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

• Published in: Osteoporosis international Vol. 29; no. 6; pp. 1285 - 1293
• Main Authors: van Dort, M. J., Romme, E. A. P. M., Smeenk, F. W. J. M., Geusens, P. P. P. M., Wouters, E. F. M., van den Bergh, J. P.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.06.2018; Springer Nature B.V
• Subjects: Chest; Chronic obstructive pulmonary disease; Computed tomography; Diagnosis; Dual energy X-ray absorptiometry; Endocrinology; Lung diseases; Medical diagnosis; Medical screening; Medicine; Medicine & Public Health; Obstructive lung disease; Original; Original Article; Orthopedics; Osteoporosis; Rheumatology; Spine; Spine (thoracic); Vertebrae; Vertebral fracture; Osteoporosis; Screening; Vertebral deformity; DXA; COPD
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-018-4412-1

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.