Diagnostic performance of morphometric vertebral fracture analysis (MXA) in children using a 33-point software
Fawaz F Alqahtani1, Nicola J Crabtree2, Paul A Bromiley3
1Academic Unit of Child Health, University of Sheffield, Sheffield, UK.
Bone
|January 25, 2020
Summary
Morphometric vertebral fracture analysis (MXA) software, designed for adults, is unreliable for diagnosing mild pediatric vertebral fractures. A specialized pediatric standard is needed to account for age-related changes in children's bone shape.
Area of Science:
- Pediatric Radiology
- Medical Imaging Analysis
- Skeletal Health in Children
Background:
- Diagnosing vertebral fractures in children suffers from significant inter and intraobserver variability.
- Accurate diagnosis is crucial for appropriate management and monitoring of pediatric skeletal conditions.
Purpose of the Study:
- To evaluate the diagnostic accuracy of morphometric vertebral fracture analysis (MXA) using adult-designed software on pediatric dual-energy x-ray absorptiometry (DXA) images.
- To assess the reliability of MXA in identifying vertebral fractures in a pediatric population.
Main Methods:
- Retrospective review of lateral spine DXA images from 420 children (ages 5-18).
- Vertebral fracture assessment (VFA) by an expert pediatric radiologist using Genant's semiquantitative scoring system as the gold standard.
- Analysis of DXA scans using semi-automated 33-point morphometry software (MXA) by a trained radiographer and multiple pediatric radiologists/clinical scientists.
- Calculation of diagnostic accuracy (sensitivity, specificity, false positive/negative rates) and inter/intraobserver agreement (kappa statistics).
Main Results:
- The radiographer using MXA software showed overall sensitivity of 80% and specificity of 90%. For mild fractures alone, sensitivity dropped to 46%.
- Additional observers using MXA had overall sensitivity of 89% and specificity of 79%. For mild fractures alone, sensitivity was 36%.
- Interobserver agreement for both VFA and MXA was fair to good, with kappa values ranging from 0.29 to 0.76.
Conclusions:
- Morphometric vertebral fracture analysis (MXA) using a 33-point technique developed for adults is not a reliable method for identifying mild vertebral fractures in children.
- A pediatric-specific standard for vertebral fracture analysis is required.
- This standard should incorporate age-related physiological changes in vertebral shape and specific vertebral body height ratios relevant to childhood development.
