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Wáng YXJ, Yu W, Leung JCS, Griffith JF, Xiao BH, Diacinti D, Guermazi A, Chan WP, Blake GM. More evidence to support a lower quantitative computed tomography (QCT) lumbar spine bone mineral density (BMD) cutpoint value for classifying osteoporosis among older East Asian women than for Caucasians. Quant Imaging Med Surg 2024; 14:3239-3247. [PMID: 38720829 PMCID: PMC11074747 DOI: 10.21037/qims-24-429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/25/2024] [Indexed: 05/12/2024]
Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jason C. S. Leung
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - James F. Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy
| | - Ali Guermazi
- Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - Wing P. Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Glen M. Blake
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
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Yu W, Guan WM, Hayashi D, Lin Q, Du MM, Xia WB, Wang YXJ, Guermazi A. Vertebral fracture severity assessment on anteroposterior radiographs with a new semi-quantitative technique. Osteoporos Int 2024; 35:831-839. [PMID: 38296865 DOI: 10.1007/s00198-024-07024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
We developed a new tool to assess the severity of osteoporotic vertebral fracture using radiographs of the spine. Our technique can be used in patient care by helping to stratify patients with osteoporotic vertebral fractures into appropriate treatment pathways. It can also be used for research purposes. PURPOSE The aim of our study was to propose a semi-quantitative (SQ) grading scheme for osteoporotic vertebral fracture (OVF) on anteroposterior (AP) radiographs. METHODS On AP radiographs, the vertebrae are divided into right and left halves, which are graded (A) vertical rectangle, (B) square, (C) traverse rectangle, and (D) trapezoid; whole vertebrae are graded (E) transverse band or (F) bow-tie. Type A and B were compared with normal and Genant SQ grade 1 OVF, Type C and D with grade 2 OVF, and Type E and F with grade 3 OVF. Spine AP radiographs and lateral radiographs of 50 females were assessed by AP radiographs SQ grading. After training, an experienced board-certified radiologist and a radiology trainee assessed the 50 AP radiographs. RESULTS The height-to-width ratio of the half vertebrae varied 1.32-1.48. On lateral radiographs, 84 vertebrae of the 50 patients had OVFs (38 grade 1, 24 grade 2, and 22 grade 3). On AP radiographs, the radiologist correctly assigned 84.2%, 91.7%, and 77.2% and the trainee correctly assigned 68.4%, 79.2%, and 81.8% of grade 1, 2, and 3 OVFs, respectively. Compared with lateral radiographs, the radiologist had a weighted Kappa of 0.944 including normal vertebrae and 0.883 not including normal vertebrae, while the corresponding Kappa values for the trainee were 0.891 and 0.830, respectively. CONCLUSION We propose a new semi-quantitative grading system for vertebral fracture severity assessment on AP spine radiographs.
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Affiliation(s)
- W Yu
- Department of Radiology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
| | - W-M Guan
- Department of Radiology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - D Hayashi
- Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Q Lin
- Department of Radiology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
- Department of Radiology, Beijing Arion Cancer Center, Beijing, China
| | - M-M Du
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Zhejiang Province, Wenzhou, China
| | - W-B Xia
- Department of Endocrinology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Y-X J Wang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - A Guermazi
- Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA
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Wáng YXJ, Diacinti D, Aparisi Gómez MP, Santiago FR, Becce F, Tagliafico AS, Prakash M, Isaac A, Dalili D, Griffith JF, Guglielmi G, Bazzocchi A. Radiological diagnosis of prevalent osteoporotic vertebral fracture on radiographs: an interim consensus from a group of experts of the ESSR osteoporosis and metabolism subcommittee. Skeletal Radiol 2024:10.1007/s00256-024-04678-4. [PMID: 38662094 DOI: 10.1007/s00256-024-04678-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
When a low-energy trauma induces an acute vertebral fracture (VF) with clinical symptoms, a definitive diagnosis of osteoporotic vertebral fracture (OVF) can be made. Beyond that, a "gold" radiographic standard to distinguish osteoporotic from non-osteoporotic VFs does not exist. Fracture-shaped vertebral deformity (FSVD) is defined as a deformity radiographically indistinguishable from vertebral fracture according to the best of the reading radiologist's knowledge. FSVD is not uncommon among young populations with normal bone strength. FSVD among an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely to be associated with compromised bone strength. In more severe grade deformities or when a vertebra is collapsed, OVF diagnosis can be made with a relatively high degree of certainty by experienced readers. In "milder" cases, OVF is often diagnosed based on a high probability rather than an absolute diagnosis. After excluding known mimickers, singular vertebral wedging in older women is statistically most likely an OLVF. For older women, three non-adjacent minimal grade OLVF (< 20% height loss), one minimal grade OLVF and one mild OLVF (20-25% height loss), or one OLVF with ≥ 25% height loss, meet the diagnosis of osteoporosis. For older men, a single OLVF with < 40% height loss may be insufficient to suggest the subject is osteoporotic. Common OLVF differential diagnoses include X-ray projection artifacts and scoliosis, acquired and developmental short vertebrae, osteoarthritic wedging, oncological deformities, deformity due to high-energy trauma VF, lateral hyperosteogeny of a vertebral body, Cupid's bow, and expansive endplate, among others.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Radiology, IMSKE, Valencia, Spain
| | - Fernando Ruiz Santiago
- Department of Radiology and Physical Medicine, Faculty of Medicine, University of Granada, Granada, Spain
- Musculoskeletal Radiology Unit, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alberto Stefano Tagliafico
- Department of Radiology, DISSAL, University of Genova, Genoa, Italy
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Mahesh Prakash
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Danoob Dalili
- Academic Surgical Unit, Southwest London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, UK
- Department of Radiology, Epsom and St Hellier University Hospitals NHS Trust, Dorking Road, Epsom, London, UK
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
- Radiology Unit, Dimiccoli Teaching Hospital Barletta, Barletta, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Ma D, Wang Y, Zhang X, Su D, Wang C, Liu H, Yang X, Gao J, Wu Y. Differences in Vertebral Morphology and bone Mineral Density between Grade 1 Vertebral Fracture and Non-Fractured Participants in the Chinese Population. Calcif Tissue Int 2024; 114:397-408. [PMID: 38483546 DOI: 10.1007/s00223-024-01185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/12/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To investigate the difference in vertebral morphology and bone mineral density (BMD) between grade 1 VFs and non-fractured participants in the Chinese population to shed light on the clinical significance of grade 1 VFs from various perspectives. METHODS This retrospective cohort study included patients who received a chest low-dose computed tomography (LDCT) scan for health examination and visited the First Affiliated Hospital of Zhengzhou University, Henan, China, from October 2019 to August 2022. Data were analyzed from March 2023 to July 2023. The main outcome of this study was the difference in morphological parameters and BMD between grade 1 VFs and non-fractured participants. The prevalence of grade 1 VFs in China populations was calculated. The difference in BMD of three fracture types in the Grade 1 group was also evaluated. RESULTS A total of 3652 participants (1799 males, 54.85 ± 9.02 years, range, 40-92 years; 1853 females, 56.00 ± 9.08 years, range, 40-93 years) were included. The prevalence of grade 2 and 3 increase with age. The prevalence of grade 1 VFs gradually increases ≤ 50y to 60-69y group, but there is a decrease in the ≥ 70 years male group (6.6%) and a rise in the female group (25.5%). There was no significant statistical difference observed in vertebral shape indices (VSI) and BMD between the Grade 1 group and the no-fractured group aged < 50 years old except the wedge index in male. The biconcavity index did not differ between the non-fractured group and the Grade 1 group in men aged 50-59 years, whereas a significant statistical difference was observed in women. Additionally, the results of BMD were consistent with these findings. For the 40-59 years age group, there were significant differences between the compression deformity group and the other groups. CONCLUSIONS The grade 1 group had higher VSI and lower BMD than the non-fractured group, suggesting an association between the Grade 1 group and osteoporosis in individuals aged over 50 for women and over 60 for men. Different fracture types have significant variations in BMD among middle-aged people. The prevalence of grade 1 VFs exhibits an age-related increase in both genders, with opposite trends observed between older males and females. We suggested VSI can aid physicians in the diagnosis of grade 1 VFs.
