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Vertebral fracture severity assessment on anteroposterior radiographs with a new semi-quantitative technique

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Abstract

Summary

We developed a new tool to assess the severity of osteoporotic vertebral fracture using radiographs of the spine. Our technique can be used in patient care by helping to stratify patients with osteoporotic vertebral fractures into appropriate treatment pathways. It can also be used for research purposes.

Purpose

The aim of our study was to propose a semi-quantitative (SQ) grading scheme for osteoporotic vertebral fracture (OVF) on anteroposterior (AP) radiographs.

Methods

On AP radiographs, the vertebrae are divided into right and left halves, which are graded (A) vertical rectangle, (B) square, (C) traverse rectangle, and (D) trapezoid; whole vertebrae are graded (E) transverse band or (F) bow-tie. Type A and B were compared with normal and Genant SQ grade 1 OVF, Type C and D with grade 2 OVF, and Type E and F with grade 3 OVF. Spine AP radiographs and lateral radiographs of 50 females were assessed by AP radiographs SQ grading. After training, an experienced board-certified radiologist and a radiology trainee assessed the 50 AP radiographs.

Results

The height-to-width ratio of the half vertebrae varied 1.32–1.48. On lateral radiographs, 84 vertebrae of the 50 patients had OVFs (38 grade 1, 24 grade 2, and 22 grade 3). On AP radiographs, the radiologist correctly assigned 84.2%, 91.7%, and 77.2% and the trainee correctly assigned 68.4%, 79.2%, and 81.8% of grade 1, 2, and 3 OVFs, respectively. Compared with lateral radiographs, the radiologist had a weighted Kappa of 0.944 including normal vertebrae and 0.883 not including normal vertebrae, while the corresponding Kappa values for the trainee were 0.891 and 0.830, respectively.

Conclusion

We propose a new semi-quantitative grading system for vertebral fracture severity assessment on AP spine radiographs.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Department of Radiology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China

    W. Yu, W.-M. Guan & Q. Lin

  2. Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China

    W.-M. Guan

  3. Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA

    D. Hayashi

  4. Department of Radiology, Beijing Arion Cancer Center, Beijing, China

    Q. Lin

  5. Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Zhejiang Province, Wenzhou, China

    M.-M. Du

  6. Department of Endocrinology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China

    W.-B. Xia

  7. Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China

    Y.-X.J. Wang

  8. Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA

    A. Guermazi

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  1. W. Yu
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Corresponding author

Correspondence to W. Yu.

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Conflicts of interest

Ali Guermazi is the President of Boston Imaging Core Lab (BICL), LLC, and a consultant to Merck Serono, AstraZeneca, Pfizer, Galapagos, Roche, and Tissue Gene. Daichi Hayashi received publication royalties from Wolters Kluwer. Wei Yu, Wen-Min Guan, Qiang Lin, Mei-Mei Du, Wei-Bo Xia, and Yi-Xiang J Wang declare that they have no conflict of interest.

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Yu, W., Guan, WM., Hayashi, D. et al. Vertebral fracture severity assessment on anteroposterior radiographs with a new semi-quantitative technique. Osteoporos Int 35, 831–839 (2024). https://doi.org/10.1007/s00198-024-07024-5

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  • DOI: https://doi.org/10.1007/s00198-024-07024-5

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