Die Reliabilität radiologischer Befunde zur Differentialdiagnose der vertebralen Osteoporose

Raspe, Heiner; Raspe, A.; Holzmann, M; Leidig, Gudrun; Scheidt‐Nave, Christa; Felsenberg, Dieter; Banzer, D.; Matthis, Christine

doi:10.1007/bf03041997

Cited by 8 publications

(7 citation statements)

References 4 publications

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“…In conclusioin, in prospective studies of vertebral deformity incidence in populations of women who are relatively unaffected by osteoporosis at the start of the study, MXA now seems to be the method of choice, given dosimetric considerations, the similar performance of morphometry using the two technologies and the uncertainties of qualitative assessment using conventional radiographs when expert radiographic assessors report the results in isolation from each another [4]. It may be wondered why a low radiation dose technology should peform so well in comparison with a higher-dose technology which achieves much better pictorial de®nition.…”

Section: Discussionmentioning

confidence: 97%

“…Accurate identi®cation of prevalent and incident vertebral fractures is of central importance in epidemiologic studies and in the assessment of interventions for osteoporosis, but de®nition of vertebral fracture has proved problematic [4,5]. Qualitative assessment of vertebral deformities is inaccurate because of signi®cant inter-and intra-individual variations in vertebral dimensions, and in recent years a number of morphometric approaches have been devised in which individual vertebral heights in the lumbar and thoracic spine are compared with vertebra-speci®c data from a reference population [5±7].…”

Section: Introductionmentioning

confidence: 99%

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Vertebral Morphometry: Repeat Scan Precision Using the Lunar Expert-XL and the Hologic 4500A. A Study for the "WISDOM" RCT of Hormone Replacement Therapy

Crabtree

Wright

Walgrove³

et al. 2000

Osteoporosis International

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On radiation safety grounds there is concern about the morbidity attributable to routine radiographs of the spine for the identification of new fractures in large-scale trials of fracture prevention. However, the role of the potentially safer low-radiation-dose technique of vertebral morphometry performed by third generation dual-energy X-ray absorptiometry equipment requires evaluation for use in clinical trials. We have therefore investigated the short-term inter-scan imprecision as well as the imprecision attributable to different-day analyses by the same operator and differences in analyses by different operators. The volunteer subjects were participants in a pilot study for a randomized controlled trial of hormone replacement therapy (Women's International Study of long Duration Oestrogen after Menopause, WISDOM). Each subject had two morphometric X-ray analysis scans separated by 2-4 weeks. Exclusions were women with densitometrically defined osteoporosis, as defined by the WHO criterion, and women with a body mass index exceeding 30.9 kg/m2. On average, the women were 58.7 years of age and had bone mineral density values in the lumbar spine which were about 0.7 SD units higher than a reference US female age-matched population. Scans were assessed from vertebrae T7 through L4. In the study there were no clinically significant differences in performance between the Hologic QDR 4500A and the Lunar Expert XL equipment. Between-scan imprecision was significantly worse than imprecision attributable to reanalysis of the same scan by a different operator or the same operator after an interval. Vertebral level had an effect on measurement uncertainty, especially at the level of the diaphragm and at T7. Coefficients of variation, expressed as percentages of mean values, were better for absolute height measurements than for height ratios, ranging from 1.75% to 3.40% for the three heights measured on three separate machines and from 2.34% to 4.11% for the two height ratios. These results compared favorably with the equivalent figures from a parallel study of morphometry precision undertaken using standard lateral radiographs of the thoracic and lumbar spine (3.1-3.6% and 3.8-3.9%, respectively). We conclude that in trials of prevention therapy in women (or men) selected for not having osteoporosis, low-dose vertebral morphometry using the Hologic 4500A, the Lunar Expert XL or similar equipment is preferable on safety grounds to the classical technique based on standard radiographs, although conventional radiology may still be required in those with prevalent or incident deformities to exclude causes other than osteoporosis. The place of this low-dose technique in trials performed on patients with osteoporosis requires further study.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Vertebral Morphometry: Repeat Scan Precision Using the Lunar Expert-XL and the Hologic 4500A. A Study for the "WISDOM" RCT of Hormone Replacement Therapy

Crabtree

Wright

Walgrove³

et al. 2000

Osteoporosis International

View full text Add to dashboard Cite

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“…In pilot work, we found a disturbing amount of disagreement between members of a panel of expert radiologists and clinicians who each evaluated a selection of normal and abnormal films to explore the possibility of decentralizing the reading of X-rays in the study. (30) This pilot clearly showed that clinical reading of X-rays without adequate safeguards to ensure the identity of criteria used to score osteoporotic vertebral fractures differs between centers. (30) There are other problems that, however, can make the achievement of accuracy and reproducibility in the reading of X-rays for incident fractures using vertebral morphometry difficult.…”

Section: Determinants Of the Size Of Incident Vertebral Deformitiesmentioning

confidence: 95%

“…(30) This pilot clearly showed that clinical reading of X-rays without adequate safeguards to ensure the identity of criteria used to score osteoporotic vertebral fractures differs between centers. (30) There are other problems that, however, can make the achievement of accuracy and reproducibility in the reading of X-rays for incident fractures using vertebral morphometry difficult. These include the variability in quality of X-rays taken in different centers, changes in personnel at the central morphometry center, and the increasing discrimination of the same personnel as they gain experience in point placement on film images between the first and second films.…”

