Abstract
In 100 patients (20 male, 80 female) radiographs of the lumbar spine were obtained in both planes, anteroposterior and lateral. Nine readers independently and without specific criteria or training assessed the radiographs for presence of osteopenia in the form of a binary decision. A posteroanterior dual x-ray absorptiometry (PA DXA) measurement of the lumbar spine was performed in all patients using the Hologic QDR 1000 bone densitometer. A bone mineral density (BMD) of 0.83 g/ cm2 (T-score about 2 SD and 2.5 SD lower than BMD in normal young female and male subjects respectively) was used as a threshold for the diagnosis of osteopenia. Complete agreement amongst the 9 readers was achieved in 43 patients. In 26 more patients at least 8 readers agreed, κ-coefficients for interobserver variation ranged from 0.458 to 0.691 for reader pairs. For agreement between the observer ratings and the DXA results, κ-coefficients ranging between 0.347 and 0.555 were found. The vast majority of readers agreed in the diagnosis of osteopenia in cases where the BMD was less than 0.73 g/cm2. Where the BMD was between 0.73 and 1.03 g/cm2 a substantial disagreement was found between reader evaluation and DXA measurement, and also amongst the readers. We conclude from our results that osteopenia can reliably be detected from lumbar spine radiographs by all readers only after a substantial amount of BMD is lost. On the other hand, a diagnosis based solely on PA DXA measurement of the spine may also lack accuracy, due to a substantial influence of degenerative changes of the lumbar spine and aortic calcification. Therefore, spine radiographs remain an important cornerstone in the detection and differential diagnosis of osteopenia.
Similar content being viewed by others
References
Ardran GM (1951) Bone destruction not demonstrable by radiography. Br J Radiol 24:107
Barnett E, Nordin BEC (1960) The radiological diagnosis of osteoporosis: a new approach. Clin Radiol 11:166
Cockshott WP, Park WM (1983) Observer variation in skeletal radiology. Skeletal Radiol 10:86
Consensus Development Conference (1991) Prophylaxis and treatment of osteoporosis. Osteoporosis Int 1:114
Doyle FH, Gutteridge DH, Joplin GF, Fraser R (1967) An assessment of radiological criteria used in the study of spinal osteoporosis. Br J Radiol 40:241
Drinka PJ, DeSmet AA, Bauwens SF, Rogot A (1992) The effect of overlying calcification on lumbar bone densitometry. Calcif Tissue Int 50:507
Eldevik OP, Dugstad G, Dorrison W, Haughton VM (1982) Effect of clinical bias on the interpretation of myelography and spinal computed tomography. Radiology 145:85
Epstein DM, Dalinka MK, Kaplan FS, Aronchick JM, Marinelli DL, Kundel HL (1986) Observer variation in the detection of osteopenia. Skeletal Radiol 15:347
Faulkner KG, Glüer CC, Majumdar S, Lang P, Engelke K, Genant HK (1991) Noninvasive measurements of bone mass, structure, and strength: current methods and experimental techniques. Am J Radiol 157:1229
Haller J, André MP, Resnick D, Miller C, Howard BA, Mitchell MJ, Schils JP, Sartoris DJ, Trudell D (1990) Detection of thoracolumbar vertebral body destruction with lateral spine radiography. Part I. Investigation in cadavers. Invest Radiol 25:517
Haller J, André MP, Resnick D, Miller C, Howard BA, Mitchell MJ, Schils JP, Sartoris DJ, Trudell D (1990) Detection of thoracolumbar vertebral body destruction with lateral spine radiography. Part II. Clinical investigation with computed tomography. Invest Radiol 25:523
Hurxthal LM, Vose GP, Dotter WE (1969) Densitometric and visual observations of spinal radiographs. Geriatrics 24:93
Kovarik J, Küster W, Seidl G, Linkesch W, Dorda W, Willvonseder R, Kotscher E (1981) Clinical relevance of radiologic examination of the skeleton and bone density measurements in osteoporosis of old age. Skeletal Radiol 7:37
Lachmann E, Whelan M (1936) The roentgen diagnosis of osteoporosis and its limitations. Radiology 26:165
Landis JR, Koch GG (1977) The measurement of observer agreement for categorial data. Biometrics 33:159
Michel BA, Lane NE, Jones HH, Fries JF, Bloch DA (1990) Plain radiographs can be useful in estimating lumbar bone density. J Rheumatol 17:528
Revicki DA, Israel RG (1986) Relationship between body mass indices and measures of body adiposity. Am J Public Health 76:992
Smith-Bindman R, Cummings SR, Steiger P, Genant HK (1991) A comparison of morphometric definitions of vertebral fracture. J Bone Min Res 6:25
Virtama P (1960) Uneven distribution of bone mineral and covering effect of non-mineralized tissue as reasons for impaired detectability of bone density from roentgenograms. Ann Med Int Fenn 49:57
Virtama P, Telkkä A, Helelä T (1965) Relative density of the vertebral endplates as an estimate of osteoporosis. Br J Radiol 38:360
Whitehouse RW, Karantanas A, Adams JE (1992) Discrepancies in spinal bone mass measured by QCT and DXA. In: Ring EFG (ed) Current research in osteoporosis and bone mineral measurement II: 1992. British Institute of Radiology, London, p 26
Williamson MR, Boyd CM, Williamson SL (1990) Osteoporosis: diagnosis by plain chest film versus dual photon bone densitometry. Skeletal Radiol 19:27
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jergas, M., Uffmann, M., Escher, H. et al. Interobserver variation in the detection of osteopenia by radiography and comparison with dual X-ray absorptiometry of the lumbar spine. Skeletal Radiol. 23, 195–199 (1994). https://doi.org/10.1007/BF00197459
Issue Date:
DOI: https://doi.org/10.1007/BF00197459