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Reliability of vertebral fracture assessment using multidetector CT lateral scout views: the Framingham Osteoporosis Study

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Abstract

Summary

Two radiologists evaluated images of the spine from computed tomography (CT) scans on two occasions to diagnose vertebral fracture in 100 individuals. Agreement was fair to good for mild fractures, and agreement was good to excellent for more severe fractures. CT scout views are useful to assess vertebral fracture.

Introduction

We investigated inter-reader agreement between two radiologists and intra-reader agreement between duplicate readings for each radiologist, in assessment of vertebral fracture using a semi-quantitative method from lateral scout views obtained by CT.

Methods

Participants included 50 women and 50 men (age 50-87 years, mean 70 years) in the Framingham Study. T4-L4 vertebrae were assessed independently by two radiologists on two occasions using a semi-quantitative scale as normal, mild, moderate, or severe fracture.

Results

Vertebra-specific prevalence of grade ≥1 (mild) fracture ranged from 3% to 5%. We found fair (κ = 56-59%) inter-reader agreement for grade ≥1 vertebral fractures and good (κ = 68-72%) inter-reader agreement for grade ≥2 fractures. Intra-reader agreement for grade ≥1 vertebral fracture was fair (κ = 55%) for one reader and excellent for another reader (κ = 77%), whereas intra-reader agreement for grade ≥2 vertebral fracture was excellent for both readers (κ = 76% and 98%). Thoracic vertebrae were more difficult to evaluate than the lumbar region, and agreement was lowest (inter-reader κ = 43%) for fracture at the upper (T4-T9) thoracic levels and highest (inter-reader κ = 76-78%) for the lumbar spine (L1-L4).

Conclusions

Based on a semi-quantitative method to classify vertebral fractures using CT scout views, agreement within and between readers was fair to good, with the greatest source of variation occurring for fractures of mild severity and for the upper thoracic region. Agreement was good to excellent for fractures of at least moderate severity. Lateral CT scout views can be useful in clinical research settings to assess vertebral fracture.

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Acknowledgments

This work was supported by NIH R01AR053986, R01AR/AG041398, K01 AR053118, T32 AG023480, and by the National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study (NIH/NHLBI Contract N01-HC-25195).

Conflict of interest

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Authors and Affiliations

  1. Hebrew SeniorLife, Institute for Aging Research Boston, Boston, MA, USA

    E. J. Samelson, K. E. Broe, C. A. Meng & D. P. Kiel

  2. Department of Medicine, Harvard Medical School, Boston, MA, USA

    E. J. Samelson, C. J. O’Donnell, U. Hoffmann & D. P. Kiel

  3. Beth Israel Deaconess Medical Center, Center for Advanced Orthopedic Studies, Boston, MA, USA

    B. A. Christiansen & M. L. Bouxsein

  4. Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA

    B. A. Christiansen & M. L. Bouxsein

  5. Department of Orthopaedics, University of California Davis, Sacramento, CA, USA

    B. A. Christiansen

  6. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA

    S. Demissie & Y. Zhou

  7. Radiology, Peking Union Medical College Hospital, Beijing, China

    W. Yu

  8. Radiology, Beijing Ji Shui Tan hospital, Beijing, China

    X. Cheng

  9. National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA, USA

    C. J. O’Donnell

  10. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    U. Hoffmann

  11. Department of Radiology, University of California San Francisco, and Synarc, Inc., San Francisco, CA, USA

    H. K. Genant

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  1. E. J. Samelson
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Correspondence to E. J. Samelson.

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Samelson, E.J., Christiansen, B.A., Demissie, S. et al. Reliability of vertebral fracture assessment using multidetector CT lateral scout views: the Framingham Osteoporosis Study. Osteoporos Int 22, 1123–1131 (2011). https://doi.org/10.1007/s00198-010-1290-6

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