Institutional members access full text with Ovid®

Comprehensive Vertebral Deformity and Vertebral Fracture Assessment in Clinical Practice: Intra- and Inter-Reader Agreement of a Clinical Workflow Tool

Guglielmi, Giuseppe MD, PhD*,†; Haslam, Jane PhD; D'Errico, Francesco RT; Steiger, Peter PhD§; Nasuto, Michelangelo MD*

doi: 10.1097/BRS.0000000000000048
Diagnostics

Study Design. Study design randomized intra- and inter-reader reproducibility study.

Objective. To evaluate reproducibility of quantitative morphometry (QM) and agreement of dichotomous fracture/no-fracture status on lateral spinal radiographs acquired during routine clinical practice using a clinical workflow tool.

Summary of Background Data. Several recent guidelines have underlined the importance of Genant semi-quantitative scoring and selective QM to confirm and grade suspected vertebral fractures in clinical practice.

Methods. Thoracic and lumbar spine radiographs were acquired from 98 consecutive subjects (mean age, 60.1 ± 11.7 yr) attending the clinic for osteoporosis evaluation. For each subject, QM and Genant semi-quantitative scoring were performed on all evaluable vertebrae from L4 to T4 using a software workflow tool. A radiologist and an experienced radiographical technician performed 2 repeat reading sessions of the radiographs 12 months apart, blinded to each other's results; for the second read, the cases were anonymized and the order was randomized.

Results. Inter-reader reproducibility results were 3.1% and 3.2% coefficient of variation (%) for heights, 0.030 and 0.031 root mean square standard deviation for height ratios. For intrareader reproducibility, these values were 2.2% and 3.5% coefficient of variation %; 0.023 and 0.034 root mean square standard deviation. Kappa score results for agreement of dichotomous fracture/no-fracture status were 0.67 and 0.72 (inter-rater) and 0.50 and 0.67 (intrarater).

Conclusion. The software assessed in this study is a reliable clinical tool that facilitates QM and Genant semi-quantitative scoring of the spine in routine clinical practice.

Level of Evidence: 3

We evaluated reproducibility of quantitative morp hometry (QM) and agreement of fracture/no-fracture status on lateral spinal radiographs acquired during routine practice using a clinical workflow tool. The software assessed in this study is a reliable clinical tool that facilitates QM and Genant SQ scoring of the spine in routine clinical practice.

*Department of Radiology, University of Foggia, Viale Luigi Pinto, Foggia, Italy

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

Optasia Medical Ltd, Mellor House, Cheadle Hulme, Cheadle, United Kingdom; and

§Optasia Medical Inc, Sudbury, MA.

Address correspondence and reprint requests to Giuseppe Guglielmi, MD, PhD, Department of Radiology, University of Foggia, Viale Luigi Pinto, 171120, Foggia, Italy; E-mail: giuseppe.guglielmi@unifg.it

Acknowledgment date: May 28, 2013. First revision date: September 6, 2013. Acceptance date: September 16, 2013.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership.

© 2013 by Lippincott Williams & Wilkins