Abstract
Introduction
A wrong diagnosis of latent vertebral fracture is often made when it is based on plain X-ray imaging. Magnetic resonance imaging (MRI) has a high degree of accuracy for the definite diagnosis. This study was designed to identify ways to support improvements in the diagnostic accuracy of plain X-ray (X-P).
Methods
We studied X-P and MRI images of 120 women and men (age range: 50–96 years). Five orthopedists and two radiologists interpreted front and lateral thoracolumbar X-Ps and MRI images. The correct diagnosis rate for the presence and location of incident vertebral fractures and the correct diagnosis rate according to morphological classifications were analyzed.
Results
A correct diagnosis of incident fractures was made in 51.5% of cases overall. Diagnoses of non-incident fracture based on X-P in those cases with incident fracture based on MRI (false positive) occurred in 24.8% of the patients, while diagnoses of incident fracture based on X-P in those cases without incident fracture based on MRI (false negative) occurred in 6.5% of the patients. The application of morphological classifications (the primary osteoporosis diagnostic criteria and Yoshida’s classification) resulted in the correct diagnosis rate being significantly higher in the group without prevalent fracture even when there were morphological changes (wedge, indented, protruding type) in the anterior bone cortex. Odds ratios were investigated for factors that would affect the correct diagnosis rate, including age, body weight, lumbar vertebrae bone mineral density, and examiner ability. In an overall investigation, age (OR=0.660), body weight (OR=2.082), and examiner ability (p=0.0205) affected the correct diagnosis rate.
Conclusion
The correct diagnosis rate for incident vertebral fractures with X-Ps was low (24.8%) and in cases with prevalent fractures, the rate was even lower (16.8%), but the number of prevalent fractures and BMD did not exert an effect. One key improving the correct diagnosis rate may be to pay attention to morphological changes in the anterior bone cortex.
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References
Majumdar SR, Kim N, Colman I, Chahal AM, Raymond G, Jen H, Siminoski KG, Hanley DA, Rowe BH (2005) Incidental vertebral fractures discovered with chest radiography in the emergency department: prevalence, recognition, and osteoporosis management in a cohort of elderly patients. Arch Intern Med 165:905–909
Gibson ES, Martin RH, Terry CW (1980) Incidence of low back pain and pre-placement x-ray screening. J Occup Med 22:515–519
Simmons ED, Guyer RD, Graham-Smith A, Herzog R (2003) Radiograph assessment for patients with low back pain. Spine J 3:3S–5S
Rankine JJ, Gill KP, Hutchinson CE, Ross ER, Williamson JB (1998) The therapeutic impact of lumbar spine MRI on patients with low back and leg pain. Clin Radiol 53:688–693
McNally EG, Wilson DJ, Ostlere SJ (2001) Limited magnetic resonance imaging in low back pain instead of plain radiographs: experience with first 1000 cases. Clin Radiol 56:922–925
Shih TT, Tsuang YH, Huang KM, Chen PQ, Su CT (1996) Magnetic resonance imaging of vertebral compression fractures. J Formos Med Assoc 95:313–319
Nathan H (1962) Osteophytes of the vertebral column. An anatomical study of their development according to age, race, and sex with consideration as to their etiology and significance. J Bone Joint Surg 44-A:243–268
Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148
Yoshida T, Nanba H, Mimatsu K, Kasai T (2000) Treatment of osteoporotic spinal compression fractures. Conservative therapy and its limitation (in Japanese). Clin Calcium 10:53–58
Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7:221–227
Fujiwara S (2004) Degeneration of lumber spine and QOL (in Japanese). Ther Osteoporos 3:32–37
Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800
O’Neill TW, Cockerill W, Matthis C, Raspe HH, Lunt M, Cooper C, Banzer D, Cannata JB, Naves M, Felsch B, Felsenberg D, Janott J, Johnell O, Kanis JA, Kragl G, Lopes Vaz A, Lyritis G, Masaryk P, Poor G, Reid DM, Reisinger W, Scheidt-Nave C, Stepan JJ, Todd CJ, Woolf AD, Reeve J, Silman AJ (2004) Back pain, disability, and radiographic vertebral fracture in European women: a prospective study. Osteoporos Int 15:760–765
Ross PD, Davis JW, Epstein RS, Wasnich RD (1992) Ability of vertebral dimensions from a single radiograph to identify fractures. Calcif Tissue Int 51:95–99
Isaacs DM, Marinac J, Sun C (2004) Radiograph use in low back pain: a United States Emergency Department database analysis. J Emerg Med 26:37–45
Khoo LA, Heron C, Patel U, Given-Wilson R, Grundy A, Khaw KT, Dundas D (2003) The diagnostic contribution of the frontal lumbar spine radiograph in community referred low back pain-a prospective study of 1030 patients. Clin Radiol 58:606–609
Pandey R, McNally E, Ali A, Bulstrode C (1998) The role of MRI in the diagnosis of occult hip fractures. Injury 29:61–63
Rizzo PF, Gould ES, Lyden JP, Asnis SE (1993) Diagnosis of occult fractures about the hip. Magnetic resonance imaging compared with bone-scanning. J Bone Joint Surg Am 75:395–401
Nakano T, Inaba D, Takada K, Tsurugami H (2003) Rate of correct diagnosis for vertebral fracture by MRI and natural history (in Japanese). Osteoporos Jpn 11:25–28
Nakano T, Ochi R, Miyazono K, Inaba D, Tsurugami H (2004) Diagnosis precision of MRI for fresh osteoporotic vertebral body fracture and a diagnosis by follow-up roentgenogram (in Japanese). Osteoporos Jpn 12:89–90
Kanchiku T, Taguchi T, Kawai S (2003) Magnetic resonance imaging diagnosis and new classification of the osteoporotic vertebral fracture. J Orthop Sci 8:463–466
Rupp RE, Ebraheim NA, Coombs RJ (1995) Magnetic resonance imaging differentiation of compression spine fractures or vertebral lesions caused by osteoporosis or tumor. Spine 20:2499–2503
Cuenod CA, Laredo JD, Chevret S, Hamze B, Naouri JF, Chapaux X, Bondeville JM, Tubiana JM (1996) Acute vertebral collapse due to osteoporosis or malignancy: appearance on unenhanced and gadolinium-enhanced MR images. Radiology 199:541–549
Jarvik JG, Hollingworth W, Martin B, Emerson SS, Gray DT, Overman S, Robinson D, Staiger T, Wessbecher F, Sullivan SD, Kreuter W, Deyo RA (2003) Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA 289:2810–2818
Delmas PD, van de Langerijt L, Watts NB, Eastell R, Genant H, Grauer A, Cahall DL; IMPACT Study Group (2005) Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res 20:557–563
Hachiya Y (1994) MRI of compression and osteoporotic fracture (in Japanese. MB Orthop 7:173–185)
Nakano T, Abe Y, Shimizu Y, Ochi R, Seike I, Iwamoto K, Fujiwara K, Takagi K (1999) Rate of correct diagnosis for vertebral fracture by plain roentgenograms (in Japanese). Fracture 21:586–588
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The authors wish to thank all the technicians who performed the measurements in the different centers.
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Ito, Z., Harada, A., Matsui, Y. et al. Can you diagnose for vertebral fracture correctly by plain X-ray?. Osteoporos Int 17, 1584–1591 (2006). https://doi.org/10.1007/s00198-006-0123-0
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DOI: https://doi.org/10.1007/s00198-006-0123-0