M. Takada et al., Vertebral fracture assessment using the lateral scoutview of computed tomography in comparison with radiographs, OSTEOPOR IN, 8(3), 1998, pp. 197-203
Semiquantitative vertebral fracture assessment was compared between lateral
computed tomography (CT) scoutviews and conventional thoracolumbar spinal
radiographs. Vertebral levels T4-L4 were assessed by both techniques in a g
roup of 56 women (mean age 60 +/- 13 years). In order to compare inter- and
intraobserver variabilities for the two techniques, the images were analyz
ed twice by two independent observers, and percentage agreement and kappa s
tatistics were measured both between readings and between observers. Percen
tage agreement and kappa statistics were also used to quantify differences
between techniques. In the CT scoutviews, noise and artifacts from overlyin
g tissues in the thoracic spinal levels rendered 3.4% of the vertebrae unre
adable for the first observer and 8.3% for the second observer. For the CT
scoutviews the agreement between readings was 98.1%, 97.3% and 100% (kappa
= 0.87, 0.83 and 1.0) on T4-L12, T4-12 and L1-4, respectively for the first
observer, and 97.8%, 97.1% and 99.5% (kappa = 0.79, 0.73 and 0.92) for the
second observer. For the lateral radiographs, the agreement between readin
gs was 97.7%, 96.9% and 100% (rc = 0.87, 0.85 and 1.0) on T4-L12, T4-12 and
L1-4, respectively for the first observer, and 98.4%, 97.7% and 99.5% (kap
pa = 0.86, 0.82 and 0.95) for the second observer. The agreement between ob
servers was 96.1%, 94.4% and 100% (kappa = 0.68, 0.58 and 1.0) on T4- L12,
T4-12 and L1-4, respectively for the CT scoutviews and 96.8%, 95.9% and 99.
0% (kappa = 0.79, 0.76 and 0.91) for the lateral radiographs. The inter-tec
hnique was 95.8%, 94.2% and 99.5% (kappa = 0.73, 0.68 and 0.95) on T4-L12,
T4-12 and L1-4, respectively for the first observer and 95.6%, 94.2% and 99
.0% (kappa = 0.64, 0.55 and 0.90) for the second observer, with the scoutvi
ew technique detecting, on average, 23% fewer fractures than the lateral ra
diographs. Although the vertebral fracture detection in lumbar spine is qui
te comparable to that of conventional radiographs, given its reduced sensit
ivity for vertebral fracture detection in thoracic spine, the lateral CT sc
outview technique should not be substituted for conventional radiographs wh
ere diagnosis of all vertebral fractures is of primary importance.