Dennis M Hedderich1, Christian Maegerlein2, Thomas Baum2, Alexander Hapfelmeier3, Y-Mi Ryang4, Claus Zimmer2, Jan S Kirschke2. 1. Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. Electronic address: dennis.hedderich@tum.de. 2. Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 3. Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 4. Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Abstract
OBJECTIVES: To assess the ability of multislice detector computed tomography (MDCT) to differentiate old versus acute/subacute vertebral fractures (VF) and to identify characteristic MDCT imaging signs. METHODS: 74 consecutive patients demonstrated 192 VF that were classified as either acute/subacute or old based on magnetic resonance imaging, MDCT, and clinical information as reference standard. Classification as acute/subacute versus old fractures based on MDCT alone was evaluated on a Likert scale by 2 independent radiologists. Morphologic MDCT features of fractures, such as trabecular compaction or fracture line, were recorded. Receiver operating characteristic analyses and Cohen's κ were used to assess the discriminatory power of the MDCT and interrater agreement, respectively. RESULTS: Out of all 192 VF, 148 fractures were acute/subacute and 44 were old according to the reference standard. Receiver operating characteristic analyses of sole MDCT assessment showed very good identification of acute/subacute VF, with areas under the curve of 0.854 and 0.861 for readers 1 and 2, respectively. When indeterminate findings were treated as acute/subacute fractures, sensitivity and specificity were 97.2% and 58.1% for reader 1 and 94.5% and 65.1% for reader 2. Interrater agreement regarding fracture age was good (weighted Cohen's κ = 0.607). Trabecular compression/callus distinct from the cortex (double compaction sign) was present in approximately half of acute/subacute VF and highly specific for acute/subacute VF (specificity = 93.2% and 88.6% for readers 1 and 2, respectively). CONCLUSION: The acuity of VF can be assessed by MDCT alone with high sensitivity and in case of a double compaction sign with high specificity.
OBJECTIVES: To assess the ability of multislice detector computed tomography (MDCT) to differentiate old versus acute/subacute vertebral fractures (VF) and to identify characteristic MDCT imaging signs. METHODS: 74 consecutive patients demonstrated 192 VF that were classified as either acute/subacute or old based on magnetic resonance imaging, MDCT, and clinical information as reference standard. Classification as acute/subacute versus old fractures based on MDCT alone was evaluated on a Likert scale by 2 independent radiologists. Morphologic MDCT features of fractures, such as trabecular compaction or fracture line, were recorded. Receiver operating characteristic analyses and Cohen's κ were used to assess the discriminatory power of the MDCT and interrater agreement, respectively. RESULTS: Out of all 192 VF, 148 fractures were acute/subacute and 44 were old according to the reference standard. Receiver operating characteristic analyses of sole MDCT assessment showed very good identification of acute/subacute VF, with areas under the curve of 0.854 and 0.861 for readers 1 and 2, respectively. When indeterminate findings were treated as acute/subacute fractures, sensitivity and specificity were 97.2% and 58.1% for reader 1 and 94.5% and 65.1% for reader 2. Interrater agreement regarding fracture age was good (weighted Cohen's κ = 0.607). Trabecular compression/callus distinct from the cortex (double compaction sign) was present in approximately half of acute/subacute VF and highly specific for acute/subacute VF (specificity = 93.2% and 88.6% for readers 1 and 2, respectively). CONCLUSION: The acuity of VF can be assessed by MDCT alone with high sensitivity and in case of a double compaction sign with high specificity.
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Authors: F T Gassert; A Kufner; F G Gassert; Y Leonhardt; S Kronthaler; B J Schwaiger; C Boehm; M R Makowski; J S Kirschke; T Baum; D C Karampinos; A S Gersing Journal: Osteoporos Int Date: 2021-09-18 Impact factor: 4.507