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Open Access 01-06-2018 | Original Article

Diagnosis of vertebral deformities on chest CT and DXA compared to routine lateral thoracic spine X-ray

Authors: M. J. van Dort, E. A. P. M. Romme, F. W. J. M. Smeenk, P. P. P. M. Geusens, E. F. M. Wouters, J. P. van den Bergh

Published in: Osteoporosis International | Issue 6/2018

Abstract

Summary

X-ray, CT and DXA enable diagnosis of vertebral deformities. For this study, level of agreement of vertebral deformity diagnosis was analysed. We showed that especially on subject level, these imaging techniques could be used for opportunistic screening of vertebral deformities in COPD patients.

Introduction

X-ray and CT are frequently used for pulmonary evaluation in patients with chronic obstructive pulmonary disease (COPD) and also enable to diagnose vertebral deformities together with dual-energy X-ray absorptiometry (DXA) imaging. The aim of this research was to study the level of agreement of these imaging modalities for diagnosis of vertebral deformities from T4 to L1.

Methods

Eighty-seven subjects (mean age of 65; 50 males; 57 COPD patients) who had X-ray, chest CT (CCT) and DXA were included. Evaluable vertebrae were scored twice using SpineAnalyzer™ software. ICCs and kappas were calculated to examine intra-observer variability. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUROC) were calculated to compare vertebral deformities diagnosed on the different imaging modalities.

Results

ICCs for height measurements were excellent (> 0.94). Kappas were good to excellent (0.64–0.77). At vertebral level, the AUROC was 0.85 for CCT vs. X-ray, 0.74 for DXA vs. X-ray and 0.77 for DXA vs. CCT. Sensitivity (51%–73%) and PPV (57%–70%) were fair to good; specificity and NPV were excellent (≥ 96%). At subject level, the AUROC values were comparable.

Conclusions

Reproducibility of height measurements of vertebrae is excellent with all three imaging modalities. On subject level, diagnostic performance of CT (PPV 79–82%; NPV 90–93%), and to a slightly lesser extend of DXA (PPV 73–77%; NPV 80–89%), indicates that these imaging techniques could be used for opportunistic screening of vertebral deformities in COPD patients.

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Okazaki R, Watanabe R, Inoue D (2016) Osteoporosis associated with chronic obstructive pulmonary disease. J Bone Metab 23(3):111–120. https://doi.org/10.11005/jbm.2016.23.3.111 CrossRefPubMedPubMedCentral

Conradie M, Conradie MM, Scher AT, Kidd M, Hough S (2015) Vertebral fracture prevalence in black and white south African women. Arch Osteoporos 10(1):203. https://doi.org/10.1007/s11657-015-0203-x CrossRefPubMed

Marwaha RK, Tandon N, Gupta Y, Bhadra K, Narang A, Mani K, Mithal A, Kukreja S (2012) The prevalence of and risk factors for radiographic vertebral fractures in older Indian women and men: Delhi vertebral osteoporosis study (DeVOS). Arch Osteoporos 7(1-2):201–207. https://doi.org/10.1007/s11657-012-0098-8 CrossRefPubMed

Tracy JK, Meyer WA, Grigoryan M, Fan B, Flores RH, Genant HK, Resnik C, Hochberg MC (2006) Racial differences in the prevalence of vertebral fractures in older men: the Baltimore Men's osteoporosis study. Osteoporos Int 17(1):99–104. https://doi.org/10.1007/s00198-005-1919-z CrossRefPubMed

Jorgensen NR, Schwarz P, Holme I, Henriksen BM, Petersen LJ, Backer V (2007) The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: a cross sectional study. Respir Med 101(1):177–185. https://doi.org/10.1016/j.rmed.2006.03.029 CrossRefPubMed

McEvoy CE, Ensrud KE, Bender E, Genant HK, Yu W, Griffith JM, Niewoehner DE (1998) Association between corticosteroid use and vertebral fractures in older men with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 157(3 Pt 1):704–709. https://doi.org/10.1164/ajrccm.157.3.9703080 CrossRefPubMed

Nuti R, Siviero P, Maggi S, Guglielmi G, Caffarelli C, Crepaldi G, Gonnelli S (2009) Vertebral fractures in patients with chronic obstructive pulmonary disease: the EOLO study. Osteoporos Int 20(6):989–998. https://doi.org/10.1007/s00198-008-0770-4 CrossRefPubMed