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Affiliation(s)
- Duoshan Ma
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yan Wang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xinxin Zhang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Danyang Su
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Chunyu Wang
- Medical 3D Printing Center, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Huilong Liu
- Medical 3D Printing Center, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xiaopeng Yang
- Medical 3D Printing Center, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yan Wu
- Medical 3D Printing Center, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China.
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Wáng YXJ, Griffith JF, Blake GM, Diacinti D, Xiao BH, Yu W, Su Y, Jiang Y, Guglielmi G, Guermazi A, Kwok TCY. Revision of the 1994 World Health Organization T-score definition of osteoporosis for use in older East Asian women and men to reconcile it with their lifetime risk of fragility fracture. Skeletal Radiol 2024; 53:609-625. [PMID: 37889317 DOI: 10.1007/s00256-023-04481-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
The 1994 WHO criterion of a T-score ≤ -2.5 for densitometric osteoporosis was chosen because it results in a prevalence commensurate with the observed lifetime risk of fragility fractures in Caucasian women aged ≥ 50 years. Due to the much lower risk of fragility fracture among East Asians, the application of the conventional WHO criterion to East Asians leads to an over inflated prevalence of osteoporosis, particularly for spine osteoporosis. According to statistical modeling and when a local BMD reference is used, we tentatively recommend the cutpoint values for T-score of femoral neck, total hip, and spine to be approximately -2.7, -2.6, and -3.7 for Hong Kong Chinese women. Using radiographic osteoporotic vertebral fracture as a surrogate clinical endpoint, we empirically demonstrated that a femoral neck T-score of -2.77 for Chinese women was equivalent to -2.60 for Italian women, a spine T-score of -3.75 for Chinese women was equivalent to -2.44 for Italian women, and for Chinese men a femoral neck T-score of -2.77 corresponded to spine T-score of -3.37. For older Chinese men, we tentatively recommend the cutpoint values for T-score of femoral neck, total hip, and spine to be approximately -2.7, -2.6, and -3.2. With the BMD reference published by IKi et al. applied, T-score of femoral neck, total hip, and spine of -2.75, -3.0, and -3.9 for Japanese women will be more in line with the WHO osteoporosis definition. The revised definition of osteoporosis cutpoint T-scores for East Asians will allow a more meaningful international comparison of disease burden.
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Affiliation(s)
- Yi Xiang J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Glen M Blake
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy
| | - Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yi Su
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | - Yebin Jiang
- VA Healthcare System, University of Michigan, Ann Arbor, MI, USA
| | - Giuseppe Guglielmi
- Radiology Unit, Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
- Department of Radiology, Scientific Institute "Casa Sollievo Della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Timothy C Y Kwok
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Wáng YXJ, Leung JCS, Lam PMS, Kwok TCY. Weak correlation between osteoporotic-like vertebral fracture severity and densitometric T-scores in older Chinese men. Ann Transl Med 2023; 11:374. [PMID: 37675328 PMCID: PMC10477661 DOI: 10.21037/atm-23-639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/02/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C. S. Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Patti M. S. Lam
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Timothy C. Y. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Láinez Ramos-Bossini AJ, Ruiz Santiago F, Moraleda Cabrera B, López Zúñiga D, Ariza Sánchez A. Imaging of low-energy vertebral fractures. Radiologia (Engl Ed) 2023; 65:239-250. [PMID: 37268366 DOI: 10.1016/j.rxeng.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/01/2023] [Indexed: 06/04/2023]
Abstract
Low-energy vertebral fractures pose a diagnostic challenge for the radiologist due to their often-inadvertent nature and often subtle imaging semiology. However, the diagnosis of this type of fractures can be decisive, not only because it allows targeted treatment to prevent complications, but also because of the possibility of diagnosing systemic pathologies such as osteoporosis or metastatic disease. Pharmacological treatment in the first case has been shown to prevent the development of other fractures and complications, while percutaneous treatments and various oncological therapies can be an alternative in the second case. Therefore, it is necessary to know the epidemiology and typical imaging findings of this type of fractures. The objective of this work is to review the imaging diagnosis of low-energy fractures, with special emphasis on the characteristics that should be outlined in the radiological report to guide a specific diagnosis that favours and optimizes the treatment of patients suffering of low energy fractures.
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Affiliation(s)
- A J Láinez Ramos-Bossini
- Sección de Radiología Musculoesquelética, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain; Programa de doctorado en Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain; Departamento de Psiquiatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - F Ruiz Santiago
- Sección de Radiología Musculoesquelética, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain; Departamento de Medicina Física y Rehabilitación, Facultad de Medicina, Universidad de Granada, Granada, Spain.