Section: Determinants Of the Size Of Incident Vertebral Deformitiesmentioning

confidence: 95%

Determinants of the Size of Incident Vertebral Deformities in European Men and Women in the Sixth to Ninth Decades of Age: The European Prospective Osteoporosis Study (EPOS)

Reeve¹

2003

Journal of Bone and Mineral Research

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More severe vertebral fractures have more personal impact. In the European Prospective Osteoporosis Study, more severe vertebral collapse was predictable from prior fracture characteristics. Subjects with bi-concave or crush fractures at baseline had a 2-fold increase in incident fracture size and thus increased risk of a disabling future fracture.Introduction: According to Euler's buckling theory, loss of horizontal trabeculae in vertebrae increases the risk of fracture and suggests that the extent of vertebral collapse will be increased in proportion. We tested the hypothesis that the characteristics of a baseline deformity would influence the size of a subsequent deformity. Methods: In 207 subjects participating in the European Prospective Osteoporosis Study who suffered an incident spine fracture in a previously normal vertebra, we estimated loss of volume (fracture size) from plane film images of all vertebral bodies that were classified as having a new fracture. The sum of the three vertebral heights (anterior, mid-body, and posterior) obtained at follow-up was subtracted from the sum of the same measures at baseline. Each of the summed height loss for vertebrae with a McCloskey-Kanis deformity on the second film was expressed as a percentage. Results and Conclusions:In univariate models, the numbers of baseline deformities and the clinical category of the most severe baseline deformity were each significantly associated with the size of the most severe incident fracture and with the cumulated sum of all vertebral height losses. In multivariate modeling, age and the clinical category of the baseline deformity (crush Ͼ bi-concave Ͼ uni-concave Ͼ wedge) were the strongest determinants of both more severe and cumulative height loss. Baseline biconcave and crush fractures were associated at follow-up with new fractures that were approximately twice as large as those seen with other types of deformity or who previously had undeformed spines. In conclusion, the characteristics of a baseline vertebral deformity determines statistically the magnitude of vertebral body volume lost when a subsequent fracture occurs. Because severity of fracture and number of fractures are determinants of impact, the results should improve prediction of the future personal impact of osteoporosis once a baseline prevalent deformity has been identified. J Bone Miner Res 2003;18:1664 -1673Key words: osteoporosis, vertebral fractures, cohort study, radiological morphometry, fracture risk INTRODUCTION T HE IMPACT OF osteoporotic vertebral fractures has become the subject of increasing attention.(1-4) Because nonspecific or mechanical back pain is common, it has proved sometimes difficult to show the impact of osteoporotic fractures in the vertebral bodies. These are relatively uncommon in populations but were thought to have a large impact on affected individuals. In more recent work, better instruments have been used to measure impact in terms of activities of daily living, bodily function, and pain. (3,5,6) It has become clear t...

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“…Part of the impetus for using vertebral morphometry rather than clinical assessment by an expert radiologist (as is usual in clinical practice) is the perception that experts do not always agree on what is a vertebral fracture [1], so that multicenter evaluations are unreliable or not reproducible in other centers. There are also some well-recognized limitations with vertebral morphometry.…”

Section: Introductionmentioning

confidence: 99%

A Statistical Method to Minimize Magnification Errors in Serial Vertebral Radiographs

Gowin

Johnell

Armbrecht

et al. 2001

Osteoporosis International

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Incident vertebral deformities are commonly defined by observed changes in height between measurements on two consecutive radiographs. However, conventional radiographs are subject to magnification, and this magnification may differ between films, leading to artifactual changes in height. In order to minimize this effect, it is common practice to record the spine-film and film-focus distances, and from this to calculate a magnification factor for each film. We present a simple statistical method for correcting for differences in magnification between two films if the spine-film and film-focus distances are unknown. This method is shown to reduce the variance of the magnification differences in vertebral heights by 14%, considerably more than is possible using the spine-film distance. Using the statistical method, the number of vertebrae that showed not only a reduction in one or more height of 15%, but were also judged clinically to be free from any incident deformity by an expert radiologist, was reduced from 100 to 46. The number showing a reduction of 20% that were judged fracture-free was reduced from 15 to 9. In the subset of subjects for whom the spine-film distance was known, the reduction in false positives was similar, whichever method was used to correct for magnification. There was no difference in the number of confirmed incident fractures detected when magnification correction by either method was employed. It is concluded that correcting for magnification differences using the statistical method outlined here reduces the number of false positive deformities very substantially and by a similar extent as correcting the magnification using reliable, measured spine-film and film-focus distances. A further advantage of this method is that it can be used retrospectively.

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Die Reliabilität radiologischer Befunde zur Differentialdiagnose der vertebralen Osteoporose

Cited by 8 publications

References 4 publications

Vertebral Morphometry: Repeat Scan Precision Using the Lunar Expert-XL and the Hologic 4500A. A Study for the "WISDOM" RCT of Hormone Replacement Therapy

Vertebral Morphometry: Repeat Scan Precision Using the Lunar Expert-XL and the Hologic 4500A. A Study for the "WISDOM" RCT of Hormone Replacement Therapy

Determinants of the Size of Incident Vertebral Deformities in European Men and Women in the Sixth to Ninth Decades of Age: The European Prospective Osteoporosis Study (EPOS)

A Statistical Method to Minimize Magnification Errors in Serial Vertebral Radiographs

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