Inter-observer and inter-examination variability of manual vertebral bone attenuation measurements on computed tomography

• Published in: European radiology Vol. 26; no. 9; pp. 3046 - 3053
• Main Authors: Pompe, Esther, de Jong, Pim A., de Jong, Werner U., Takx, Richard A. P., Eikendal, Anouk L. M., Willemink, Martin J., Oudkerk, Matthijs, Budde, Ricardo P. J., Lammers, Jan-Willem J., Mohamed Hoesein, Firdaus A. A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2016; Springer Nature B.V
• Subjects: Aged; Agreements; Bone density; Cardiovascular disease; Diagnostic Radiology; Early Detection of Cancer; Female; Fractures; Humans; Imaging; Internal Medicine; Interventional Radiology; Lumbar Vertebrae - physiology; Lumbar Vertebrae - radiation effects; Lung cancer; Lung Neoplasms - diagnostic imaging; Male; Medical screening; Medicine; Medicine & Public Health; Middle Aged; Mortality; Musculoskeletal; Neuroradiology; Observer Variation; Osteoporosis; Osteoporosis - diagnostic imaging; Radiation Dosage; Radiology; Reproducibility of Results; Retrospective Studies; Tomography; Tomography, X-Ray Computed - methods; Ultrasound; Vertebrae; Netherlands; Osteoporosis; Inter-observer variability; Bone mineral density; Computed tomography; Intra-observer variability
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-015-4145-x

Objective To determine inter-observer and inter-examination variability of manual attenuation measurements of the vertebrae in low-dose unenhanced chest computed tomography (CT). Methods Three hundred and sixty-seven lung cancer screening trial participants who underwent baseline and repeat unenhanced low-dose CT after 3 months because of an indeterminate lung nodule were included. The CT attenuation value of the first lumbar vertebrae (L1) was measured in all CTs by one observer to obtain inter-examination reliability. Six observers performed measurements in 100 randomly selected CTs to determine agreement with limits of agreement and Bland-Altman plots and reliability with intraclass correlation coefficients (ICCs). Reclassification analyses were performed using a threshold of 110 HU to define osteoporosis. Results Inter-examination reliability was excellent with an ICC of 0.92 ( p  < 0.001). Inter-examination limits of agreement ranged from -26 to 28 HU with a mean difference of 1 ± 14 HU. Inter-observer reliability ICCs ranged from 0.70 to 0.91. Inter-examination variability led to 11.2 % reclassification of participants and inter-observer variability led to 22.1 % reclassification. Conclusions Vertebral attenuation values can be manually quantified with good to excellent inter-examination and inter-observer reliability on unenhanced low-dose chest CT. This information is valuable for early detection of osteoporosis on low-dose chest CT. Key Points • Vertebral attenuation values can be manually quantified on low-dose unenhanced CT reliably. • Vertebral attenuation measurements may be helpful in detecting subclinical low bone density. • This could become of importance in the detection of osteoporosis.