| | - B Moraleda Cabrera
- Sección de Radiología Musculoesquelética, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain
| | - D López Zúñiga
- Sección de Radiología Musculoesquelética, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain
| | - A Ariza Sánchez
- Sección de Radiología Musculoesquelética, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain
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Wáng YXJ. A summary of our recent evidence-based works on radiographic diagnostics of prevalent osteoporotic vertebral fracture in older men and women. Quant Imaging Med Surg 2023; 13:1264-1285. [PMID: 36915360 PMCID: PMC10006108 DOI: 10.21037/qims-22-1411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Wáng YXJ, Wang XR, Leung JCS, Yu BWM, Griffith JF, Kwok TCY. Schmorl's nodes are associated with prevalent osteoporotic vertebral fracture and low bone mineral density: a population-based thoracic spine MRI study in older men and women. Quant Imaging Med Surg 2023; 13:1914-1926. [PMID: 36915321 PMCID: PMC10006149 DOI: 10.21037/qims-22-1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/05/2023] [Indexed: 02/25/2023]
Abstract
Background Schmorl's node (SN) corresponds to nucleus pulposus herniation into the vertebral spongy bone with thickened trabeculae around the formed node. We hypothesize that a pathway may exist that: osteoporosis → weakened endplate → SN development ↔ endplate fracture of an osteoporotic vertebra. Methods For osteoporotic fractures in men (MrOS) and in women (MsOS) Hong Kong studies, at 14-year follow-up, thoracic spine magnetic resonance imaging (MRI) was sampled in 270 males (mean: 82.9±3.7 years) and 150 females (mean: 81.5±4.3 years). SN and Modic change were assessed as existed or not existed. For posterior disc protrusion, ligamentum flavum ossification, and spinal canal stenosis, semi-quantitative gradings were applied. For each vertebra in women, a score of 0, 0.5, 1, 1.5, 2, 2.5, 3 was assigned for no osteoporotic vertebral fracture (OVF) or OVF of <1/5, ≥1/5-1/4, ≥1/4-1/3, ≥1/3-2/5, ≥2/5-2/3, and ≥2/3 vertebral height loss, respectively, and a summed score was calculated by summing up the scores of vertebrae T1 to T12. For men, those of minimal grade were not considered as OVF and assigned a '0' score. Results SN prevalence in women (55.5%) almost doubled that in men (25.9%). SN was statistically significantly correlated with lower bone mineral density (BMD) derived femoral neck T-score, while the other four spine degeneration changes were not statistically significantly correlated with the T-score. SN were statistically significantly correlated with OVF score. Subjects with SN were more likely to have OVF, with odds ratio for men of 4.32 [95% confidence interval (CI): 1.70-11.00, P=0.002] and odds ratio for women of 3.28 (95% CI: 1.23-8.74, P=0.018). Conclusions Among older population, many features of SN parallel those of OVF.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiao-Rong Wang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Jason C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Blanche W M Yu
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Wáng YXJ, Leung JC, Lam PM, Kwok TC. Conversion of osteoporotic-like vertebral fracture severity score to osteoporosis T-score equivalent status: A framework study for older Chinese men. Osteoporos Sarcopenia 2023; 9:14-21. [PMID: 37082356 PMCID: PMC10111950 DOI: 10.1016/j.afos.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/28/2023] [Accepted: 03/09/2023] [Indexed: 04/22/2023] Open
Abstract
Objectives To define what portion of older community men with what severity of radiographic osteoporotic-like vertebral fracture (OLVF) correspond to what low T-score status. Methods There were 755 community Chinese men (age: 76.4 ± 6.7 years) with thoracic and lumbar spine radiographs, and hip and lumbar spine bone mineral density measures. For each vertebra in a subject, a score of 0, -0.5, -1, -1.5, -2, -2.5, and -3 was assigned for no OLVF or OLVF of <20%, ≥ 20-25%, ≥ 2 5%-1/3, ≥ 1/3-40%, ≥ 40%-2/3, and ≥ 2/3 vertebral height loss, respectively. OLVFss was defined as the summed score of vertebrae T4 to L5. OLVFss and T-scores were ranked from the smallest to the largest values. Results OLVFss of -2, -2.5, -3, corresponded to a mean femoral neck T-score of -2.297 (range: -2.355∼-2.247), -2.494 (range: -2.637∼ -2.363), and -2.773 (range: -2.898∼-2.643), a mean hip T-score of-2.311 (range: -2.420∼-2.234), -2.572 (range: -2.708∼-2.432), -2.911 (range: -3.134∼-2.708), a mean lumbar spine T-score of -2.495 (range: -2.656∼-2.403), -2.931 (range: -3.255∼-2.664), and -3.369 (range: -3.525∼-3.258). The Pearson correlation value of OLVFss and T-score of femoral neck, hip and lumbar spine was r = 0.21, 0.26, and 0.22 (all P < 0.0001). Conclusions A single severe grade radiological OLVF (≥ 40% height loss) or OLVFss ≤ -2.5 suggest the subject is osteoporotic, and a single collapse grade (≥ 2/3 height loss) OLVF or OLVFss ≤ -3 meets osteoporosis diagnosis criterion. The results highlight the difficulty of diagnosing osteoporotic vertebral fractures among Chinese older men.
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Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Corresponding author.
| | - Jason C.S. Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Patti M.S. Lam
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Timothy C.Y. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
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Maciel J, Salmon C, Hosseini B, Azevedo-Marques P, de Paula F, Nogueira-Barbosa M. Features of lumbar spine texture extracted from routine MRI correlate with bone mineral density and can potentially differentiate patients with and without fragility fractures in the spine. Braz J Med Biol Res 2023; 56:e12454. [PMID: 36856253 PMCID: PMC9974079 DOI: 10.1590/1414-431x2023e12454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/25/2023] [Indexed: 03/02/2023] Open
Abstract
The use of routine magnetic resonance imaging (MRI) to potentially assess skeletal fragility has been widely studied in osteoporosis. The aim of this study was to evaluate bone texture attributes (TA) from routine lumbar spine (LS) MRI and their correlation with vertebral fragility fractures (VFF) and bone mineral density (BMD). Sixty-four post-menopausal women were submitted to LS densitometry, total spine radiographs, and routine T2-weighted LS MRI. Twenty-two TA were extracted with the platform IBEX from L3 vertebra. The statistical difference was evaluated using ANOVA and Duncan's post-test. Correlation analyses were performed using Spearman's coefficient. Statistical significance was considered when P<0.05. The results did not show a significant difference in BMD between the women with and without fractures. Two bone TA (cluster tendency and variance) were significantly lower in the fracture group. Cluster tendency with VFF in osteopenia was 1.54±1.37 and in osteoporosis was 1.11±58. Cluster tendency without VFF in osteopenia was 2.23±1.38 and in osteoporosis was 1.88±1.14). Variance with VFF in osteopenia was 1.44±1.37 and in osteoporosis was 1.13±59. Variance without VFF in osteopenia was 2.34±1.38 and in osteoporosis was 1.89±1.14. There was a significant correlation between BMD and cluster prominence (r=0.409), cluster tendency (r=0.345), correlation (r=0.570), entropy (r=0.364), information measure corr1 (r=0.378), inverse variance (r=0.449), sum entropy (r=0.320), variance (r=0.338), sum average (r=-0.274), and sum variance (r=-0.266). Our results demonstrated the potential use of TA extracted from routine MRI as a biomarker to assess osteoporosis and identify the tendency of skeletal fragility vertebral fractures.
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Affiliation(s)
- J.G. Maciel
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C.E.G. Salmon
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - B.S. Hosseini
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - P.M. Azevedo-Marques
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F.J.A. de Paula
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M.H. Nogueira-Barbosa
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, MO, USA
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12
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Wáng YXJ, Lu ZH, Leung JCS, Fang ZY, Kwok TCY. Osteoporotic-like vertebral fracture with less than 20% height loss is associated with increased further vertebral fracture risk in older women: the MrOS and MsOS (Hong Kong) year-18 follow-up radiograph results. Quant Imaging Med Surg 2023; 13:1115-1125. [PMID: 36819281 PMCID: PMC9929386 DOI: 10.21037/qims-2022-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
Background For osteoporotic fractures in men (MrOS) and in women (MsOS) (Hong Kong) baseline (BL) study, Chinese men and women ≥65 years were recruited during 2001 to 2003. This study presents the year-18 follow-up (FU) results. We were particularly interested in whether women with 'minimal' grade osteoporotic-like vertebral fracture (OLVF) of <20% height loss have an increased vertebral fracture (VF) risk than those without BL OLVF. Methods At year-18 FU, spine radiography was performed on 144 males (mean: 87.4±3.1 years) and 156 females (mean: 87.0±3.2 years). OLVF classification included no OLVF (grade 0), and OLVFs with <20%, ≥20-25%, ≥25%-1/3, ≥1/3-40%, ≥40%-2/3, ≥2/3 height loss (grades 1-6). With an existing OLVF, a further height loss of ≥15% was an OLVF progression. A new incident OLVF was a change from grade 0 to ≥ grade 2 or to grade 1 with the appearance of endplate and/or cortex fracture (ECF) during FU. Both OLVF progression and incident OLVF were considered incident VF. Acquired short vertebra (aSV) was defined as with decreased vertebral anterior and middle heights, while without anterior wedging and bi-concave changes, and only those with at least two adjacent aSVs were recorded as aSV cases. Results For subjects without BL OLVF, 12.5% of the males and 27.1% of the females had incident VF. For subjects with BL OLVF of ≥20% height loss, males' and females' incident VF rate were 20% and 66.7% respectively. Females subjects with BL minimal OLVF, while all without radiographic ECF, had an incident VF rate of 59.3% during the FU. For males with and without aSV, 11.8% and 15% have incident fracture of other vertebrae. For females with and without aSV, 35.3% and 34.5% have incident fracture of other vertebrae. Recovery from minimal or mild grades OLVF to normal shape was observed in a number of cases. Conclusions OLVF with less than 20% height loss is associated with increased VF risk in older females, but not in older males. Acquired short vertebra (SV) is not associated with increased incident fracture risk for other vertebrae, both for females and males. OLVF among older subjects can repair and heal.
