Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 5/2017

Open Access 01-05-2017 | Paediatric

Diagnostic accuracy of DXA compared to conventional spine radiographs for the detection of vertebral fractures in children

Authors: E. Adiotomre, L. Summers, A. Allison, S. J. Walters, M. Digby, P. Broadley, I. Lang, G. Morrison, N. Bishop, P. Arundel, A. C. Offiah

Published in: European Radiology | Issue 5/2017

Login to get access

Abstract

Objectives

In children, radiography is performed to diagnose vertebral fractures and dual energy x-ray absorptiometry (DXA) to assess bone density. In adults, DXA assesses both. We aimed to establish whether DXA can replace spine radiographs in assessment of paediatric vertebral fractures.

Methods

Prospectively, lateral spine radiographs and lateral spine DXA of 250 children performed on the same day were independently scored by three radiologists using the simplified algorithm-based qualitative technique and blinded to results of the other modality. Consensus radiograph read and second read of 100 random images were performed. Diagnostic accuracy, inter/intraobserver and intermodality agreements, patient/carer experience and radiation dose were assessed.

Results

Average sensitivity and specificity (95 % confidence interval) in diagnosing one or more vertebral fractures requiring treatment was 70 % (58–82 %) and 97 % (94–100 %) respectively for DXA and 74 % (55–93 %) and 96 % (95–98 %) for radiographs. Fleiss’ kappa for interobserver and average kappa for intraobserver reliability were 0.371 and 0.631 respectively for DXA and 0.418 and 0.621 for radiographs. Average effective dose was 41.9 μSv for DXA and 232.7 μSv for radiographs. Image quality was similar.

Conclusion

Given comparable image quality and non-inferior diagnostic accuracy, lateral spine DXA should replace conventional radiographs for assessment of vertebral fractures in children.

