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Vertebral morphometry by dual-energy X-ray absorptiometry (DXA) for osteoporotic vertebral fractures assessment (VFA)

Morfometria vertebrale con tecnica assorbimetrica a raggi X a doppia energia (DXA) per la valutazione delle fratture vertebrali da osteoporosi (VFA)

  • Musculoskeletal Radiology / Radiologia Muscolo-Scheletrica
  • Published:
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Abstract

Purpose

This study was done to evaluate the diagnostic accuracy of dual-energy X-ray absorptiometry (DXA) compared with conventional radiography for identifying vertebral fractures.

Materials and methods

A total of 930 postmenopausal women underwent conventional radiography and DXA imaging of the spine. The images were evaluated by two expert skeletal radiologists using the semiquantitative (SQ) method for conventional radiography and the morphometric vertebral fracture assessment (VFA) for DXA.

Results

The SQ method for radiography (SQ-Rx) analysed 99.1% of vertebrae, identifying 442 vertebral fractures; VFA analysed 97.5% vertebrae, detecting 420 vertebral fractures. Agreement between SQ-Rx and VFA reached 98.76%, and the κ-score was 0.96 [95% confidence interval (CI), 0.95–0.98]. Assessing the grading of vertebral fractures, agreement reached 97.5% and the κ-score was 0.841 (95% CI, 0.821–0.891). Considering SQ-Rx method as “gold standard”, VFA had a sensitivity of 97.85 % and a specificity of 99.81%. The negative (NPV) and positive (PPV) predictive value for VFA were 99.83 % and 98.15%, respectively. Fractures were identified in 251 (27 %) and 242 (26 %) of patients on SQ-Rx and VFA, respectively. On a per-patient basis, the agreement between the two methods was 97% and the κ-score was 0.95 (95% CI, 0.920–0.968). The diagnostic parameters for VFA were 97.23% sensitivity, 98.86% specificity, 97.60% PPV and 98.84% NPV.

Conclusions

This study demonstrated that VFA with DXA may reach a high level of accuracy for diagnosing vertebral fractures, suggesting that VFA should be introduced in the screening of individuals with a risk of osteoporosis and in the follow-up of osteoporotic patients receiving treatment.

Riassunto

Obiettivo

Scopo del presente lavoro è stato valutare l’accuratezza diagnostica della tecnica assorbimetrica a raggi X a doppia energia (DXA) a confronto con la radiologia convenzionale per la identificazione delle fratture vertebrali.

Materiali e metodi

Novecentotrenta donne in postmenopausa sono state sottoposte ad esame radiologico convenzionale e ad esame DXA del rachide. Le immagini sono state valutate da due radiologi esperti dello scheletro utilizzando rispettivamente il metodo semiquantitativo per l’esame radiologico (SQ-Rx) e la valutazione morfometrica vertebrale (VFA) per l’esame DXA.

Risultati

Il metodo SQ-Rx ha analizzato il 99,1% delle vertebre, identificando 442 fratture vertebrali; VFA ha analizzato il 97,5% delle vertebre identificando 420 fratture vertebrali; la concordanza tra i due metodi è risultata pari al 98,76% con k-score di 0,96; [95% intervallo di confidenza (CI) 0,95–0,98]. Valutando il grado delle fratture vertebrali, la concordanza tra SQRx e VFA è risultata 97,5% con k-score 0,84 (95% CI 0,821–0,891). Considerando il metodo SQ-Rx come riferimento, la VFA aveva una sensibilità del 97,85% ed una specificità 99,81%. Il valore predittivo negativo (VPN) ed il valore predittivo positivo (VPP) erano 99,83% e 98,15%, rispettivamente. Duecentocinquantuno (27%) e 242 (26%) dei pazienti sono stati giudicati fratturati con il metodo SQ-Rx e con il metodo VFA, rispettivamente. Nella valutazione per paziente la concordanza tra le due tecniche era 97% (k-score: 0,948; 95% CI 0,920–0,968). I parametri diagnostici della VFA sono risultati: sensibilità 97,2%; specificità 98,9%; VPP 97,60%; VPN: 98,84%.

Conclusioni

Questo studio dimostra che la VFA mediante la tecnica DXA può avere una elevata accuratezza per la diagnosi delle fratture vertebrali, suggerendone l’introduzione nello screening dei soggetti a rischio di osteoporosi e nel follow-up terapeutico di pazienti osteoporotici.

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Authors and Affiliations

  1. Department of Radiology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    D. Diacinti, D. Diacinti, R. Argirò & C. Catalano

  2. Department of Radiology, Scientific Institute Hospital “Casa Sollievo della Sofferenza”, Viale Cappuccini 1, 71013, San Giovanni Rotondo, Foggia, Italy

    G. Guglielmi

  3. Department of Radiology, University of Foggia, Viale L. Pinto 1, 71100, Foggia, Italy

    G. Guglielmi

  4. Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’ Andrea Hospital, Via Grottarossa 1035, 00189, Rome, Italy

    D. Pisani

  5. Department of Clinical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    C. Serafini, E. Romagnoli & S. Minisola

  6. Department of Radiology, Sapienza University of Rome, Sant’Andrea Hospital, Via Grottarossa 1035, 00189, Rome, Italy

    V. David

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  1. D. Diacinti
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  8. S. Minisola
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  9. C. Catalano
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Correspondence to G. Guglielmi.

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Diacinti, D., Guglielmi, G., Pisani, D. et al. Vertebral morphometry by dual-energy X-ray absorptiometry (DXA) for osteoporotic vertebral fractures assessment (VFA). Radiol med 117, 1374–1385 (2012). https://doi.org/10.1007/s11547-012-0835-5

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  • DOI: https://doi.org/10.1007/s11547-012-0835-5

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