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Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - Zhi-Hui Lu
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - Jason C. S. Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - Ze-Yu Fang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, China;,Department of Electronic Engineering and Information Science, The University of Science and Technology of China, Hefei, China
| | - Timothy C. Y. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, China;,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Láinez Ramos-Bossini A, Ruiz Santiago F, Moraleda Cabrera B, López Zúñiga D, Ariza Sánchez A. Diagnóstico por imagen de las fracturas vertebrales de baja energía. Radiología 2023. [DOI: 10.1016/j.rx.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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14
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Wáng YXJ, Diacinti D, Leung JCS, Iannacone A, Kripa E, Kwok TCY, Diacinti D. Conversion of osteoporotic vertebral fracture severity score to osteoporosis T-score equivalent status: a framework and a comparative study of Hong Kong Chinese and Rome Caucasian older women. Arch Osteoporos 2022; 18:1. [PMID: 36462068 DOI: 10.1007/s11657-022-01178-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/13/2022] [Indexed: 12/04/2022]
Abstract
We explored how the severity of radiological osteoporotic vertebral fracture (OVF) can be converted to the equivalent T-score values. INTRODUCTION To perform a study to define what portion of older community women with what severity of radiographic OVF correspond to what low T-score status. METHODS There were age-matched 301 Italian community women and 301 Chinese community women (sub-group A, age, 73.6 ± 6.1 years). In addition, Chinese sub-groups B and C included 110 community women (age, 68.9 ± 5.5 years) and 101 community women (age: 82.2 ± 4.3 years), respectively. For each vertebra in women, a score of 0, - 0.5, - 1, - 1.5, - 2, - 2.5, and - 3 was assigned for no OVF or OVF of < 20%, ≥ 20 ~ 25%, ≥ 25% ~ 1/3, ≥ 1/3 ~ 40%, ≥ 40%-2/3, and ≥ 2/3 vertebral height loss, respectively, OVFss was defined as the summed score of vertebrae T4 to L5. OVFss and T-scores were ranked from the smallest to the largest values. RESULTS For the Chinese total group (sub-groups A, B, and C together), OVFss = - 1 corresponded to lowest T-score (lowest T-score of lumbar spine, femoral neck, and total hip) of - 3.4 ~ - 3.2. OVFss ≤ - 1.5 corresponded to femoral neck T-score ≤ - 2.5. OVFss = -1.5 corresponded to a mean femoral neck T-score of - 3.0, - 2.6, and - 2.4, among Chinese sub-groups B, A, and C subjects, respectively. For Italians, all cases with OVFss ≤ - 1 had lowest T-score ≤ - 2.5. For cases with femoral neck T-score = - 2.5, 41.7% had OVFss = - 1.5, and 58.3% had OVFss = - 1. CONCLUSION For older women, statistically OVFss ≤ - 1 suggests this subject is osteoporotic according to lowest T-score. If using femoral neck T-score, OVFss ≤ - 1.5 qualifies osteoporosis diagnosis.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
| | - Davide Diacinti
- Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy
- Department of Diagnostic and Molecular Imaging, Radiology and Radiotherapy, University Foundation Hospital Tor Vergata, Rome, Italy
| | - Jason C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Antonio Iannacone
- Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy
| | - Endi Kripa
- Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy
| | - Timothy C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy.
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15
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Ma JB, Wáng YXJ. Chest radiograph prevalence of vertebral deformity among young and middle-aged population of mixed city dwellers and rural residents. J Thorac Dis 2022; 14:4685-4698. [PMID: 36647490 PMCID: PMC9840051 DOI: 10.21037/jtd-22-1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022]
Abstract
Background To interpret the importance of minimal and mild vertebral deformities (VDs) among elderly subjects, we need to know their prevalence among mostly non-osteoporotic subjects. Methods We retrospectively analyzed VDs among 408 female and 374 male patients who had lateral chest radiographs due to mild illness or for routine healthcheck, all with indications other than spine disorders or metabolic disorders. The study subjects were divided into four age groups, i.e., ≤20, 20-34, 35-44, and ≥45 years. For those aged >20 years, 27.2% females had family roots from farming communities, and 26.4% males had the history of being a farmer or physical laborer (this was 36.1% for males aged ≥45 years). Fracture shaped vertebral deformities (FSVDs) were VDs radiographically indistinguishable from vertebral fracture. Acquired short vertebrae were those with decreased vertebral anterior and middle heights, while without anterior wedging or bi-concave changes, and the diagnosis required at least two adjacent short vertebrae in the same subject. Results Congenital VDs were observed in four cases (three males, one female). In the age group of ≤20, 20-34, 35-44, and ≥45 years, females had any FSVD prevalence of 13.4%, 8.3%, 11.8%, 25.8% respectively, while the prevalence was 29.3%, 26%, 34.3%, 44.8% respectively for males. From the female ≤20 years group to the 21-34 years group, cases involved multiple vertebrae decreased from 53.8% to 16.7%. For cases ≤34 years, no female case had ≥ mild FSVD (which was defined to have ≥20% vertebral height loss), while five male cases had ≥ mild FSVD. For the 35-44 years group, vertebral endplate depression was noted among 2.0% of the females and 2.9% of the males. Among the cases aged ≤44 years, there was only one male and one female had acquired short vertebrae. For the male cases, acquired short vertebrae prevalence was 15.6% in the group of ≥45 years. Conclusions FSVD is common among young and middle-aged population (≤44 years) assumed with normal bone strength, and with a higher FSVD prevalence among men. FSVD may heal among younger subjects, and physical labor may increase VD prevalence.
