Underdiagnosis of vertebral fractures is a worldwide problem: The IMPACT study
Underdiagnosis of vertebral fractures is a worldwide problem: The IMPACT study
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DOI：
10.1359/jbmr.041214
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发表时间：
2005-04-01
影响因子：
6.2
通讯作者：
Cahall, DL
中科院分区：
文献类型：
--
作者：
Delmas, PD;van de Langerijt, L;Cahall, DL
准确的影像学诊断对脊椎骨折是很重要的。这项多中心、多国研究评估了2451名绝经后骨质疏松妇女的脊椎骨折影像学诊断。地方和中央读数之间的比较产生了34%的假阴性率。脊椎骨折的漏诊是一个世界性的问题。前言：脊椎骨折是骨质疏松症最常见的并发症。虽然它们与显著的发病率相关，但它们通常不引起临床注意。准确的影像学诊断是important.Materials和方法：在一个多中心，多国前瞻性研究（IMPACT试验），影像学诊断椎体骨折的准确性进行了评估，在绝经后妇女65-80岁的新诊断为骨质疏松症（基于BMD测量）。采用经验证的半定量方法，评价胸腰椎侧位X线片以识别椎体骨折，首先在局部，随后在中央阅读中心。假阳性和假阴性率是根据当地研究中心的初始判读与随后的中心阅读（视为“参考标准”）之间的裁定差异计算的。“结果：在2451名具有中央和局部可评估X光照片的女性中，789人（32%）至少有一处椎骨骨折。裁定的差异350例患者中，由于未发现椎体骨折（68%）或当地放射学报告中的术语不明确（32%），导致当地和中心读数之间的假阴性率为34%。（假阴性率：北美45.2%;拉丁美洲46.5%;欧洲/南非/澳大利亚29.5%）。全球假阳性率为5%。脊椎骨折的漏诊是一个世界性的问题，部分原因是缺乏影像学检查，在放射学报告中使用模糊的术语，或两者兼而有之。努力提高准确性，减少术语和解释的变异性，可能会增加脊柱X线摄影检测骨质疏松症患者椎体骨折的有效性。
Accurate radiographic diagnosis of vertebral fractures is important. This multicenter, multinational study assessed radiographic diagnoses of vertebral fracture in 2451 postmenopausal women with osteoporosis. Comparison between local and central readings yielded a false-negative rate of 34%. Underdiagnosis of vertebral fracture is a worldwide problem.Introduction: Vertebral fractures are the most common complication of osteoporosis. Although they are associated with significant morbidity, they frequently do not come to clinical attention. Accurate radiographic diagnosis is important.Materials and Methods: In a multicenter, multinational prospective study (the IMPACT trial), the accuracy of radiographic diagnosis of vertebral fracture was evaluated in postmenopausal women 65-80 years of age newly diagnosed with osteoporosis (based on BMD measurement). Lateral radiographs of the thoracolumbar spine were evaluated for identification of vertebral fractures, first locally and subsequently at a central reading center, using a validated semiquantitative method. False-positive and false-negative rates were calculated based on adjudicated discrepancies between the initial interpretation at the local site and the subsequent central reading, considered the "reference standard."Results: Of 2451 women with an evaluable radiograph both centrally and locally, 789 (32%) had at least one vertebral fracture. Adjudicated discrepancies (n = 350 patients) between local and central readings because of undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%.Conclusions: Underdiagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America, 45.2%; Latin America, 46.5%; Europe/South Africa/Australia, 29.5%). The false-positive rate was 5% globally. Underdiagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection, use of ambiguous terminology in the radiology report, or both. Efforts to improve accuracy and reduce variability in terminology and interpretation may increase the effectiveness of spinal radiography for detecting vertebral fractures in patients with osteoporosis.