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Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly

  • Musculoskeletal
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Abstract

Objectives

Thoracic spine radiography becomes more difficult with age. Tomosynthesis is a low-dose tomographic extension of radiography which may facilitate thoracic spine evaluation. This study assessed the added value of tomosynthesis in imaging of the thoracic spine in the elderly.

Methods

Four observers compared the image quality of 50 consecutive thoracic spine radiography and tomosynthesis data sets from 48 patients (median age 67 years, range 55–92 years) on a number of image quality criteria. Observer variation was determined by free-marginal multirater kappa. The conversion factor and effective dose were determined from the dose–area product values.

Results

For all observers significantly more vertebrae were seen with tomosynthesis than with radiography (mean 12.4/9.3, P < 0.001) as well as significantly more fractures (mean 0.9/0.7, P = 0.017). The image quality score for tomosynthesis was significantly higher than for radiography, for all evaluated structures. Tomosynthesis took longer to evaluate than radiography. Despite this, all observers scored a clear preference for tomosynthesis. Observer agreement was substantial (mean κ = 0.73, range 0.51–0.94). The calibration or conversion factor was 0.11 mSv/(Gy cm2) for the combined examination. The resulting effective dose was 0.87 mSv.

Conclusion

Tomosynthesis can increase the detection rate of thoracic vertebral fractures in the elderly, at low added radiation dose.

Key Points

• Tomosynthesis helps evaluate the thoracic spine in the elderly.

• Observer agreement for thoracic spine tomosynthesis was substantial (mean κ = 0.73).

• Significantly more vertebrae and significantly more fractures were seen with tomosynthesis.

• Tomosynthesis took longer to evaluate than radiography.

• There was a clear preference among all observers for tomosynthesis over radiography.

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Acknowledgments

The scientific guarantor of this publication is Mats Geijer, Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, case-control study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Örebro University, Örebro, Sweden

    Mats Geijer

  2. Department of Clinical Sciences, Lund University, Lund, Sweden

    Mats Geijer & Lars Weber

  3. Department of Medical Imaging and Physiology, Lund University and Skåne University Hospital, Lund, Sweden

    Eirikur Gunnlaugsson & Simon Götestrand

  4. Department of Radiation Physics, Skåne University Hospital, Lund, Sweden

    Lars Weber

  5. Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

    Håkan Geijer

Authors
  1. Mats Geijer
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  2. Eirikur Gunnlaugsson
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  4. Lars Weber
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  5. Håkan Geijer
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Correspondence to Mats Geijer.

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Geijer, M., Gunnlaugsson, E., Götestrand, S. et al. Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly. Eur Radiol 27, 491–497 (2017). https://doi.org/10.1007/s00330-016-4392-5

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  • DOI: https://doi.org/10.1007/s00330-016-4392-5

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