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Affiliation(s)
- Jian-Bing Ma
- Department of Radiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Xiao BH, Zhu MSY, Du EZ, Liu WH, Ma JB, Huang H, Gong JS, Diacinti D, Zhang K, Gao B, Liu H, Jiang RF, Ji ZY, Xiong XB, He LC, Wu L, Xu CJ, Du MM, Wang XR, Chen LM, Wu KY, Yang L, Xu MS, Diacinti D, Dou Q, Kwok TYC, Wáng YXJ. A software program for automated compressive vertebral fracture detection on elderly women's lateral chest radiograph: Ofeye 1.0. Quant Imaging Med Surg 2022; 12:4259-4271. [PMID: 35919046 PMCID: PMC9338385 DOI: 10.21037/qims-22-433] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022]
Abstract
Background Because osteoporotic vertebral fracture (OVF) on chest radiographs is commonly missed in radiological reports, we aimed to develop a software program which offers automated detection of compressive vertebral fracture (CVF) on lateral chest radiographs, and which emphasizes CVF detection specificity with a low false positivity rate. Methods For model training, we retrieved 3,991 spine radiograph cases and 1,979 chest radiograph cases from 16 sources, with among them in total 1,404 cases had OVF. For model testing, we retrieved 542 chest radiograph cases and 162 spine radiograph cases from four independent clinics, with among them 215 cases had OVF. All cases were female subjects, and except for 31 training data cases which were spine trauma cases, all the remaining cases were post-menopausal women. Image data included DICOM (Digital Imaging and Communications in Medicine) format, hard film scanned PNG (Portable Network Graphics) format, DICOM exported PNG format, and PACS (Picture Archiving and Communication System) downloaded resolution reduced DICOM format. OVF classification included: minimal and mild grades with <20% or ≥20–25% vertebral height loss respectively, moderate grade with ≥25–40% vertebral height loss, severe grade with ≥40%–2/3 vertebral height loss, and collapsed grade with ≥2/3 vertebral height loss. The CVF detection base model was mainly composed of convolution layers that include convolution kernels of different sizes, pooling layers, up-sampling layers, feature merging layers, and residual modules. When the model loss function could not be further decreased with additional training, the model was considered to be optimal and termed ‘base-model 1.0’. A user-friendly interface was also developed, with the synthesized software termed ‘Ofeye 1.0’. Results Counting cases and with minimal and mild OVFs included, base-model 1.0 demonstrated a specificity of 97.1%, a sensitivity of 86%, and an accuracy of 93.9% for the 704 testing cases. In total, 33 OVFs in 30 cases had a false negative reading, which constituted a false negative rate of 14.0% (30/215) by counting all OVF cases. Eighteen OVFs in 15 cases had OVFs of ≥ moderate grades missed, which constituted a false negative rate of 7.0% (15/215, i.e., sensitivity 93%) if only counting cases with ≥ moderate grade OVFs missed. False positive reading was recorded in 13 vertebrae in 13 cases (one vertebra in each case), which constituted a false positivity rate of 2.7% (13/489). These vertebrae with false positivity labeling could be readily differentiated from a true OVF by a human reader. The software Ofeye 1.0 allows ‘batch processing’, for example, 100 radiographs can be processed in a single operation. This software can be integrated into hospital PACS, or installed in a standalone personal computer. Conclusions A user-friendly software program was developed for CVF detection on elderly women’s lateral chest radiographs. It has an overall low false positivity rate, and for moderate and severe CVFs an acceptably low false negativity rate. The integration of this software into radiological practice is expected to improve osteoporosis management for elderly women.
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Affiliation(s)
- Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Er-Zhu Du
- Department of Radiology, Dongguan Traditional Chinese Medicine Hospital, Dongguan, China
| | - Wei-Hong Liu
- Department of Radiology, General Hospital of China Resources & Wuhan Iron and Steel Corporation, Wuhan, China
| | - Jian-Bing Ma
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hua Huang
- Department of Radiology, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Jing-Shan Gong
- Department of Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Davide Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Sapienza University of Rome, Rome, Italy.,Department of Diagnostic and Molecular Imaging, Radiology and Radiotherapy, University Foundation Hospital Tor Vergata, Rome, Italy
| | - Kun Zhang
- Department of Radiology, First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Bo Gao
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Heng Liu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ri-Feng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhong-You Ji
- PET-CT Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiao-Bao Xiong
- Department of Radiology, Zhejiang Provincial Tongde Hospital, Hangzhou, China
| | - Lai-Chang He
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lei Wu
- Department of Radiology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chuan-Jun Xu
- Department of Radiology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Mei-Mei Du
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Rong Wang
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Li-Mei Chen
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kong-Yang Wu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,College of Electrical and Information Engineering, Jinan University, Guangzhou, China
| | - Liu Yang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mao-Sheng Xu
- Department of Radiology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Sapienza University of Rome, Rome, Italy
| | - Qi Dou
- Department of Computer Science and Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Y C Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Wáng YXJ. An update of our understanding of radiographic diagnostics for prevalent osteoporotic vertebral fracture in elderly women. Quant Imaging Med Surg 2022; 12:3495-3514. [PMID: 35782246 PMCID: PMC9246755 DOI: 10.21037/qims-22-360] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 08/30/2023]
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18
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Du EZ, Wáng YXJ. CT detects more osteoporotic endplate depressions than radiograph: a descriptive comparison of 76 vertebrae. Osteoporos Int 2022; 33:1569-1577. [PMID: 35368223 DOI: 10.1007/s00198-022-06391-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
UNLABELLED This study analyzed elderly women who had chest radiograph and chest CT with indications other than spine disorders. Using CT images as reference, the study demonstrates that radiograph can miss a high portion of mild endplate depression. Detection of endplate depression is confounded by the limitation of projectional overlay for radiograph. INTRODUCTION The definition of radiographic OVF (osteoporotic vertebral fracture) remains controversial. Some authors suggest all OVFs should demonstrate endplate fracture/depression on radiograph. Using CT image as the reference, our study tests the hypothesis that a considerable portion of endplate depressions not seen on radiograph can be detected on CT. METHODS We retrospectively analyzed 46 female cases (age: 67-94 years) who had both chest radiography and chest CT with indications other than spine disorders. Sixty-six "vertebrae of interest" were identified on radiograph; then, CT images were read side-by-side with lateral chest radiograph. RESULTS Thirty-eight vertebrae (38/66) had anterior wedging deformity with height loss of < 20% while without radiographic endplate depression. Among them, 28 vertebrae had endplate depression and 8 vertebrae had no endplate depression on CT, while 2 vertebrae with "very" minimal deformity were read as normal on CT. In 9 vertebrae (9/66) with anterior wedging and height loss of ≥ 20%, all had additional endplate depression seen on CT. Five vertebrae (5/66) had ambiguous endplate depression on radiograph, 3 had endplate depression on CT while the other 2 vertebrae in one patient were false positive due to X-ray projection. There were 14 short height vertebrae (14/66) where middle and anterior heights were reduced to the same extent while did not show apparent anterior wedging or bi-concaving. Four cases each had one short height vertebra, and all had endplate depression on CT. Another 4 cases had 2, 2, 3, and 3 adjacent short height vertebrae, respectively, and all did not show endplate depression on CT. In addition, inspection of spine CT showed 10 vertebrae in 9 cases appeared normal on radiograph while demonstrated endplate depression on CT. CONCLUSION With CT images as reference, radiograph can miss a high portion of mild endplate depressions.