Ogura-Tomomatsu H, Asano K, Tomomatsu K, Miyata J, Ohmori N, Kodama M, Ueda S, Takihara T, Tanaka K, Kamiishi N, Suzuki Y, Fukunaga K, Oguma T, Sayama K, Betsuyaku T (2012) Predictors of osteoporosis and vertebral fractures in patients presenting with moderate-to-severe chronic obstructive lung disease. Copd 9(4):332–337. https://doi.org/10.3109/15412555.2012.667850 CrossRefPubMed

Papaioannou A, Parkinson W, Ferko N, Probyn L, Ioannidis G, Jurriaans E, Cox G, Cook RJ, Kumbhare D, Adachi JD (2003) Prevalence of vertebral fractures among patients with chronic obstructive pulmonary disease in Canada. Osteoporos Int 14(11):913–917. https://doi.org/10.1007/s00198-003-1449-5 CrossRefPubMed

10.

Watanabe R, Tanaka T, Aita K, Hagiya M, Homma T, Yokosuka K, Yamakawa H, Yarita T, Tai N, Hirano J, Inoue D, Okazaki R (2015) Osteoporosis is highly prevalent in Japanese males with chronic obstructive pulmonary disease and is associated with deteriorated pulmonary function. J Bone Miner Metab 33(4):392–400. https://doi.org/10.1007/s00774-014-0605-7 CrossRefPubMed

11.

Pluijm SM, Tromp AM, Smit JH, Deeg DJ, Lips P (2000) Consequences of vertebral deformities in older men and women. J Bone Miner Res 15(8):1564–1572. https://doi.org/10.1359/jbmr.2000.15.8.1564 CrossRefPubMed

12.

Cortet B, Roches E, Logier R, Houvenagel E, Gaydier-Souquieres G, Puisieux F, Delcambre B (2002) Evaluation of spinal curvatures after a recent osteoporotic vertebral fracture. Joint Bone Spine 69(2):201–208CrossRefPubMed

13.

Wei Y, Tian W, Zhang GL, Lv YW, Cui GY (2017) Thoracolumbar kyphosis is associated with compressive vertebral fracture in postmenopausal women. Osteoporos Int 28(6):1925–1929. https://doi.org/10.1007/s00198-017-3971-x CrossRefPubMed

14.

Ismail AA, Cockerill W, Cooper C, Finn JD, Abendroth K, Parisi G, Banzer D, Benevolenskaya LI, Bhalla AK, Armas JB, Cannata JB, Delmas PD, Dequeker J, Dilsen G, Eastell R, Ershova O, Falch JA, Felsch B, Havelka S, Hoszowski K, Jajic I, Kragl U, Johnell O, Lopez Vaz A, Lorenc R, Lyritis G, Marchand F, Masaryk P, Matthis C, Miazgowski T, Pols HA, Poor G, Rapado A, Raspe HH, Reid DM, Reisinger W, Janott J, Scheidt-Nave C, Stepan J, Todd C, Weber K, Woolf AD, Ambrecht G, Gowin W, Felsenberg D, Lunt M, Kanis JA, Reeve J, Silman AJ, O'Neill TW (2001) Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European prospective osteoporosis study. Osteoporos Int 12(2):85–90. https://doi.org/10.1007/s001980170138 CrossRefPubMed

15.

Karlsson MK, Kherad M, Hasserius R, Nilsson JA, Redlund-Johnell I, Ohlsson C, Lorentzon M, Mellstrom D, Rosengren BE (2016) Characteristics of prevalent vertebral fractures predict new fractures in elderly men. J Bone Joint Surg Am 98(5):379–385. https://doi.org/10.2106/JBJS.15.00328 CrossRefPubMed

16.

Schousboe JT, Vo T, Taylor BC, Cawthon PM, Schwartz AV, Bauer DC, Orwoll ES, Lane NE, Barrett-Connor E, Ensrud KE (2016) Prediction of incident major osteoporotic and hip fractures by trabecular bone score (TBS) and prevalent radiographic vertebral fracture in older men. J Bone Miner Res 31(3):690–697. https://doi.org/10.1002/jbmr.2713 CrossRefPubMed

17.

Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of osteoporotic fractures research group. J Bone Miner Res 14(5):821–828. https://doi.org/10.1359/jbmr.1999.14.5.821 CrossRefPubMed

18.

Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285(3):320–323. https://doi.org/10.1001/jama.285.3.320 CrossRefPubMed

19.

Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15(1):38–42. https://doi.org/10.1007/s00198-003-1490-4 CrossRefPubMed

20.

Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR (1999) Vertebral fractures and mortality in older women: a prospective study. Study of osteoporotic fractures research group. Arch Intern Med 159(11):1215–1220. https://doi.org/10.1001/archinte.159.11.1215 CrossRefPubMed

21.

Harrison RA, Siminoski K, Vethanayagam D, Majumdar SR (2007) Osteoporosis-related kyphosis and impairments in pulmonary function: a systematic review. J Bone Miner Res 22(3):447–457. https://doi.org/10.1359/jbmr.061202 CrossRefPubMed

22.

Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR (2000) Recognition of vertebral fracture in a clinical setting. Osteoporos Int 11(7):577–582. https://doi.org/10.1007/s001980070078 CrossRefPubMed

23.

Kim YM, Demissie S, Eisenberg R, Samelson EJ, Kiel DP, Bouxsein ML (2011) Intra-and inter-reader reliability of semi-automated quantitative morphometry measurements and vertebral fracture assessment using lateral scout views from computed tomography. Osteoporos Int 22(10):2677–2688. https://doi.org/10.1007/s00198-011-1530-4 CrossRefPubMed

24.

Takada M, Wu CY, Lang TF, Genant HK (1998) Vertebral fracture assessment using the lateral scoutview of computed tomography in comparison with radiographs. Osteoporos Int 8(3):197–203. https://doi.org/10.1007/s001980050054 CrossRefPubMed

25.

Lee JH, Cho SK, Han M, Lee S, Kim JY, Ryu JA, Choi YY, Bae SC, Sung YK (2014) Validity and role of vertebral fracture assessment in detecting prevalent vertebral fracture in patients with rheumatoid arthritis. Joint Bone Spine 81(2):149–153. https://doi.org/10.1016/j.jbspin.2013.07.003 CrossRefPubMed

26.

Lee JH, Lee YK, Oh SH, Ahn J, Lee YE, Pyo JH, Choi YY, Kim D, Bae SC, Sung YK, Kim DY (2016) A systematic review of diagnostic accuracy of vertebral fracture assessment (VFA) in postmenopausal women and elderly men. Osteoporos Int 27(5):1691–1699. https://doi.org/10.1007/s00198-015-3436-z CrossRefPubMed

27.

Romme EA, Murchison JT, Phang KF, Jansen FH, Rutten EP, Wouters EF, Smeenk FW, Van Beek EJ, Macnee W (2012) Bone attenuation on routine chest CT correlates with bone mineral density on DXA in patients with COPD. J Bone Miner Res 27(11):2338–2343. https://doi.org/10.1002/jbmr.1678 CrossRefPubMed

28.

Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J (2007) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 176(6):532–555. https://doi.org/10.1164/rccm.200703-456SO CrossRefPubMed

29.

CBO (2011) Richtlijn Osteoporose en fractuurpreventie derde herziening (2011). http://www.ephor.nl/media/1112/richtlijn-osteoporose-28-04-2011.pdf

30.

Brett A, Miller CG, Hayes CW, Krasnow J, Ozanian T, Abrams K, Block JE, van Kuijk C (2009) Development of a clinical workflow tool to enhance the detection of vertebral fractures: accuracy and precision evaluation. Spine (Phila Pa 1976) 34(22):2437–2443. https://doi.org/10.1097/BRS.0b013e3181b2eb69 CrossRef

31.

van der Velde R, Ozanian T, Dumitrescu B, Haslam J, Staal J, Brett A, van den Bergh J, Geusens P (2015) Performance of statistical models of shape and appearance for semiautomatic segmentations of spinal vertebrae T4-L4 on digitized vertebral fracture assessment images. Spine J 15(6):1248–1254. https://doi.org/10.1016/j.spinee.2015.02.018 CrossRefPubMed

32.

Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148. https://doi.org/10.1002/jbmr.5650080915 CrossRefPubMed

33.

Cicchetti C (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6(4):284–290. https://doi.org/10.1037/1040-3590.6.4.284 CrossRef

34.

