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Agreement between semi-automatic radiographic morphometry and Genant semi-quantitative method in the assessment of vertebral fractures

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Abstract

Summary

Semi-automatic morphometry is highly reproducible and not time intensive; however, no study has evaluated agreement between semi-automated morphometric methods and the Genant semi-quantitative method performed as a rule by radiologists. Our study shows substantial agreement between both methods; however, semi-automatic morphometry upgrades mild deformities and overestimates the prevalence of fractures.

Introduction

The aim of this study was to evaluate the agreement between radiologists using the Genant semi-quantitative (SQ) method and semi-automated morphometry in the diagnosis of vertebral fractures in post-menopausal women.

Methods

Cross-sectional study was conducted in 2006–2007 in an age-stratified population-based sample of 824 post-menopausal women over the age of 50. From this population two sets of 95 and 50 X-ray were randomly extracted to test inter-rater agreement and agreement between SQ and semi-automated morphometry, and vertebral fractures were classified according to both methods. The Genant method was used to homogenise the diagnosis of fractures. Agreement was evaluated with weighted kappa. We evaluated each vertebral body independently and also the whole vertebral column (T4–L4) classifying women into the worst grade of fracture. For the qualitative interpretation of the agreement, we used the criteria described by Landis and Koch (Biometrics 33:159–174, 1977).

Results

The radiologists' agreement was 98.4% (Kappa, 0.75; 95% CI, 0.42–0.89). Agreement between semi-automated morphometry and SQ reached 97.6% and Kappa was 0.86 (95% CI, 0.66–0.94). In the whole evaluation of the spine semi-automated morphometry overestimates, the prevalence of fractures compared with the radiologists were 15.8% of women with fractures and 7.4% of women with moderate–severe fractures by semi-automated morphometry vs. 8.4% and 3.2% by the SQ method. The negative predictive value for MorphoXpress was 99% while the positive was 40%.

Conclusions

Semi-automated morphometry shows high reliability and a substantial agreement with the SQ approach but overestimates the prevalence of fractures. Its role in routine clinical practice is limited because positive results should be reassessed by qualitative or semi-quantitative methods.

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Acknowledgments

The FRAVO Study was funded by the General Directorate for Health Organization, Evaluation and Research (Project 0018/2005) and the General Directorate for Public Health of the Ministry of Health of the Autonomous Government of Valencia and a non-conditioned research grant from Sanofi-Aventis.

Conflicts of interest

None of the sponsors played any role in the design of the study, the collection, analysis or interpretation of data, the writing of the manuscript or in the decision to submit it for publication. JSG and SP have received research grants from various pharmaceutical companies and fees for participation in scientific meetings sponsored by pharmaceutical companies.

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Authors and Affiliations

  1. Health Services Research Unit, Centro Superior de Investigación en Salud Pública (CSISP), Avda. Cataluña 21, 46020, Valencia, Spain

    J. Sanfélix-Genovés, G. Sanfélix-Gimeno & S. Peiró

  2. Departamento de Salud 5, Centro de Salud de Nazaret, Agencia Valenciana de la Salud, Valencia, Spain

    J. Sanfélix-Genovés

  3. Red Española de Investigadores de la Espalda, Fundación Instituto de Investigación en Servicios de Salud, Valencia, Spain

    E. Arana

  4. Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, Spain

    M. Graells-Ferrer & M. Vega-Martínez

  5. Departamento de Salud 10, Agencia Valenciana de la Salud, Valencia, Spain

    M. Graells-Ferrer & M. Vega-Martínez

Authors
  1. J. Sanfélix-Genovés
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  2. E. Arana
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  3. G. Sanfélix-Gimeno
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  4. S. Peiró
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  5. M. Graells-Ferrer
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  6. M. Vega-Martínez
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Correspondence to J. Sanfélix-Genovés.

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Sanfélix-Genovés, J., Arana, E., Sanfélix-Gimeno, G. et al. Agreement between semi-automatic radiographic morphometry and Genant semi-quantitative method in the assessment of vertebral fractures. Osteoporos Int 23, 2129–2134 (2012). https://doi.org/10.1007/s00198-011-1819-3

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  • DOI: https://doi.org/10.1007/s00198-011-1819-3

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