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| 运用定量形态学测量法检定原发性脊椎骨折 |
| The application of quantitative morphometry for assessment of prevalent vertebral fracuture: comparison with semiquantitative technique |
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| DOI： |
| 中文关键词: 半定量性评定法 定量形态学测量法 脊椎骨折 X线平片 |
| 英文关键词:Vertebral fracuture Semiquantitative assessment Quantitative morphometry |
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| 中文摘要: |
| 为比较半定量评定法(Visual Semiquantitative Assessment，SQ)与定量形态学测量法(Quantitative Morphometric Assessment，QM)对脊椎骨折的检测结果，随机抽样 400名用DXA测量有骨量减少的绝经后妇女。她们的侧位标准胸腰椎平片均由三位经培训的放射科医师评阅(使用同一骨折判定标准)。并由一位放射科医师运用“六点法”测量每一椎体的前、中、后高度(T4-L4)。QM法的骨折阈值分别定为低于正常人椎体高度比例的平均值的2.0,2.5,3.0,3.5和4.0个标准差(即2.0s，2.5s，3.0s，3.5s，4.0s)，分析两种方法所检出的骨折椎体,再由第4位放射科医师将由两种诊断方法存在差异的椎体重新分析以确定此椎体是否有骨折，此结果作为“诊断标准”(CR)。各放射科医师间的Kappa值为0.80~0.81，各放射科医师与CR间的Kappa值为0.84~0.87，敏感性为85.17%~91.75% ，特异性为97.19%~98.06%。QM法的各骨折阈值与CR间的Kappa值为0.54~0.75,其中以2.5s阈值与CR结果最为符合。其Kappa值为0.75,敏感性为70.23%,特异性为98.76%。实验结果表明，放射科医师间的SQ法结果符合率最好，且优于SQ与QM间的符合率。选用2.5s作为QM法筛选骨折阈值，可获得与CR较好的符合率。 |
| 英文摘要: |
| To compare visual semiquantitative and quantitative morphometric methods of vertebral
Fracture assessment，radiographs of the lateral thoracic and lumbar spine of 400 postmenopausal women with osteopenia，as defined by spinal DXA measurements，were evaluated independently by three trained radiologists．All radiographs were digitized by a radiologist and the presence of vertebral fractures was determined using standard deviation(SD) reductions of vertebral height ratios of 2.0，2.5，3.0，3.5 and 4.0 as cutoff criteria．The results from a joint consensus reading (CR) of the radiographs including a fourth experienced radiologist was compared to the results from the individual readings and quantitative morphometry．A kappa statistic was applied to assess the agreement among all readers, morphometry and the consensus reading．Kappa values among the three radiologists ranged from 0.80 to 0.81；between the radiologists readings and the CR kappa values ranged from 0. 84 to 0?87.Sensitivities and specificities of the three radiologists with respect to the consensus reading ranged from 85.17% to 91.75% and from 97.19% to 98.06%，respectively．The kappa values for the agreement between morphometry and the CR ranged from 0.54 to 0.75 using the above cutoff criteria．Compared to the CR, the kappa score for morphometry at 2.5SD was 0.75，with a sensitivity and specificity of 70.23% and 98.76%,respectively．Our results indicate that the concordance among trained radiologists for semiquantitative assessment of vertehral fractures is excellent and is higher than that between semiquantitative and quantitative methods regardless of the cutoff criterion used．Using a reduction of 2.5 SD in vertebral height ratios from normal as a cutoff criterion for morphometry provided the highest concordance with the consensus reading for assessing prevalent fractures． |
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