Bazzocchi A, Spinnato P, Fuzzi F, Diano D, Morselli-Labate AM, Sassi C, Salizzoni E, Battista G, Guglielmi G (2012) Vertebral fracture assessment by new dual-energy X-ray absorptiometry. Bone 50(4):836–841. https://doi.org/10.1016/j.bone.2012.01.018 CrossRefPubMed

35.

Binkley N, Krueger D, Gangnon R, Genant HK, Drezner MK (2005) Lateral vertebral assessment: a valuable technique to detect clinically significant vertebral fractures. Osteoporos Int 16(12):1513–1518. https://doi.org/10.1007/s00198-005-1891-7 CrossRefPubMed

36.

Damiano J, Kolta S, Porcher R, Tournoux C, Dougados M, Roux C (2006) Diagnosis of vertebral fractures by vertebral fracture assessment. J Clin Densitom 9(1):66–71. https://doi.org/10.1016/j.jocd.2005.11.002 CrossRefPubMed

37.

Diacinti D, Del Fiacco R, Pisani D, Todde F, Cattaruzza MS, Arima S, Romagnoli E, Pepe J, Cipriani C, Minisola S (2012) Diagnostic performance of vertebral fracture assessment by the lunar iDXA scanner compared to conventional radiography. Calcif Tissue Int 91(5):335–342. https://doi.org/10.1007/s00223-012-9643-0 CrossRefPubMed

38.

Diacinti D, Guglielmi G, Pisani D, Argiro R, Serafini C, Romagnoli E, Minisola S, Catalano C, David V (2012) Vertebral morphometry by dual-energy X-ray absorptiometry (DXA) for osteoporotic vertebral fractures assessment (VFA). Radiol Med 117(8):1374–1385. https://doi.org/10.1007/s11547-012-0835-5 CrossRefPubMed

39.

Domiciano DS, Figueiredo CP, Lopes JB, Kuroishi ME, Takayama L, Caparbo VF, Fuller P, Menezes PF, Scazufca M, Bonfa E, Pereira RM (2013) Vertebral fracture assessment by dual X-ray absorptiometry: a valid tool to detect vertebral fractures in community-dwelling older adults in a population-based survey. Arthritis Care Res (Hoboken) 65(5):809–815. https://doi.org/10.1002/acr.21905 CrossRef

40.

Hospers IC, van der Laan JG, Zeebregts CJ, Nieboer P, Wolffenbuttel BH, Dierckx RA, Kreeftenberg HG, Jager PL, Slart RH (2009) Vertebral fracture assessment in supine position: comparison by using conventional semiquantitative radiography and visual radiography. Radiology 251(3):822–828. https://doi.org/10.1148/radiol.2513080887 CrossRefPubMed

41.

Rea JA, Li J, Blake GM, Steiger P, Genant HK, Fogelman I (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11(8):660–668. https://doi.org/10.1007/s001980070063 CrossRefPubMed

42.

Chapurlat RD, Duboeuf F, Marion-Audibert HO, Kalpakcioglu B, Mitlak BH, Delmas PD (2006) Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporos Int 17(8):1189–1195. https://doi.org/10.1007/s00198-006-0121-2 CrossRefPubMed

43.

Sullivan S, Wagner J, Resnick NM, Nelson J, Perera SK, Greenspan SL (2011) Vertebral fractures and the misclassification of osteoporosis in men with prostate cancer. J Clin Densitom 14(3):348–353. https://doi.org/10.1016/j.jocd.2011.05.003 CrossRefPubMedPubMedCentral

44.

Vokes TJ, Dixon LB, Favus MJ (2003) Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int 14(11):871–878. https://doi.org/10.1007/s00198-003-1461-9 CrossRefPubMed

45.

Deleskog L, Laursen NO, Nielsen BR, Schwarz P (2016) Vertebral fracture assessment by DXA is inferior to X-ray in clinical severe osteoporosis. Osteoporos Int 27(7):2317–2326. https://doi.org/10.1007/s00198-016-3532-8 CrossRefPubMed

Title: Diagnosis of vertebral deformities on chest CT and DXA compared to routine lateral thoracic spine X-ray
Authors: M. J. van Dort
E. A. P. M. Romme
F. W. J. M. Smeenk
P. P. P. M. Geusens
E. F. M. Wouters
J. P. van den Bergh
Publication date: 01-06-2018
Publisher: Springer London
Published in: Osteoporosis International / Issue 6/2018
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-018-4412-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnosis of vertebral deformities on chest CT and DXA compared to routine lateral thoracic spine X-ray

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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