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Affiliation(s)
- E-Z Du
- Department of Radiology, Dongguan Traditional Chinese Medicine Hospital, Dongguan, Guangdong province, China
| | - Y X J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
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Wáng YXJ, Deng M, Griffith JF, Kwok AWL, Leung JCS, Lam PMS, Yu BWM, Leung PC, Kwok TCY. 'Healthier Chinese spine': an update of osteoporotic fractures in men (MrOS) and in women (MsOS) Hong Kong spine radiograph studies. Quant Imaging Med Surg 2022; 12:2090-2105. [PMID: 35284274 PMCID: PMC8899940 DOI: 10.21037/qims-2021-07] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/16/2021] [Indexed: 08/09/2023]
Abstract
For the MrOS (Hong Kong) and MsOS (Hong Kong) baseline (BL) studies, community-dwelling 2,000 Chinese men (mean age: 72.3 years) and 2,000 Chinese women (mean age: 72.5 years) were recruited from 2001 to 2003. These two studies have spanned two decades till now. This review summarizes our spine radiograph results. Senile and post-menopausal osteoporosis were associated with intervertebral disc volume reduction; and in women, menopause accelerates disc degeneration. Elderly women's osteoporotic vertebral fracture (OVF) prevalence was double of that of elderly men. For year-4 follow-up (FU), male participants with BL OVF had little increased risk for further OVF. In our study comparing OVF rates in age-matched Hong Kong Chinese women and Italian Caucasian women (mean age: 74.1 years), endplate and/or cortex fracture (ECF) prevalence was 26% for Chinese and 47% for Italian. OVF with ≥40% vertebral height loss was recorded among 9.5% of the Chinese subjects while among 26% of the Italian subjects. OVFs in Italian subjects were more likely to be multiple and generally severer. Clinical spine fractures were recorded 133 cases/100,000 person-years in MrOS (Hong Kong) participants and 273 cases/100,000 person-years in MsOS (Hong Kong) participants. Literature review suggests the clinical vertebral fracture rates among elderly Hong Kong Chinese subjects are approximately half of those of American, Australian, and Canadian subjects. Data synthesis suggests elderly Caucasians have a higher degenerative spondylolisthesis prevalence, being approximately 70% higher than that of elderly Hong Kong Chinese. Literature review of other authors' publications shows, compared with Caucasians, Chinese have a much lower incident rate of back pain. We conclude that elderly Chinese have a generally healthier spine relative to elderly Caucasians.
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Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Min Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - James F. Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anthony W. L. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR, China
| | - Jason C. S. Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patti M. S. Lam
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Blanche Wai Man Yu
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ping Chung Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy C. Y. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Liu Y, Yu A, Li K, Wang L, Huang P, Geng J, Zhang Y, Duanmu YY, Blake GM, Cheng X. Differences in spine volumetric bone mineral density between grade 1 vertebral fracture and non-fractured participants in the China action on spine and hip status study. Front Endocrinol (Lausanne) 2022; 13:1013597. [PMID: 36387886 PMCID: PMC9647629 DOI: 10.3389/fendo.2022.1013597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE This study evaluated the prevalence of vertebral fractures (VF) in middle-aged and elderly Chinese men and women and explored the differences in lumbar spine volumetric bone mineral density (vBMD) derived from quantitative CT (QCT) between those with a grade 1 vertebral fracture and non-fractured individuals. MATERIALS AND METHODS 3,457 participants were enrolled in the China Action on Spine and Hip Status (CASH) study and had upper abdominal CT examinations. Vertebral fractures were identified by Genant's semi-quantitative method from lateral CT scout views or CT sagittal views. L1-3 vBMD was measured by Mindways QCT Pro v5.0 software. The characteristics of different fracture severity groups were compared using one-way ANOVA, independent-samples t-tests, and Kruskal-Wallis H-tests. RESULTS 1267 males (aged 62.77 ± 9.20 years) and 2170 females (aged 61.41 ± 9.01 years) were included in the analysis. In men, the prevalence of VF increased from 14.7% at age<50 years to 23.2% at age ≥70 years, and in women from 5.1% at age<50 years to 33.0% at age ≥70 years. Differences in mean age and vBMD were found between the different fracture grade groups. After age stratification, vBMD differences in men aged < 50 years old disappeared (p = 0.162) but remained in the older age bands. There was no significant difference in mean vBMD between those with multiple mild fractures and those with a single mild fracture. CONCLUSION In women, the prevalence of VF increased rapidly after age 50, while it grew more slowly in men. In general, with the exception of men <50 years old, participants with a grade 1 VF had lower vBMD than non-fractured individuals. The majority of women younger than 50 with a grade 1 VF had normal bone mass. We recommend that a vertebral height reduction ratio of <25% be diagnosed as a deformity rather than a fracture in people under the age of 50. The presence of multiple mild fractured vertebrae does not imply lower BMD.
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Affiliation(s)
- Yandong Liu
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Aihong Yu
- Radiology Department, Beijing Anding Hospital Capital Medical University, Beijing, China
| | - Kai Li
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Ling Wang
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Pengju Huang
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Jian Geng
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Yong Zhang
- Intervention Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yang-yang Duanmu
- South Medical Image Center, The First Affiliated Hospital of University of Science and Technology of China (USTC), Anhui, China
| | - Glen M. Blake
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Xiaoguang Cheng
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
- *Correspondence: Xiaoguang Cheng,
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Qian TY, Wan H, Huang CY, Hu XJ, Yao WF. OUP accepted manuscript. Lab Med 2022; 53:446-452. [PMID: 35311990 DOI: 10.1093/labmed/lmac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tie-Yong Qian
- Department of Endocrinology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, China
| | - Hui Wan
- Department of Endocrinology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, China
| | - Ci-You Huang
- Department of Endocrinology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, China
| | - Xiao-Jing Hu
- Department of Endocrinology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, China
| | - Wei-Feng Yao
- Department of Endocrinology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, China
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Wáng YXJ, Diacinti D, Leung JCS, Iannacone A, Kripa E, Kwok TCY, Diacinti D. Much lower prevalence and severity of radiographic osteoporotic vertebral fracture in elderly Hong Kong Chinese women than in age-matched Rome Caucasian women: a cross-sectional study. Arch Osteoporos 2021; 16:174. [PMID: 34783904 DOI: 10.1007/s11657-021-00987-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/17/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Many earlier studies reported that East Asians and Caucasians have similar radiographic osteoporotic vertebral fracture (OVF) prevalence. Since elderly Chinese's osteoporotic hip fracture prevalence is half (or less than half) of that of their age-match Caucasians, we hypothesize that elderly Chinese's OVF prevalence could be only half, or even less than half, of that of their age-match Caucasians. MATERIALS Age-matched (mean: 74.1 years; range: 65-87 years) elderly women's radiographs (T4-L5) were from two OVF population-based epidemiological studies conducted in Hong Kong (n = 200) and in Rome (n = 200). All radiographs were double read by one reader in Hong Kong and one reader in Rome. Radiological osteoporotic vertebral deformity (ROVD) classification included no ROVD (grade 0), and ROVDs with < 20%, 20 ~ 25%, ≥ 25% ~ 1/3, ≥ 1/3 ~ 40%, ≥ 40% ~ 2/3, and ≥ 2/3 height loss (grade 1 ~ 6) as well as endplate/cortex fracture (ECF). Spinal deformity index (SDI) was calculated with each vertebra assigned a score of 0, 0.5, 1, 1.5, 2, 2.5, and 3 for no ROVD or ROVDs grade 1 ~ 6. RESULTS Seventy-seven (38.5%) Chinese subjects and 123 Italian subjects (61.5%) had ROVD respectively (p < 0.0001). Chinese subjects had ECF in 52 (26%) cases involving 100 vertebrae, while Italian subjects had ECF in 93 (47%) cases involving 230 vertebrae. ROVDs in Italian subjects tended to be more severe (total and mean SDI: 454.5 and 3.71 for Italian, and 212 and 2.72 for Chinese, p < 0.05), more likely to be multiple, more likely to have severe and collapsed grades. The slope of the relationship between age vs. SDI was steeper for the Italian subjects than for the Chinese subjects, suggesting ROVD severity developed faster for aging Italian subjects. A trend suggested earlier onset of ROVD among Italian. CONCLUSION OVFs in Chinese women tend to be less common, less severe, and less likely to have multiple fractures.
