Skip Navigation LinksHome > December 15, 2013 - Volume 38 - Issue 26 > Comprehensive Vertebral Deformity and Vertebral Fracture Ass...
doi: 10.1097/BRS.0000000000000048

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*

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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

© 2013 by Lippincott Williams & Wilkins

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