Fracturas osteoporóticas vertebrales en la proyección lateral de tórax

Abstract

ObjectiveThis study was performed to determine the percentage of morphological changes considered as vertebral fractures due to osteoporosis in the lateral thorax projection of patients older than 50 years old who were attended for different medical reasons for spine problems in a third level hospital. MethodThree investigators evaluated 237 digital radiographs of the thorax of patients with a median age of 66.86 years (range 50-90) using 2 standardized methods sequentially: the Algorithm-Base Qualitative approach (ABQ) method and the Genant method. Each examiner used a similar resolution screen and evaluated the radiographs independently. ResultsThe cases included 152 females and 85 males. There were 23 fractures where the distribution by Genant method was 10 (6.5%) of grade 1, and only one (0.6%) of grade 2 for a total of 11 (7.2%) in the female group. In the male group there were 7 (8.2%) of grade 1, and 5 (5.8%) of grade 2 fractures, for a total of 12 (14.1%). The total number of grade 1 fractures was 17 (7.17%) and 6 (2.53%) grade 2. The fractures identified by ABQ method were 11 (7.2%) in the female group and 12 (14.1%) in the male group.The interobserver agreement for the 3 evaluators using the Genant method had a Kappa value of 0.88 (Z of 23.59 with p>Z of 0.0) and 0.9237 (Z of 24.63 with p>Z of 0.0) by ABQ method. The agreement for each evaluator respect the consensus of them for each method had a Kappa of 0.929 for the first and second evaluators, and 0.954 for the third. Whilst using the Genant method it was 0.911, 0.886 and 0.907, respectively. Both of them with P<.005.The intraobserver agreement had a Kappa value of 0.83 and 1 for the first evaluator, 0.704 and 0.86 for the second; and, 1 and 1 for the third evaluator for ABQ and Genant methods, respectively, with P<.005.The median age for grade 1 fractures (17 cases) was 72.17 years with range 60-90 (SD of 8.96 years), and for grade 2 (6 cases) it was 74 years with range 68-87 (SD of 6.72 years). ConclusionsThe percentage of morphological changes considered dorsal vertebral osteoporotic fractures was 9.7% (23 fractures), which was lower compared to that reported internationally. The distribution of the abnormalities by sex was similar in both groups and the inter- and intra-observer agreement using the 2 methods together was excellent.