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Du EZ, Liu WH, Wáng YXJ. Improving osteoporotic vertebral deformity detection on chest frontal view radiograph by adjusted X-ray beam positioning. J Orthop Translat 2021; 28:169-78. [PMID: 34036040 DOI: 10.1016/j.jot.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose In clinics, chest frontal view radiograph (CFR) is often taken for patients suspected of respiratory diseases and for assessing the heart and big vessels. CFR can be utilised to opportunistically detect osteoporotic vertebral fracture (OVF). However, for standard CFR, the site of highest OVF prevalence, i.e., the thoracolumbar junction, is usually 'off-centre' to the X-ray beam focus. This study tested the hypothesis that, if a CRF is taken with approximately two vertebrae lower than the standard X-ray beam positioning, the visualization of thoraco-lumbar junction can be much improved. Materials Four hospitals (A, B, C, D) provided 101 elderly women's digital CFRs with standard filming (28, 20, 24, and 21 cases respectively). Eighty four elderly female patients were prospectively recruited from hospitals-A and B, who were consecutive patients referred for chest radiograph with indications other than spine disorders. For theses prospective CFRs, the focus of X-ray beam was adjusted from towards vertebra T6 to towards T8, and standard lateral radiographs were obtained for reference. Visibility of spine and detectability of OVF were assessed on the CFRs. OVF was diagnosed based on chest lateral radiograph (CLR) after excluding other potential causes both radiographically and clinically. Results For standardly filmed CFR, spine readability was similar among those from Hospitals-A, B, and C, while performed less well for those from Hospital-D. With the prospective cases from Hospitals-A and B, spines readable to vertebra L1 level or lower increased from 48.2% for standard filming to 80.7% for adjusted filming. Spines with 'blurry' labelling decreased from 35.7% for standard filming to 15.7% for adjusted filming. For the 84 prospective cases, 42.9% (36/84) of the patients had OVF, and 26 cases of CLR positive cases were detected as having vertebral deformity on CFR. For minimal OVF cases (<20% height loss), 38% (5/13) were detected on CFR. Among 22 cases with apparent OVF (≥20% height loss), two cases were missed on CFR. False positivity was labelled in five cases, among them four cases had 'burry' spines. Conclusion CFR can help opportunistically detect OVF, which can be further improved if X-ray beam is adjusted to towards vertebra T8 instead of towards vertebra T6. The translational potential of this article This study confirms that CFR can help detect OVF opportunistically, and the visibility of the mid/lower thoracic spine and thoracolumbar junction can be much improved after minor adjustment of X-ray beam positioning. This study also suggests high positive rate of OVF in elderly Chinese female patients indicated for chest radiograph. Radiologists should be trained and sensitized in vertebral deformity identification on CFR as the clinical management can be improved by opportunistic detection of OVF.
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Zuo XH, Chen YB, Xie P, Zhang WD, Xue XY, Zhang QX, Shan B, Zhang XB, Bao HG, Si YN. Finite element analysis of wedge and biconcave deformity in four different height restoration after augmentation of osteoporotic vertebral compression fractures. J Orthop Surg Res 2021; 16:138. [PMID: 33588890 PMCID: PMC7885256 DOI: 10.1186/s13018-021-02225-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Biomechanical comparison of wedge and biconcave deformity of different height restoration after augmentation of osteoporotic vertebral compression fractures was analyzed by three-dimensional finite element analysis (FEA). Methods Three-dimensional finite element model (FEM) of T11-L2 segment was constructed from CT scan of elderly osteoporosis patient. The von Mises stresses of vertebrae, intervertebral disc, facet joints, displacement, and range of motion (ROM) of wedge and biconcave deformity were compared at four different heights (Genant 0–3 grade) after T12 vertebral augmentation. Results In wedge deformity, the stress of T12 decreased as the vertebral height in neutral position, flexion, extension, and left axial rotation, whereas increased sharply in bending at Genant 0; L1 and L2 decreased in all positions excluding flexion of L2, and T11 increased in neutral position, flexion, extension, and right axial rotation at Genant 0. No significant changes in biconcave deformity. The stress of T11-T12, T12-L1, and L1-L2 intervertebral disc gradually increased or decreased under other positions in wedge fracture, whereas L1-L2 no significant change in biconcave fracture. The utmost overall facet joint stress is at Genant 3, whereas there is no significant change under the same position in biconcave fracture. The displacement and ROM of the wedge fracture had ups and downs, while a decline in all positions excluding extension in biconcave fracture. Conclusions The vertebral restoration height after augmentation to Genant 0 affects the von Mises stress, displacement, and ROM in wedge deformity, which may increase the risk of fracture, whereas restored or not in biconcave deformity.
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Affiliation(s)
- Xiao-Hua Zuo
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.,Department of Pain Management, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Yin-Bing Chen
- Department of Orthopedic Surgery, The Affiliated Haian Hospital of Nantong University, Haian, 226600, China
| | - Peng Xie
- Department of Neurosurgery, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Wen-Dong Zhang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Xiang-Yun Xue
- Department of Pain Management, Yancheng No.1 People's Hospital, Yancheng, 224000, China
| | - Qian-Xi Zhang
- Department of Pain Management, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Ben Shan
- Department of Radiology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Xiao-Bing Zhang
- Department of Radiology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China.
| | - Hong-Guang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Yan-Na Si
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
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Wáng YXJ, Du EZ, Gong J, Cheng X. Interpretation of osteoporotic vertebral deformity on frontal view radiographs of the chest and abdomen: a pictorial review. Quant Imaging Med Surg 2021; 11:423-442. [PMID: 33392042 DOI: 10.21037/qims-2020-28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Osteoporotic vertebral fracture (OVF) has high prevalence in the elderly population. It affects at least one-fourth of all postmenopausal women and is commonly seen among women approximately one decade after menopause. A vertebral fracture, after minor trauma, is a hallmark of osteoporosis. Many fractures and associated complications, including secondary fractures and mortality, can be prevented by routine osteoporosis screening in older people and timely treatment initiation in at-risk individuals. Depending on the technical condition of the radiographs, a substantial portion of moderate to severe grades OVFs in mid-thoracic and lower thoracic spine as well as lumbar spine can be detected on a frontal view digital radiograph of the chest or abdomen. Radiologists should pay attention to the potential existence of an OVF while reading chest and abdominal radiographs of elderly female subjects. In this pictorial review, we describe our experience in evaluating the normal shaped and deformed vertebrae on chest and abdominal radiographs.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Er-Zhu Du
- Department of Radiology, Dongguan Traditional Chinese Medicine Hospital, Dongguan, China
| | - Jingshan Gong
- Department of Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
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Abstract
Despite the growing use of computed tomography (CT) and magnetic resonance imaging (MRI) in the study of spinal disorders, radiography still plays an important role in many conditions affecting the spine. However, the study and interpretation of spine radiograph is receiving less attention and radiologists are increasingly unfamiliar with the typical findings in normal and pathologic conditions of the spine. The aim of this article is to review the radiologic indications of radiograph in different pathologic conditions that affect the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumour disorders, as well as their main radiographic manifestations.
