Andreas Kyriakou1, Sheila Shepherd2, Avril Mason3, S Faisal Ahmed4. 1. Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), 1345 Govan Road, Glasgow G51 4TF, United Kingdom. Electronic address: Andreas.Kyriakou@glasgow.ac.uk. 2. Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), 1345 Govan Road, Glasgow G51 4TF, United Kingdom. Electronic address: Sheila.Shepherd@glasgow.ac.uk. 3. Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), 1345 Govan Road, Glasgow G51 4TF, United Kingdom. Electronic address: avrilmason@nhs.net. 4. Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), 1345 Govan Road, Glasgow G51 4TF, United Kingdom. Electronic address: faisal.ahmed@glasgow.ac.uk.
Abstract
PURPOSE: There is a need to improve our understanding of the clinical utility of vertebral fracture assessment (VFA) in paediatrics and this requires a thorough evaluation of its readability, reproducibility, and accuracy for identifying VF. METHODS: VFA was performed independently by two observers, in 165 children and adolescents with a median age of 13.4 years (range, 3.6, 18). In 20 of these subjects, VFA was compared to lateral vertebral morphometry assessment on lateral spine X-ray (LVM). RESULTS: 1528 (84%) of the vertebrae were adequately visualised by both observers for VFA. Interobserver agreement in vertebral readability was 94% (kappa, 0.73 [95% CI, 0.68, 0.73]). 93% of the non-readable vertebrae were located between T6 and T9. Interobserver agreement per-vertebra for the presence of VF was 99% (kappa, 0.85 [95% CI, 0.79, 0.91]). Interobserver agreement per-subject was 91% (kappa, 0.78 [95% CI, 0.66, 0.87]). Per-vertebra agreement between LVM and VFA was 95% (kappa 0.79 [95% CI, 0.62, 0.92]) and per-subject agreement was 95% (kappa, 0.88 [95% CI, 0.58, 1.0]). Accepting LVM as the gold standard, VFA had a positive predictive value (PPV) of 90% and a negative predictive value (NPV) of 95% in per-vertebra analysis and a PPV of 100% and NPV of 93% in per-subject analysis. CONCLUSION: VFA reaches an excellent level of agreement between observers and a high level of accuracy in identifying VF in a paediatric population. The readability of vertebrae at the mid thoracic region is suboptimal and interpretation at this level should be exercised with caution.
PURPOSE: There is a need to improve our understanding of the clinical utility of vertebral fracture assessment (VFA) in paediatrics and this requires a thorough evaluation of its readability, reproducibility, and accuracy for identifying VF. METHODS: VFA was performed independently by two observers, in 165 children and adolescents with a median age of 13.4 years (range, 3.6, 18). In 20 of these subjects, VFA was compared to lateral vertebral morphometry assessment on lateral spine X-ray (LVM). RESULTS: 1528 (84%) of the vertebrae were adequately visualised by both observers for VFA. Interobserver agreement in vertebral readability was 94% (kappa, 0.73 [95% CI, 0.68, 0.73]). 93% of the non-readable vertebrae were located between T6 and T9. Interobserver agreement per-vertebra for the presence of VF was 99% (kappa, 0.85 [95% CI, 0.79, 0.91]). Interobserver agreement per-subject was 91% (kappa, 0.78 [95% CI, 0.66, 0.87]). Per-vertebra agreement between LVM and VFA was 95% (kappa 0.79 [95% CI, 0.62, 0.92]) and per-subject agreement was 95% (kappa, 0.88 [95% CI, 0.58, 1.0]). Accepting LVM as the gold standard, VFA had a positive predictive value (PPV) of 90% and a negative predictive value (NPV) of 95% in per-vertebra analysis and a PPV of 100% and NPV of 93% in per-subject analysis. CONCLUSION: VFA reaches an excellent level of agreement between observers and a high level of accuracy in identifying VF in a paediatric population. The readability of vertebrae at the mid thoracic region is suboptimal and interpretation at this level should be exercised with caution.
Authors: David R Weber; Alison Boyce; Catherine Gordon; Wolfgang Högler; Heidi H Kecskemethy; Madhusmita Misra; Diana Swolin-Eide; Peter Tebben; Leanne M Ward; Halley Wasserman; Christopher Shuhart; Babette S Zemel Journal: J Clin Densitom Date: 2019-07-10 Impact factor: 2.617
Authors: Tasma Harindhanavudhi; Anna Petryk; Richard Jones; Amanda Regodón Wallin; James S Hodges; Sara Van Nortwick; Bradley S Miller; Tara L Holm; Kyriakie Sarafoglou Journal: J Investig Med Date: 2018-04-04 Impact factor: 2.895
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 Journal: Eur Radiol Date: 2016-09-21 Impact factor: 5.315