Lateral vertebral assessment: a valuable technique to detect clinically significant vertebral fractures
Lateral vertebral assessment: a valuable technique to detect clinically significant vertebral fractures
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DOI：
10.1007/s00198-005-1891-7
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发表时间：
2005-12-01
影响因子：
4
通讯作者：
Drezner, MK
中科院分区：
文献类型：
--
作者：
Binkley, N;Krueger, D;Drezner, MK
虽然许多椎体骨折在临床上是无症状的，但它们与随后发生骨质疏松性骨折的风险增加有关。其中相当数量的骨折可以通过使用霍洛氏密度计的即时椎体评估来显示。使用GE月球密度计的双能量侧位椎体评估(LVA)是否有可能进行类似的识别仍不确定。因此，我们评估了临床医生使用LVA检测常见椎体骨折的能力。对80例绝经后妇女同时行双能LVA和常规胸腰椎X线片检查。使用建立的视觉半定量系统，由两名非放射科临床医生在LVA图像上单独识别椎体骨折，并将结果与专家放射科医生的脊柱X线片评估进行比较。使用LVA，T7至L4椎体95%可评价，但T4至T6椎体大部分(66%)不能充分显示。在LVA可评估的椎体中，40个椎体通过X线片发现了普遍的骨折。在这方面，临床医生使用LVA发现了18个放射学上明显的2级或3级椎体骨折中的17个，假阴性率为6%。他们确定了50%(11/22)的1级骨折。此外，绝大多数可评价的未骨折椎体(764/794，96.2%)被LVA正确分类为正常。因此，使用LVA的临床医生正确地识别了绝大多数2级或3级椎体压缩骨折和正常椎体，尽管对1级骨折的检测效果较差。总之，低辐射、双能量LVA技术为临床医生提供了一种快速、方便的方法来识别是否有2级或3级椎体骨折的患者，从而加强了对骨质疏松患者的护理。
Although many vertebral fractures are clinically silent, they are associated with increased risk for subsequent osteoporotic fractures. A substantial number of these fractures are demonstrable using instant vertebral assessment with Hologic densitometers. Whether similar recognition is possible using dual-energy lateral vertebral assessment (LVA) with GE Lunar densitometers remains uncertain. Thus, we evaluated the ability of clinicians using LVA to detect prevalent vertebral fractures. Dual-energy LVA and conventional thoracic and lumbar spine radiographs were concurrently obtained in 80 postmenopausal women. Using an established visual semiquantitative system, vertebral fractures were identified individually by two non-radiologist clinicians on LVA images, and the results were compared with spinal radiograph evaluation by an expert radiologist. Using LVA, 95% of vertebral bodies from T7 through L4 were evaluable, but a majority (66%) of vertebrae from T4 to T6 were not adequately visualized. In the LVA-evaluable vertebrae, prevalent fractures were identified in 40 vertebral bodies by radiography. In this regard, the clinicians using LVA detected 17 of 18 radiographically evident vertebral fractures of grade 2 or 3, a false negative rate of 6%. They identified 50% (11/22) of grade 1 fractures. Additionally, the vast majority of evaluable non-fractured vertebrae, (764/794, 96.2%) were correctly classified as normal by LVA. Thus, clinicians utilizing LVA correctly identified the vast majority of grade 2 or 3 vertebral compression fractures and normal vertebral bodies, although detection of grade 1 fractures was less effective. In conclusion, the low-radiation, dual-energy LVA technique provides a rapid and convenient way for clinicians to identify patients with, and without, grade 2 or 3 vertebral fractures, thereby enhancing care of osteoporotic patients.