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Affiliation(s)
- Fernando Ruiz Santiago
- Department of Radiology, Neuro-traumatology Hospital, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | | | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Daniel López Zúñiga
- Department of Radiology, Neuro-traumatology Hospital, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
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Wáng YXJ, Che-Nordin N, Leung JCS, Man Yu BW, Griffith JF, Kwok TCY. Elderly men have much lower vertebral fracture risk than elderly women even at advanced age: the MrOS and MsOS (Hong Kong) year 14 follow-up radiology results. Arch Osteoporos 2020; 15:176. [PMID: 33159570 DOI: 10.1007/s11657-020-00845-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
UNLABELLED MrOS MsOS (Hong Kong) studies year 14 follow-up shows for subjects without baseline osteoporotic vertebral deformity, women's incident vertebral fracture (VF) rate was twice that of men. For subjects with vertebral deformity of baseline ≥ 20% height loss, counting subject, women's incident VF rate was three times higher than that of men. INTRODUCTION For MrOS MsOS (Hong Kong) baseline (BL) studies, 2000 men and 2000 women ≥ 65 years were recruited during 2001 to 2003. This study presents the year 14 follow-up (FU). MATERIALS Whole spine MRI was performed in 271 males (mean, 82.8 ± 3.6 years) and 150 females (mean, 82.0 ± 4.29 years). Osteoporotic vertebral deformity (OVD) classification included no OVD (grade 0), and OVDs with < 20%, 20~25%, > 25%~1/3, > 1/3~40%, > 40%~2/3, and > 2/3 height loss (grade 1~6). With an existing VD, a further height loss of ≥ 15% was a VD progression. A new incident VD was a change from grade 0 to ≥ grade 2 or to grade 1 with ≥ 10% height loss. OVD progression and new incident OVD were considered incident VF. RESULTS The proportion of osteoporotic subjects only slightly increased during FU for men but doubled for women. Groupwise, OVD was not associated with back pain in men; but OVD with > 1/3 height loss was associated with back pain in women. For subjects without BL OVD, 7.9% of men and 14.6% of women had incident VF. For subjects with BL OVD of ≥ 20% height loss, men's and women's incident VF were 17.6% and 52.6%, respectively, counting subject and 1.68% and 7.89%, respectively, counting vertebra. CONCLUSION Elderly men with or without existing osteoporotic VD have much lower future VF risk than elderly women.
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Wáng YXJ, Lentle BC. Radiographic osteoporotic vertebral fractures in elderly men: a brief review focusing on differences between the sexes. Quant Imaging Med Surg 2020; 10:1863-1876. [PMID: 32879863 PMCID: PMC7417751 DOI: 10.21037/qims-2020-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 12/16/2022]
Abstract
Bone loss occurs in both sexes as a result of ageing but is exacerbated in women by the hormonal changes associated with menopause. Unlike in women, secondary osteoporosis occurs in almost half of men diagnosed with osteoporosis. Moreover, vertebral fractures (VFs) seen in elderly men may more likely be the result of high energy trauma. The osteoporotic vertebral fracture (OVF) radiograph diagnosis criteria for women may not be directly applicable for men. Particular attention should be paid to the mid-thoracic level where over-diagnosis commonly occurs. For wedge-shaped vertebral deformities (VDs) or VDs with anterior height reduction only, a diagnosis of OVF requires great caution, as they are poorly correlated to bone mineral density (BMD). For age-matched subjects, it is likely that elderly men's prevalent radiographic OVFs are approximately half of the elderly women's. This male-female ratio is very similar to other clinical fractures such as those occurring at the hip. Even so, the clinical relevance of OVF in elderly men may be less than that of elderly women. On the other hand, for elderly men with hip BMD-based osteoporosis, the OVF risk is as high as that of osteoporotic women. Elderly Chinese men have a lower OVF prevalence than age-matched Caucasian men.
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Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Brian C. Lentle
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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Wáng YXJ, Liu WH, Diacinti D, Yang DW, Iannacone A, Wang XR, Kripa E, Che-Nordin N, Diacinti D. Diagnosis and grading of radiographic osteoporotic vertebral deformity by general radiologists after a brief self-learning period. J Thorac Dis 2020; 12:4702-4710. [PMID: 33145043 PMCID: PMC7578449 DOI: 10.21037/jtd-20-2379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The expanded semi-quantitative (eSQ) osteoporotic vertebral deformity (OVD) classification has minimal, mild, moderate, moderately-severe, severe, and collapsed grades with <20%, 20–25%, >25%–1/3, >1/3–40%, >40%–2/3, >2/3 vertebral height loss respectively. This study evaluates the performance of using this grading criterion by radiology readers who did not have former training in OVD assessment. Methods Spine radiographs of 44 elderly women with 278 normal appearing vertebrae and 65 OVDs were selected, with two senior readers agreed the reference reading. Three readers from Italy and three readers from China were invited to evaluate these radiographs after reading five reference articles including one detailing eSQ criteria with illustrative examples. Before the second round of reading, the readers were asked to read an additional explanatory document. For the readers in Italy an additional on-line demonstration was given on how to measure vertebral height loss in another five cases of OVD. Two Chinese readers had a third round of reading after a 90 minutes’ on-line lecture. Results The final absolute agreement rate with the reference reading (i.e., exactly the same grading as the reference) ranged between 46.2% to 68.2% for the six readers, and the final relative agreement (with one eSQ grade difference allowed) ranged between 78.5% to 92.5%. The >1 grade disagreement rate was all below 11%, and mostly below 7%. The missed OVD were mostly minimal grade. The rate for missing a ≥ mild OVD was <4.5%, and false positive rate was generally <1.4% among the final reading. If the minimal grade was removed and the remaining gradings were converted to Genant’s semi-quantitative (GSQ) grading, the mean kappa values against the reference reading for SQ grades-1,2,3 were 0.813, 0.814, and 0.916 respectively. Conclusions This study demonstrates good performance of the six learner readers for assessing radiographic after a brief self-learning period.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Wei-Hong Liu
- Department of Radiology, General Hospital of China Resources & Wuhan Iron and Steel Corporation, Wuhan, China
| | - Davide Diacinti
- Department of Oral and MaxilloFacial Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy.,Department of Diagnostic and Molecular Imaging, Radiology and Radiotherapy, University Foundation Hospital Tor Vergata, Rome, Italy
| | - Da-Wei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Antonio Iannacone
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Xiao-Rong Wang
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Endi Kripa
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Nazmi Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
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