META: an MRI-based scoring system differentiating metastatic from osteoporotic vertebral fractures

Kato, So; Hozumi, Takeshi; Yamakawa, Kiyofumi; Saito, Makoto; Goto, Takahiro; Kondo, Taiji

doi:10.1016/j.spinee.2015.03.011

Cited by 18 publications

(24 citation statements)

References 25 publications

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“…10 Because no instructions, scoring systems, or meetings were implemented to improve agreement, [11][12][13] clinicians had to make their diagnosis on their own based on data from clinical history and imaging, with common heuristics and biases. 14 All of these factors may account for differences between the results of this study and the almost perfect agreement reported by the medical professionals who developed the META score (k, 0.93), 1 which previous studies have shown to not be reproducible. 15 In this study, readers were experts who had been managing vertebral fractures and interpreting spine imaging for up to 35 years, had participated in previous research in this field, and felt confident enough to volunteer for a study assessing their interpretation of spine images.…”

Section: Discussionmentioning

confidence: 64%

“…Diagnostic accuracy was very similar across clinical specialties, readers' experience, and hospital category and was consistent with results from the few previous studies that analyzed the reproducibility of single imaging findings and the META score. 1,15 Therefore, fair interobserver agreement and moderate diagnostic accuracy may be the best that can be realistically expected when using MRI to distinguish MVF versus OVF in routine practice, simply because with current technology, images of MVF and OVF are sometimes indistinguishable. 16,17 For instance, "bulging posterior cortex" was one of the imaging findings with the best interobserver agreement found in this and previous studies, and specifically, expansion of the posterior aspect of the vertebral contour is associated with malignant fractures.…”

Section: Discussionmentioning

confidence: 99%

“…MRI findings assessed in this study were selected through a literature review 1 Figure 1. Flowchart of the selection process.…”

Section: Mri Evaluation Reporting and Interpretationmentioning

confidence: 99%

“…They include those findings used to calculate the MRI Evaluation Totalizing Assessment (META) score. 1 The readers assessed all MRI images on their own, prospectively, from January 2018 through October 2018, using an in-house online MRI interpretation system. No attempt was made to homogenize their diagnostic criteria or interpretation of images.…”

Section: Mri Evaluation Reporting and Interpretationmentioning

confidence: 99%

“…Several imaging findings are frequently used to help distinguish between OVF and MVF. 1,2 Some have been fed into risk-scoring algorithms developed to identify patients at a higher risk of experiencing MVF. 3 To be useful in clinical practice and lead to sound treatment decisions, risk-assessment algorithms should be evidencebased and built on parameters that can be assessed reliably.…”

Section: Introductionmentioning

confidence: 99%

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Metastatic Versus Osteoporotic Vertebral Fractures on MRI: A Blinded, Multicenter, and Multispecialty Observer Agreement Evaluation

Arana

Kovacs

Royuela

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: MRI is assumed to be valid for distinguishing metastatic vertebral fractures (MVFs) from osteoporotic vertebral fractures (OVFs). This study assessed (1) concordance between the imagebased diagnosis of MVF versus OVF and the reference (biopsy or follow-up of .6 months), (2) interobserver and intraobserver agreement on key imaging findings and the diagnosis of MVF versus OVF, and (3) whether disclosing a patient's history of cancer leads to variations in diagnosis, concordance, or agreement. Patients and Methods: This retrospective cohort study included clinical data and imaging from 203 patients with confirmed MVF or OVF provided to 25 clinicians (neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists). From January 2018 through October 2018, the clinicians interpreted images in conditions as close as possible to routine practice. Each specialist assessed data twice, with a minimum 6-week interval, blinded to assessments made by other clinicians and to their own previous assessments. The kappa statistic was used to assess interobserver and intraobserver agreement on key imaging findings, diagnosis (MVF vs OVF), and concordance with the reference. Subgroup analyses were based on clinicians' specialty, years of experience, and complexity of the hospital where they worked. Results: For diagnosis of MVF versus OVF, interobserver agreement was fair, whereas intraobserver agreement was substantial. Only the latter improved to almost perfect when a patient's history of cancer was disclosed. Interobserver agreement for key imaging findings was fair or moderate, whereas intraobserver agreement on key imaging findings was moderate or substantial. Concordance between the diagnosis of MVF versus OVF and the reference was moderate. Results were similar regardless of clinicians' specialty, experience, and hospital category. Conclusions: When MRI is used to distinguish MVF versus OVF, interobserver agreement and concordance with the reference were moderate. These results cast doubt on the reliability of basing such a diagnosis on MRI in routine practice.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

“…MRI findings assessed in this study were selected through a literature review 1 Figure 1. Flowchart of the selection process.…”

Section: Mri Evaluation Reporting and Interpretationmentioning

confidence: 99%

Section: Mri Evaluation Reporting and Interpretationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Metastatic Versus Osteoporotic Vertebral Fractures on MRI: A Blinded, Multicenter, and Multispecialty Observer Agreement Evaluation

Arana

Kovacs

Royuela

et al. 2020

Journal of the National Comprehensive Cancer Network

View full text Add to dashboard Cite

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Complications

Morehouse¹,

Ashana²

2018

Metastatic Spine Disease

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Wirbelsäulenfrakturen

2016

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Osteoporotic spinal fractures are typical age-related fragility fractures. Their impact on the quality of life is often underestimated; therefore, anti-osteoporotic drug treatment according to the current guidelines is essential. Occult vertebral fractures may be difficult to detect and a differentiation between fresh and old fractures is often only possible with magnetic resonance imaging (MRI) to reveal cancellous bone edema. Treatment recommendations are predominantly based on traumatic fractures in younger adults and are thus not applicable in orthogeriatrics. A new classification currently under validation and presented in this article was developed in order to aid decision-making for operative interventions. Minimally invasive treatment options include vertebroplasty, kyphopasty and internal fixation. The application of cement provides additional stability but can be accompanied by cement-specific complications, such as extravasation and embolism.

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META: an MRI-based scoring system differentiating metastatic from osteoporotic vertebral fractures

Cited by 18 publications

References 25 publications

Metastatic Versus Osteoporotic Vertebral Fractures on MRI: A Blinded, Multicenter, and Multispecialty Observer Agreement Evaluation

Metastatic Versus Osteoporotic Vertebral Fractures on MRI: A Blinded, Multicenter, and Multispecialty Observer Agreement Evaluation

Complications

Wirbelsäulenfrakturen

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