Bone Abstracts

Purpose: We aimed to assess observer reliability and diagnostic accuracy in children, of a semi-automated 6-point technique developed for vertebral fracture diagnosis in adults, which records percentage loss of vertebral body height.

Methods: Reading 137 spine radiographs of children and adolescents, diagnostic accuracy (sensitivity, specificity and 95% confidence interval) calculations of five observers’ for SpineAnalyzer were calculated. Comparison was made with a previously established consensus arrived at by three experienced pediatric radiologists using a simplified algorithm based qualitative scoring system (sABQ).

Results: Of a total of 1781 vertebrae, 1187 (67%) were adequately visualized by 3 or more observers. Overall, 20 (15%) patients had one or more VF (vertebral height loss 20% or more). Interobserver agreement in vertebral readability for each vertebral level for five observers ranged from 0.05 to 0.47 (95% CI, −0.19, 0.76). Intraobserver agreement using the intraclass correlation coefficient (ICC) ranged from 0.25 to 0.61. Overall sensitivity and specificity were 18% (95% CI, 14–22) and 97% (95% CI, 97–98) respectively (Fig. 1).

Figure 1 (a) False positive SpineAnalyzer result. Wedging of T7 and T8 as indicated by SpineAnalyzer was reported by the consensus expert panel as physiological, rather than pathological wedging. (b) False negative SpineAnalyzer result. T11, T12 and L2 were reported by the consensus expert panel as fractured but were scored normal by SpineAnalyzer.

Conclusion: In contrast to adults, the six-point technique assessing anterior, middle and posterior vertebral height ratios is neither satisfactorily reliable nor sensitive for VF diagnosis in children. Training of the software on pediatric images is required, in order that a pediatric standard is developed which incorporates not only specific vertebral body height ratios but also the age-related physiological changes in vertebral shape that occur throughout childhood.

Disclosure: The authors declared no competing interests.