Key Points

• Vertebral fracture diagnostic accuracy of lateral spine DXA is non-inferior to radiographs.
• The rate of unreadable vertebrae for DXA is lower than for radiographs.
• Effective dose of DXA is significantly lower than radiographs.
• Children prefer DXA to radiographs.
• Given the above, DXA should replace radiographs for paediatric vertebral fracture assessment.
Literature
1.
Rajaraman P, Simpson J, Neta G et al (2011) Early life exposure to diagnostic radiation and ultrasound scans and risk of childhood cancer: case-control study. Br Med J 342:d472CrossRef
2.
Blake GM, Naeem M, Boutros M (2006) Comparison of effective dose to children and adults from dual X-ray absorptiometry examinations. Bone 38:935–942CrossRefPubMed
3.
Mathews JD, Forsythe AV, Brady Z et al (2013) Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. Br Med J 346:f2360CrossRef
4.
Bajaj M, Offiah AC (2015) Imaging in suspected child abuse: necessity or radiation hazard? Arch Dis Child 100:1163–1168CrossRefPubMed
5.
6.
Ozasa K, Shimizu Y, Suyama A et al (2012) Studies of the mortality of atomic bomb survivors, Report 14, 1950-2003: an overview of cancer and noncancer diseases. Radiat Res 177:229–243CrossRefPubMed
7.
Ronckers CM, Doody MM, Lonstein JE, Stovall M, Land CE (2008) Multiple diagnostic X-rays for spine deformities and risk of breast cancer. Cancer Epidemiol Biomarkers Prev 17:605–613CrossRefPubMed
8.
Boice JD Jr, Preston D, Davis FG, Monson RR (1991) Frequent chest X-ray fluoroscopy and breast cancer incidence among tuberculosis patients in Massachusetts. Radiat Res 125:214–222CrossRefPubMed
9.
10.
Van Aalst J, Jeukens CR, Vles JS et al (2013) Diagnostic radiation exposure in children with spinal dysraphism: an estimation of the cumulative effective dose in a cohort of 135 children from the Netherlands. Arch Dis Child 98:680–685CrossRefPubMed
11.
Genant HK, Li J, Wu CY, Shepherd JA (2000) Vertebral fractures in osteoporosis: a new method for clinical assessment. J Clin Densitom 3:281–290CrossRefPubMed
12.
Lewiecki EM, Laster AJ (2006) Clinical review: clinical applications of vertebral fracture assessment by dual-energy x-ray absorptiometry. J Clin Endocrinol Metab 91:4215–4222CrossRefPubMed
13.
Buehring B, Krueger D, Checovich M et al (2010) Vertebral fracture assessment: impact of instrument and reader. Osteoporos Int 21:487–494CrossRefPubMed
14.
Hospers IC, van der Laan JG, Zeebregts CJ et al (2009) Vertebral fracture assessment in supine position: comparison by using conventional semiquantitative radiography and visual radiography. Radiology 251:822–828CrossRefPubMed
15.
Schousboe JT, Debold CR (2006) Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int 17:281–289CrossRefPubMed
16.
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 16:1513–1518CrossRefPubMed
17.
Rea JA, Chen MB, Li J et al (2000) Morphometric X-ray absorptiometry and morphometric radiography of the spine: a comparison of prevalent vertebral deformity identification. J Bone Miner Res 15:564–574CrossRefPubMed
18.
Ferrar L, Jiang G, Eastell R, Peel NF (2003) Visual identification of vertebral fractures in osteoporosis using morphometric X-ray absorptiometry. J Bone Miner Res 18:933–938CrossRefPubMed
19.
Vokes TJ, Dixon LB, Favus MJ (2003) Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int 14:871–878CrossRefPubMed
20.
Pavlov L, Gamble GD, Reid IR (2005) Comparison of dual-energy X-ray absorptiometry and conventional radiography for the detection of vertebral fractures. J Clin Densitom 8:379–385CrossRefPubMed
21.
Fuerst T, Wu C, Genant HK et al (2009) Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting. Osteoporos Int 20:1199–1205CrossRefPubMed
22.
Diacinti D, Del Fiacco R, Pisani D et al (2012) Diagnostic performance of vertebral fracture assessment by the lunar iDXA scanner compared to conventional radiography. Calcif Tissue Int 91:335–342CrossRefPubMed
23.
Jager PL, Jonkman S, Koolhaas W, Stiekema A, Wolffenbuttel BH, Slart RH (2011) Combined vertebral fracture assessment and bone mineral density measurement: a new standard in the diagnosis of osteoporosis in academic populations. Osteoporos Int 22:1059–1068CrossRefPubMed
24.
Damiano J, Kolta S, Porcher R, Tournoux C, Dougados M, Roux C (2006) Diagnosis of vertebral fractures by vertebral fracture assessment. J Clin Densitom 9:66–71CrossRefPubMed
25.
Schousboe JT, Shepherd JA, Bilezikian JP, Baim S (2013) Executive summary of the 2013 ISCD position development conference on bone densitometry. J Clin Densitom 16:455–467CrossRefPubMed
26.
Bishop N, Arundel P, Clark E et al (2014) Fracture prediction and the definition of osteoporosis in children and adolescents: the ISCD 2013 pediatric official positions. J Clin Densitom 17:275–280CrossRefPubMed
27.
Mäyränpää MK, Helenius I, Valta H, Mäyränpää MI, Toiviainen-Salo S, Mäkitie O (2007) Bone densitometry in the diagnosis of vertebral fractures in children: accuracy of vertebral fracture assessment. Bone 41:353–359CrossRefPubMed
28.
Vokes T, Bachman D, Baim S (2006) Vertebral fracture assessment: the 2005 ISCD Official Positions. J Clin Densitom 9:37–46CrossRefPubMed
29.
Lentle BS, Brown JP, Khan A et al (2007) Recognizing and reporting vertebral fractures: reducing the risk of future osteoporotic fractures. Can Assoc Radiol J 58:27–36PubMed
30.
31.
32.
Diacinti D, Pisani D, D'Avanzo M et al (2015) Reliability of vertebral fractures assessment (VFA) in children with osteogenesis imperfecta. Calcif Tissue Int 96:307–312CrossRefPubMed
33.
Kyriakou A, Shepherd S, Mason A, Faisal Ahmed S (2015) A critical appraisal of vertebral fracture assessment in paediatrics. Bone 81:255–259CrossRefPubMed
34.
Siminoski K, Lentle B, Matzinger A, Shenouda N, Ward L (2014) The Canadian STOPP Consortium. Observer agreement in pediatric semiquantitative vertebral fracture diagnosis. Pediatr Radiol 44:457–466CrossRefPubMed
35.
Melhem E, Assi A, El Rachkidi R, Ghanem I (2016) EOS(®) biplanar X-ray imaging: concept, developments, benefits, and limitations. J Child Orthop 10:1–14CrossRefPubMedPubMedCentral
36.
McKenna C et al (2012) EOS 2D/3D X-ray imaging system: a systematic review and economic evaluation. Health Technol Assess 16:1–188CrossRefPubMedCentral
37.
38.
Bankler AA, Levine D, Halpem EF, Kressel HY (2010) Consensus interpretation in imaging research: Is there a better way? Radiology 257:14–17CrossRef
39.
Rutjes AWA, Reitsma JB, Coomarsamy A, Khan KS, Bossuyt PM (2007) Evaluation of diagnostic tests when there is no gold standard. A review of methods. Health Technol Assess 11:9–51CrossRef
40.
41.
Metadata
Title
Diagnostic accuracy of DXA compared to conventional spine radiographs for the detection of vertebral fractures in children
Authors
E. Adiotomre
L. Summers
A. Allison
S. J. Walters
M. Digby
P. Broadley
I. Lang
G. Morrison
N. Bishop
P. Arundel
A. C. Offiah
Publication date
01-05-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4556-3

Other articles of this Issue 5/2017

European Radiology 5/2017 Go to the issue

Computer Applications

Multicentre external validation of the BIMC model for solid solitary pulmonary nodule malignancy prediction

Computed Tomography

Feasibility of spectral shaping for detection and quantification of coronary calcifications in ultra-low dose CT

Oncology

Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus 90Y-radioembolization for hepatocellular carcinoma

Chest

Volume-based quantification using dual-energy computed tomography in the differentiation of thymic epithelial tumours: an initial experience

Gastrointestinal

The value of diffusion kurtosis magnetic resonance imaging for assessing treatment response of neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Neuro

Multifrequency magnetic resonance elastography of the brain reveals tissue degeneration in neuromyelitis optica spectrum disorder