Comparison of four morphometric definitions and a semiquantitative consensus reading for assessing prevalent vertebral fractures
Comparison of four morphometric definitions and a semiquantitative consensus reading for assessing prevalent vertebral fractures
复制标题
DOI：
10.1007/s001980170046
复制
发表时间：
2001-01-01
影响因子：
4
通讯作者：
Fardellone, P
中科院分区：
文献类型：
--
作者：
Grados, F;Roux, C;Fardellone, P
在过去的 10 年里，使用 Genant 等人设计的半定量 (SQ) 方法，通过传统放射线照相术对骨质疏松症患者椎骨骨折的评估得到了改进。或定量形态测量。然而。对于椎体骨折，目前还没有国际公认的定义，而且这些不同方法之间的比较研究也很少。我们的研究评估了 SQ 方法和四种常用形态测量算法（Melton 法、Eastell 法、Minne 法和 McCloskey 法）评估常见椎体骨折的可重复性。并检查了每种形态测量算法与三位专家执行的 SQ 共识读数的一致性。通过这种共识读数代替金标准，我们确定了每种形态测量算法的灵敏度、特异性和最佳截止阈值的相对测量值。该研究针对 39 名至少患有骨质疏松性椎体骨折的绝经后女性进行。正常值来自 84 名椎体明显正常的健康绝经后妇女。我们的结果表明，SQ 方法的一致性非常好（连续 X 光照片的观察者内一致性 = 96.4%。kappa = 0.91；个体读数与共识读数之间的一致性为 98%，kappa = 0.95）。三种形态测量方法表现出良好的观察者内和观察者间一致性（Melton：连续 X 光照片观察者内一致性 = 92.7％，kappa = 0.82，观察者间一致性 = 91.1％，kappa = 0.79，Eastell：连续 X 光照片观察者内一致性 = 87.6％。kappa = 0.66。观察者间一致性 = 88.6％，kappa = 0.68，McCloskey：连续 X 线照片观察者内一致性 = 91.5%，kappa = 0.72，观察者间一致性 = 93.9%，kappa = 0.78）。除 McCloskey 方法外，我们的研究中通过最高 kappa 分数或 Youden 指数与 SQ 共识读数相比定义的最佳截止阈值接近任意固定的截止阈值。四种形态测量算法与 SQ 共识读数的结果非常吻合。但更复杂的算法并没有提供更好的结果，即使我们调整了截止阈值，也没有形态测量算法与 SQ 共识读数完全一致。我们的结论是，目前使用的形态测量方法不应单独用于检测骨质疏松症研究中常见的椎骨骨折，而应与视觉评估结合使用。 SQ 方法允许对椎体畸形进行鉴别诊断，并且已证明具有更好的重现性，当由经验丰富且训练有素的读者执行时，可以单独使用。
The assessment of vertebral fracture in patients with osteoporosis by conventional radiography has been improved over the past 10 years using either the semiquantitative (SQ) method devised by Genant et al. or quantitative morphometry. However. there is still no internationally agreed definition for vertebral fracture and there have been few comparative studies between these different approaches. Our study assessed the reproducibility of the SQ method and of four commonly used morphometric algorithms (Melton's. Eastell's, Minne's and McCloskey's methods) for assessing prevalent vertebral fractures. and examined the agreement of each morphometric algorithm with a SQ consensus reading performed by three experts. With this consensus reading in place of a gold standard, we determined relative measures of sensitivity, specificity and optimal cutoff threshold for each morphometric algorithm. The study was conducted in 39 postmenopausal women who had at least one osteoporotic vertebral fracture. Normal values were derived from 84 healthy postmenopausal women with apparently normal vertebral bodies. Our results indicate that the concordance of SQ method was excellent (intraobserver agreement on serial radiographs = 96.4%. kappa = 0.91; agreement between individual readings and the consensus reading 98%, kappa = 0.95). Three morphometric approaches demonstrated good intra- and interobserver concordance (Melton: intraobserver agreement on serial radiographs = 92.7%, kappa = 0.82, interobserver agreement = 91.1%, kappa = 0.79, Eastell: intraobserver agreement on serial radiographs = 87.6%. kappa = 0.66. interobserver agreement = 88.6%, kappa = 0.68, McCloskey: intraobserver agreement on serial radiographs = 91.5%, kappa = 0.72, interobserver agreement = 93.9%, kappa = 0.78). Except for McCloskey's method., the optimal cutoff thresholds defined in our study by highest kappa score or Youden index in comparison with the SQ consensus reading were near the cutoff thresholds that were arbitrarily fixed. The four morphometric algorithms provided a good agreement with the results of the SQ consensus reading. but the more complex algorithm did not provide better results and even if we adjusted the cutoff threshold, no morphometric algorithm agreed perfectly with the SQ consensus reading. We conclude that morphometric approaches currently used should not be employed alone to detect prevalent vertebral fractures in studies on osteoporosis, but should rather be used in combination with a visual assessment. The SQ approach that allows differential diagnosis of vertebral deformities and has demonstrated a better reproducibility can be employed alone when it is performed by experienced and well-trained readers.