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Intra-and inter-reader reliability of semi-automated quantitative morphometry measurements and vertebral fracture assessment using lateral scout views from computed tomography

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Abstract

Summary

Intra-and inter-reader reliability of semi-automated quantitative vertebral morphometry measurements was determined using lateral computed tomography (CT) scout views. The method requires less time than conventional morphometry. Reliability was excellent for vertebral height measurements, good for height ratios, and comparable to semi-quantitative grading by radiologists for identification of vertebral fractures.

Introduction

Underdiagnosis and undertreatment of vertebral fracture (VFx) is a well-known problem worldwide. Thus, new methods are needed to facilitate identification of VFx. This study aimed to determine intra- and inter-reader reliability of semi-automated quantitative vertebral morphometry based on shape-based statistical modeling (SpineAnalyzer, Optasia Medical, Cheadle, UK).

Methods

Two non-radiologists independently assessed vertebral morphometry from CT lateral scout views at two time points in 96 subjects (50 men, 46 women, 70.3 ± 8.9 years) selected from the Framingham Heart Study Offspring and Third Generation Multi-Detector CT Study. VFxs were classified based solely on morphometry measurements using Genant's criteria. Intraclass correlation coefficients (ICCs), root mean squared coefficient of variation (RMS CV) and kappa (k) statistics were used to assess reliability.

Results

We analyzed 1,246 vertebrae in 96 subjects. The analysis time averaged 5.4 ± 1.7 min per subject (range, 3.2–9.1 min). Intra-and inter-reader ICCs for vertebral heights were excellent (>0.95) for all vertebral levels combined. Intra-and inter-reader RMS CV for height measurements ranged from 2.5% to 3.9% and 3.3% to 4.4%, respectively. Reliability of vertebral height ratios was good to fair. Based on morphometry measurements alone, readers A and B identified 51–52 and 46–59 subjects with at least one prevalent VFx, respectively, and there was a good intra-and inter-reader agreement (k = 0.59–0.69) for VFx identification.

Conclusions

Semi-automated quantitative vertebral morphometry measurements from CT lateral scout views are convenient and reproducible, and may facilitate assessment of VFx.

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Abbreviations

ABQ:

Algorithm-based approach for the qualitative identification of vertebral fracture

BMI:

Body mass index

CI:

Confidence interval

CT:

Computed tomography

CV:

Coefficient of variation

d B :

Biconcave deformity percentage

d C :

Crush deformity percentage

d W :

Wedge deformity percentage

DXA:

Dual energy X-ray absorptiometry

h A :

Height anterior

h M :

Height mid

h P :

Height posterior

ICCs:

Intraclass correlation coefficients

K :

Kappa

min:

Minutes

MRX:

Morphometric radiography

MXA:

Morphometric X-ray absorptiometry

QCT:

Quantitative computed tomography

QM:

Quantitative vertebral morphometry measurement

r B :

Biconcave ratio

r C :

Crush ratio

r W :

Wedge ratio

RMS CV:

Root mean squared CV

SQ:

Semi-quantitative

s:

Seconds

VFx:

Vertebral fracture

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Acknowledgments

This work was supported by grants from the National Institute for Arthritis, Musculoskeletal, and Skin Diseases (NIAMS) R01AR053986, NIAMS and the National Institute on Aging (NIA) R01AR/AG041398, and by the National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study (NIH/NHLBI Contract N01-HC-25195). We acknowledge the assistance of Peter Steiger, PhD of Optasia Medical.

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Kim, Y.M., Demissie, S., Eisenberg, R. et al. Intra-and inter-reader reliability of semi-automated quantitative morphometry measurements and vertebral fracture assessment using lateral scout views from computed tomography. Osteoporos Int 22, 2677–2688 (2011). https://doi.org/10.1007/s00198-011-1530-4

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