Daniele Diacinti1, Claudio Vitali2, Gualberto Gussoni3, Daniela Pisani4, Luigi Sinigaglia5, Gerolamo Bianchi6, Ranuccio Nuti7, Luigi Gennari7, Stefano Pederzoli8, Maddalena Grazzini9, Antonella Valerio3, Antonino Mazzone10, Carlo Nozzoli9, Mauro Campanini11, Carlina V Albanese12. 1. Department of Radiological Sciences, Oncology and Anatomo-Pathology, University Sapienza, Rome, Italy. Electronic address: daniele.diacinti@uniroma1.it. 2. Internal Medicine, Hospital of Piombino, Livorno, Italy. 3. FADOI Foundation, Research Department, Milan, Italy. 4. Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University Sapienza Rome, Italy. 5. Rheumatology, "G. Pini" Institute, Milan, Italy. 6. Department of Locomotor System, Division of Rheumatology, ASL3 - Azienda Sanitaria Genovese, Genoa, Italy. 7. Department of Medical, Surgical and Neurological Sciences, University of Siena, Italy. 8. Area Medica, Hospital of Sassuolo, Modena, Italy. 9. Department of Internal Medicine, AOU "Careggi", Florence, Italy. 10. Department of Internal Medicine, Legnano Hospital, Legnano, Italy. 11. Department of Internal Medicine, Hospital "Maggiore della Carità", Novara, Italy. 12. Department of Radiological Sciences, Oncology and Anatomo-Pathology, University Sapienza, Rome, Italy.
Abstract
BACKGROUND: Osteoporotic vertebral fractures (VFs) are often misdiagnosed because asymptomatic and occurring in the absence of specific trauma. Further, diagnostic assessment of VFs may be suboptimal. AIM OF THE STUDY: To assess the misdiagnosis of vertebral fractures on local radiographic readings in the cohort of patients enrolled in the POINT study. METHODS: We enrolled hospitalised patients, admitted for any cause to the Internal Medicine Units of 37 hospitals participating to the cross-sectional previously published POINT study. The assessment of VFs was performed both by local radiologists and by two expert skeletal radiologists, by using semiquantitative method (SQ). To better evaluate mild vertebral deformities, the two central radiologists also used the algorithm-based qualitative assessment (ABQ). RESULTS: The radiographs of 661 patients (401 females; mean age 75.8±8.0) were evaluated. The inter-reader percent agreement between two central expert radiologists per-vertebra assessment was excellent (99.78%; k=0.984; 95% CI, 0.977-0.991). Central reading identified 318/661 (48.1%) patients with at least one VF. Local and central readings agreed in 502/661 (75.9%) patients, resulting in a fair reproducibility (k=0.52; 95% confidence interval 0.44-0.59). Diagnostic performance parameters of local readings were: sensitivity 76.1%; specificity 75.8%; PPV 74.46%; NPV 77.38%). By examining 9254 vertebrae, central and local readers diagnosed 665 (7.2%) and 562 (6.1%) VFs respectively. Misdiagnosis (102 false positives and 205 false negatives) mainly occurred for mild VFs. Local readings identified correctly 460 out 665 VFs diagnosed by central readings, resulting in sensitivity of 69.2% and PPV of 81.8%. CONCLUSIONS: Following a standardized protocol of acquisition techniques and of interpretation criteria, an excellent agreement between local and central readings for moderate and severe vertebral fractures resulted. However a significant amount of mild vertebral fractures, that are the most of VFs, were misdiagnosed by local radiologists. In order to improve VFs assessment, the radiologists should be trained and sensitized in relation to the relevant clinical significance of osteoporotic VFs identification.
BACKGROUND:Osteoporotic vertebral fractures (VFs) are often misdiagnosed because asymptomatic and occurring in the absence of specific trauma. Further, diagnostic assessment of VFs may be suboptimal. AIM OF THE STUDY: To assess the misdiagnosis of vertebral fractures on local radiographic readings in the cohort of patients enrolled in the POINT study. METHODS: We enrolled hospitalised patients, admitted for any cause to the Internal Medicine Units of 37 hospitals participating to the cross-sectional previously published POINT study. The assessment of VFs was performed both by local radiologists and by two expert skeletal radiologists, by using semiquantitative method (SQ). To better evaluate mild vertebral deformities, the two central radiologists also used the algorithm-based qualitative assessment (ABQ). RESULTS: The radiographs of 661 patients (401 females; mean age 75.8±8.0) were evaluated. The inter-reader percent agreement between two central expert radiologists per-vertebra assessment was excellent (99.78%; k=0.984; 95% CI, 0.977-0.991). Central reading identified 318/661 (48.1%) patients with at least one VF. Local and central readings agreed in 502/661 (75.9%) patients, resulting in a fair reproducibility (k=0.52; 95% confidence interval 0.44-0.59). Diagnostic performance parameters of local readings were: sensitivity 76.1%; specificity 75.8%; PPV 74.46%; NPV 77.38%). By examining 9254 vertebrae, central and local readers diagnosed 665 (7.2%) and 562 (6.1%) VFs respectively. Misdiagnosis (102 false positives and 205 false negatives) mainly occurred for mild VFs. Local readings identified correctly 460 out 665 VFs diagnosed by central readings, resulting in sensitivity of 69.2% and PPV of 81.8%. CONCLUSIONS: Following a standardized protocol of acquisition techniques and of interpretation criteria, an excellent agreement between local and central readings for moderate and severe vertebral fractures resulted. However a significant amount of mild vertebral fractures, that are the most of VFs, were misdiagnosed by local radiologists. In order to improve VFs assessment, the radiologists should be trained and sensitized in relation to the relevant clinical significance of osteoporotic VFs identification.
Authors: Yì Xiáng J Wáng; Min Deng; James F Griffith; Anthony W L Kwok; Jason C S Leung; Patti M S Lam; Blanche Wai Man Yu; Ping Chung Leung; Timothy C Y Kwok Journal: Quant Imaging Med Surg Date: 2022-03
Authors: Yì Xiáng J Wáng; Davide Diacinti; Jason C S Leung; Antonio Iannacone; Endi Kripa; Timothy C Y Kwok; Daniele Diacinti Journal: Arch Osteoporos Date: 2021-11-16 Impact factor: 2.617
Authors: Nazmi Che-Nordin; Min Deng; James F Griffith; Jason C S Leung; Anthony W L Kwok; Yue-Qi Zhu; Richard H Y So; Timothy C Y Kwok; Ping Chung Leung; Yì Xiáng J Wáng Journal: Ann Transl Med Date: 2018-11
Authors: Veena Aggarwal; Christina Maslen; Richard L Abel; Pinaki Bhattacharya; Paul A Bromiley; Emma M Clark; Juliet E Compston; Nicola Crabtree; Jennifer S Gregory; Eleni P Kariki; Nicholas C Harvey; Kate A Ward; Kenneth E S Poole Journal: Ther Adv Musculoskelet Dis Date: 2021-07-10 Impact factor: 5.346