On the possibility of over-diagnosis of osteoporotic vertebral fracture at mid-thoracic level

Wáng, Yì Xiáng J.; Wang, Xiaorong; Che-Nordin, Nazmi; Xu, Feirong; Huang, Qiuli

doi:10.21037/jtd.2019.11.50

Cited by 18 publications

(19 citation statements)

References 36 publications

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“…Despite years' of research, the radiographic criteria for diagnosing osteoporotic VF and its grading remain debated (14,(25)(26)(27)(28). Recent evidences favor radiological diagnosis over OVD's morphometric criteria (14,27,28).…”

Section: Discussionmentioning

confidence: 99%

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%

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

et al. 2020

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“…X-ray cone-beam may cause geometric distortion of vertebrae located at extremities of the field-of-view, and the accuracy of diagnosis of OVF can be reduced at the upper thoracic levels. Upper thoracic spine is often associated with physiological kyphosis; however, it has been known that OVF at levels above T6 is less common [ [20] , [21] , [22] ]. One local radiologist at each center evaluated the radiographs initially, and then the images in DICOM format were sent to Center-E (the Chinese University of Hong Kong) for additional evaluation, and final consensuses were reached.…”

Section: Methodsmentioning

confidence: 99%

“…Since the spine is at the back of the chest, compared with spine RFs which are taken with the spine close to the X-ray detector, the vertebrae are more magnified on CFR and the vertebral borders are less sharp. More importantly, while the most frequent site of OVF is the thoracolumbar junction (centred around L1, followed by T12 and then L2) [ [20] , [21] , [22] ], one of the difficulties of reading spine on CFR is that the thoracolumbar junction is usually ‘off-centre’ to the X-ray beam focus. Vertebrae T12, L1, and L2, when included in the field-of-view, may not be well displayed ( Fig.…”

Section: Introductionmentioning

confidence: 99%

Improving osteoporotic vertebral deformity detection on chest frontal view radiograph by adjusted X-ray beam positioning

Liu

Wáng

2021

Journal of Orthopaedic Translation

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“…Thus, the vertebral borders on abdominal FR are usually sharp. The most frequent site of OVF involvement is the thoracolumbar junction, with the second most frequent region being the mid-thoracic spine (29,30). One of the difficulties of reading spine on FR of chest and abdomen is that the site of highest prevalence of OVF, i.e., the thoracolumbar junction, is usually 'off-centre' to the X-ray beam.…”

Section: Review Articlementioning

confidence: 99%

“…X-ray cone-beam may cause geometric distortion of vertebrae located at extremities of the scans, and the accuracy of diagnosis of VCFs can also be reduced at the upper thoracic levels. Upper thoracic spine is also often associated with physiological kyphosis; however, it has been known that OVF at levels above T6 is less common (29,30).…”

Section: Review Articlementioning

confidence: 99%

Interpretation of osteoporotic vertebral deformity on frontal view radiographs of the chest and abdomen: a pictorial review

Wáng¹,

Du²,

Gong³

et al. 2021

Quant Imaging Med Surg

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Osteoporotic vertebral fracture (OVF) has high prevalence in the elderly population. It affects at least one-fourth of all postmenopausal women and is commonly seen among women approximately one decade after menopause. A vertebral fracture, after minor trauma, is a hallmark of osteoporosis. Many fractures and associated complications, including secondary fractures and mortality, can be prevented by routine osteoporosis screening in older people and timely treatment initiation in at-risk individuals.Depending on the technical condition of the radiographs, a substantial portion of moderate to severe grades OVFs in mid-thoracic and lower thoracic spine as well as lumbar spine can be detected on a frontal view digital radiograph of the chest or abdomen. Radiologists should pay attention to the potential existence of an OVF while reading chest and abdominal radiographs of elderly female subjects. In this pictorial review, we describe our experience in evaluating the normal shaped and deformed vertebrae on chest and abdominal radiographs.

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On the possibility of over-diagnosis of osteoporotic vertebral fracture at mid-thoracic level

Cited by 18 publications

References 36 publications

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

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

Improving osteoporotic vertebral deformity detection on chest frontal view radiograph by adjusted X-ray beam positioning

Interpretation of osteoporotic vertebral deformity on frontal view radiographs of the chest and abdomen: a pictorial review

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