Misdiagnosis of vertebral fractures on plain films: Are radiologists really working so bad?

Messina, Carmelo; Albano, Domenico; Rapisarda, Santi; Sconfienza, Luca Maria

doi:10.1016/j.bone.2017.05.018

Cited by 1 publication

(2 citation statements)

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“…On the other hand, up to 48% OVD in women were missed by morphometry. Although OVD by most definitions were significantly and inversely related to BMD, a stronger association existed between BMD and osteoporotic fractures defined by RDC (17). In the early 1990s, Genant et al (6) proposed the GSQ criteria.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the height reduction estimation, emphasis is also placed on the radiological evaluation of osteoporotic vertebral deformity (OVD). However, unless there is a face-to-face training with experienced readers, it has been well documented that it is difficult to apply GSQ criteria by only reading the text description of Genant et al (5,(14)(15)(16)(17). For example, despite that a standardized protocol of radiograph acquisition techniques and of interpretation criteria was applied, Diacinti et al (16) reported a study that, among 562 OVFs identified by radiologist readers in peripheral hospitals, 102 were classified as normal vertebrae by the experienced radiologist readers in a central hospital; while 205 OVFs were incorrectly evaluated by local readings as (false) negatives.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis and grading of radiographic osteoporotic vertebral deformity by general radiologists after a brief self-learning period

et al. 2020

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Background: The expanded semi-quantitative (eSQ) osteoporotic vertebral deformity (OVD) classification has minimal, mild, moderate, moderately-severe, severe, and collapsed grades with <20%, 20-25%, >25%-1/3, >1/3-40%, >40%-2/3, >2/3 vertebral height loss respectively. This study evaluates the performance of using this grading criterion by radiology readers who did not have former training in OVD assessment.Methods: Spine radiographs of 44 elderly women with 278 normal appearing vertebrae and 65 OVDs were selected, with two senior readers agreed the reference reading. Three readers from Italy and three readers from China were invited to evaluate these radiographs after reading five reference articles including one detailing eSQ criteria with illustrative examples. Before the second round of reading, the readers were asked to read an additional explanatory document. For the readers in Italy an additional on-line demonstration was given on how to measure vertebral height loss in another five cases of OVD. Two Chinese readers had a third round of reading after a 90 minutes' on-line lecture.Results: The final absolute agreement rate with the reference reading (i.e., exactly the same grading as the reference) ranged between 46.2% to 68.2% for the six readers, and the final relative agreement (with one eSQ grade difference allowed) ranged between 78.5% to 92.5%. The >1 grade disagreement rate was all below 11%, and mostly below 7%. The missed OVD were mostly minimal grade. The rate for missing a ≥ mild OVD was <4.5%, and false positive rate was generally <1.4% among the final reading. If the minimal grade was removed and the remaining gradings were converted to Genant's semi-quantitative (GSQ) grading, the mean kappa values against the reference reading for SQ grades-1,2,3 were 0.813, 0.814, and 0.916 respectively.Conclusions: This study demonstrates good performance of the six learner readers for assessing radiographic after a brief self-learning period.

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Section: Discussionmentioning

confidence: 99%