Diagnosis of vertebral deformities on chest CT and DXA compared to routine lateral thoracic spine X-ray.
X-ray, CT and DXA enable diagnosis of vertebral deformities. For this study, level of agreement of vertebral deformity diagnosis was analysed. We showed that especially on subject level, these imaging techniques could be used for opportunistic screening of vertebral deformities in COPD patients.


INTRODUCTION
X-ray and CT are frequently used for pulmonary evaluation in patients with chronic obstructive pulmonary disease (COPD) and also enable to diagnose vertebral deformities together with dual-energy X-ray absorptiometry (DXA) imaging. The aim of this research was to study the level of agreement of these imaging modalities for diagnosis of vertebral deformities from T4 to L1.


METHODS
Eighty-seven subjects (mean age of 65; 50 males; 57 COPD patients) who had X-ray, chest CT (CCT) and DXA were included. Evaluable vertebrae were scored twice using SpineAnalyzer™ software. ICCs and kappas were calculated to examine intra-observer variability. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUROC) were calculated to compare vertebral deformities diagnosed on the different imaging modalities.


RESULTS
ICCs for height measurements were excellent (> 0.94). Kappas were good to excellent (0.64-0.77). At vertebral level, the AUROC was 0.85 for CCT vs. X-ray, 0.74 for DXA vs. X-ray and 0.77 for DXA vs. CCT. Sensitivity (51%-73%) and PPV (57%-70%) were fair to good; specificity and NPV were excellent (≥ 96%). At subject level, the AUROC values were comparable.


CONCLUSIONS
Reproducibility of height measurements of vertebrae is excellent with all three imaging modalities. On subject level, diagnostic performance of CT (PPV 79-82%; NPV 90-93%), and to a slightly lesser extend of DXA (PPV 73-77%; NPV 80-89%), indicates that these imaging techniques could be used for opportunistic screening of vertebral deformities in COPD patients.
['van Dort|M J|MJ|', 'Romme|E A P M|EAPM|', 'Smeenk|F W J M|FWJM|', 'Geusens|P P P M|PPPM|', 'Wouters|E F M|EFM|', 'van den Bergh|J P|JP|']
D015502:Absorptiometry, Photon D000368:Aged D005260:Female D006801:Humans D008159:Lumbar Vertebrae D008297:Male D008403:Mass Screening D008875:Middle Aged D015588:Observer Variation D058866:Osteoporotic Fractures D011237:Predictive Value of Tests D029424:Pulmonary Disease, Chronic Obstructive D011859:Radiography D013902:Radiography, Thoracic D015203:Reproducibility of Results D013121:Spinal Curvatures D016103:Spinal Fractures D013904:Thoracic Vertebrae
Vertebral deformity DXA Screening COPD Osteoporosis Vertebral fracture