Algorithm-Based Qualitative and Semiquantitative Identification of Prevalent Vertebral Fracture: Agreement Between Different Readers, Imaging Modalities, and Diagnostic Approaches

Abstract

We compared SQ and ABQ diagnosis of VF imaged by radiography and X-ray absorptiometry. Mild ABQ VF had stronger associations with osteoporosis than mild SQ VF. Interobserver agreement (radiographic diagnosis) was better for ABQ.Introduction: Vertebral fracture (VF) assessment from images acquired by X-ray absorptiometry (VFA) is often based on a semiquantitative approach (SQ); prevalent VF is identified if vertebral height appears reduced by >20%. Algorithm-based qualitative definition of osteoporotic VF (ABQ) requires evidence of endplate depression, and there is no threshold for reduction in vertebral height. The aims of this study were to (1) compare the prevalence of VFs; (2) compare the characteristics of women with and without VFs; (3) compare interobserver agreement; and (4) compare agreement between methods and imaging modalities for ABQ and SQ definitions of VFs. Materials and Methods: Spine radiographs and absorptiometry images for 203 elderly women were assessed using ABQ (readers ABQ-1 and ABQ-2). These readings were compared with SQ assessments (readers SQ-1 and SQ-2) of the same images performed in a previous study. Agreement between readers and methods was assessed by kappa () statistics. Results: The prevalence of VF was 15-18% (radiography) and 12-24% (VFA) for ABQ and SQ, respectively. Women with ABQ or SQ fractures were older and had lower BMD than those without fracture (p < 0.01). Mild ABQ (but not SQ) VF was associated with low BMD. scores for interobserver agreement for radiography and VFA, respectively, were as follows: ABQ, ‫ס‬ 0. Conclusions:The prevalence of radiographic VF identified by ABQ and SQ was similar, but on VFA was 50% higher for SQ. Mild ABQ VF was associated with low BMD. Interobserver agreement for radiographic diagnosis was significantly better for ABQ than for SQ. Agreement between ABQ and SQ was moderate.

Association between incident and baseline vertebral fractures in European women: vertebral fracture assessment in the Osteoporosis and Ultrasound Study (OPUS)

“…The ABQ method generally identifies fewer prevalent fractures than other approaches [8,11] which might explain the lower prevalence in this compared to other recent VFA studies [12][13][14][15][16]. We could have failed to detect some fractures due to poor differentiation of the vertebral endplates on VFA, but the relatively low prevalence identified by ABQ may also reflect differences in the criteria used to define fracture.…”

“…We have published data on the application of the ABQ method to VFA for visual diagnosis of prevalent vertebral fractures [7,8], but have not previously used the method in longitudinal VFA. Image quality is an important consideration in the ABQ definition of fracture, because of the emphasis on visual assessment of the endplate.…”

Quantitative vertebral morphometry based on parametric modeling of vertebral bodies in 3D

“…Although these morphological cases and fracture grades were quantitatively defined, classification was still based on visual examination. In clinical practice, the SQ method is accepted as the "ground truth" for the diagnosis of vertebral body fractures [7]; however, it is not considered reliable for many clinical and epidemiological studies of vertebral pathology [8,9].…”

Impact of cervicothoracic region stereotactic spine radiosurgery on adjacent organs at risk

“…Recently, the ABQ method has been applied to research cohorts (32)(33)(34)(35). In one study ABQ, SQ, and morphometric methods of defining vertebral fractures were compared (33).…”