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Inter-observer agreement of vertebral fracture assessment with dual-energy x-ray absorptiometry equipment

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Abstract

Purpose

To investigate the time and effort needed to perform vertebral morphometry, as well as inter-observer agreement for identification of vertebral fractures on vertebral fracture assessment (VFA) images.

Methods

Ninety-six images were retrospectively selected, and three radiographers independently performed semi-automatic 6-point morphometry. Fractures were identified and graded using the Genant classification. Time needed to annotate each image was recorded, and reader fatigue was assessed using a modified Simulator Sickness Questionnaire (SSQ). Inter-observer agreement was assessed per-patient and per-vertebra for detecting fractures of all grades (grades 1–3) and for grade 2 and 3 fractures using the kappa statistic. Variability in measured vertebral height was evaluated using the intraclass correlation coefficient (ICC).

Results

Per-patient agreement was 0.59 for grades 1–3 fracture detection, and 0.65 for grades 2–3 only. Agreement for per-vertebra fracture classification was 0.92. Vertebral height measurements had an ICC of 0.96. Time needed to annotate VFA images ranged between 91 and 540 s, with a mean annotation time of 259 s. Mean SSQ scores were significantly lower at the start of a reading session (1.29; 95% CI: 0.81–1.77) compared to the end of a session (3.25; 95% CI: 2.60–3.90; p < 0.001).

Conclusion

Agreement for detection of patients with vertebral fractures was only moderate, and vertebral morphometry requires substantial time investment. This indicates that there is a potential benefit for automating VFA, both in improving inter-observer agreement and in decreasing reading time and burden on readers.

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Data availability

The dataset from this study is not publicly available due to data protection regulations.

Code availability

Statistical analyses were performed using open-source python modules Scikit-learn 0.20.3, Statsmodels 0.10.1, and Pingouin 0.3.8.

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Acknowledgements

The authors would like to thank Michael Bruijns and Johan van Brecht for their enthusiasm and time annotating VFA images and Richard Raghoo, MD, for evaluating the spinal radiographs.

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Authors and Affiliations

  1. Department of Radiology, Leiden University Medical Center, Leiden, Netherlands

    Jacob M. Mostert, Stephan R. Romeijn, Petra Dibbets-Schneider, Daphne D. D. Rietbergen, Lenka M. Pereira Arias-Bouda & Willem Grootjans

  2. Department of Radiology, Alrijne Hospital, Leiderdorp, Netherlands

    Lenka M. Pereira Arias-Bouda

  3. ImageBiopsy Lab, Vienna, Austria

    Christoph Götz & Matthew D. DiFranco

  4. Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria

    Hans Peter Dimai

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Correspondence to Willem Grootjans.

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All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments and the Medical Ethics Committee of the Leiden University Medical Center waived the need to acquire informed consent (registration number G20.032).

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Authors CG and MD are employees of ImageBiopsy Lab.

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Mostert, J.M., Romeijn, S.R., Dibbets-Schneider, P. et al. Inter-observer agreement of vertebral fracture assessment with dual-energy x-ray absorptiometry equipment. Arch Osteoporos 17, 4 (2022). https://doi.org/10.1007/s11657-021-01046-w

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