessment in supine position: comparison by using conventional semiquantitative radiography and visual radiography. , 2009, Radiology.

[15]  Caroline,et al.  Patterns of Abdominal Fat Distribution: The Framingham Heart Study , 2008 .

[16]  C. Roux,et al.  Méthodes radiographiques d’évaluation des fractures vertébrales ostéoporotiques ☆ , 2009 .

[17]  C. Roux,et al.  Radiographic methods for evaluating osteoporotic vertebral fractures. , 2009, Joint, bone, spine : revue du rhumatisme.

[18]  C. Cooper,et al.  Prevalence and incidence of vertebral deformities , 1993, Osteoporosis International.

[19]  Richard Eastell,et al.  Algorithm‐Based Qualitative and Semiquantitative Identification of Prevalent Vertebral Fracture: Agreement Between Different Readers, Imaging Modalities, and Diagnostic Approaches , 2007, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[20]  Jacob Cohen.  A Coefficient of Agreement for Nominal Scales , 1960 .

[21]  L M Hurxthal,et al.  Measurement of anterior vertebral compressions and biconcave vertebrae. , 1968, The American journal of roentgenology, radium therapy, and nuclear medicine.

[22]  O Johnell,et al.  A meta-analysis of previous fracture and subsequent fracture risk. , 2004, Bone.

[23]  Ian Colman,et al.  Incidental vertebral fractures discovered with chest radiography in the emergency department: prevalence, recognition, and osteoporosis management in a cohort of elderly patients. , 2005, Archives of internal medicine.

[24]  Timothy F. Cootes,et al.  Vertebral Shape: Automatic Measurement with Dynamically Sequenced Active Appearance Models , 2005, MICCAI.

[25]  F. Duboeuf,et al.  Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture , 2006, Osteoporosis International.

[26]  Alan Brett,et al.  Development of a Clinical Workflow Tool to Enhance the Detection of Vertebral Fractures: Accuracy and Precision Evaluation , 2009, Spine.

[27]  Tim Cootes,et al.  Detection of vertebral fractures in DXA VFA images using statistical models of appearance and a semi-automatic segmentation , 2010, Osteoporosis International.

[28]  S. Achenbach,et al.  Calcium Concentration of Individual Coronary Calcified Plaques as Measured by Multidetector Row Computed Tomography , 2005, Circulation.

[29]  R. Whitehouse,et al.  Under-reporting of osteoporotic vertebral fractures on computed tomography. , 2009, European journal of radiology.

[30]  J. Li,et al.  Morphometric X‐Ray Absorptiometry and Morphometric Radiography of the Spine: A Comparison of Prevalent Vertebral Deformity Identification , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[31]  M. Nevitt,et al.  Vertebral fracture assessment using a semiquantitative technique , 1993, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[32]  H. Genant,et al.  Cortical and Trabecular Bone Mineral Loss From the Spine and Hip in Long‐Duration Spaceflight , 2004, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[33]  Y. Rhee,et al.  Prevalent vertebral fractures predict subsequent radiographic vertebral fractures in postmenopausal Korean women receiving antiresorptive agent , 2011, Osteoporosis International.

[34]  R. Eastell,et al.  Identification of Vertebral Deformities in Women: Comparison of Radiological Assessment and Quantitative Morphometry Using Morphometric Radiography and Morphometric X‐Ray Absorptiometry , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[35]  S. Cummings,et al.  Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis , 1996 .

[36]  C. Wu,et al.  Vertebral Fracture Assessment using the Lateral Scoutview of Computed Tomography in Comparison with Radiographs , 1998, Osteoporosis International.

[37]  D. Kiel,et al.  Reliability of vertebral fracture assessment using multidetector CT lateral scout views: the Framingham Osteoporosis Study , 2011, Osteoporosis International.

[38]  C. Roux,et al.  Comparison of Four Morphometric Definitions and a Semiquantitative Consensus Reading for Assessing Prevalent Vertebral Fractures , 2001, Osteoporosis International.

[39]  S. H. Kan,et al.  Epidemiology of vertebral fractures in women. , 1989, American journal of epidemiology.

[40]  G. Dinant,et al.  Risk of new clinical fractures within 2 years following a fracture , 2005, Osteoporosis International.

[41]  C. Wu,et al.  Comparison of semiquantitative and quantitative techniques for the assessment of prevalent and incident vertebral fractures , 2005, Osteoporosis International.

[42]  Marleen de Bruijne,et al.  Quantitative vertebral morphometry using neighbor-conditional shape models , 2007, Medical Image Anal..

[43]  P Geusens,et al.  Risk of new vertebral fracture in the year following a fracture. , 2001, JAMA.

[44]  L. Ferrar,et al.  Vertebral fracture assessment: the 2005 ISCD Official Positions. , 2006, Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry.