Vertebral Morphometry
Section snippets
Algorithm-Based Qualitative Method
The diagnosis of vertebral fractures is usually based on the presence of a deformation of vertebral body on lateral spinal radiographs, but a vertebral deformity is not always a vertebral fracture.24 Because there is no consensus on the exact definition of a vertebral fracture, it may sometimes be difficult to discriminate the prevalent vertebral fracture from a normal variant of vertebral shape or from a vertebral deformation that may have occurred long ago, especially in mild cases. The
Vertebral morphometry
Vertebral morphometry is a quantitative method to identify osteoporotic vertebral fractures based on the measurement of vertebral heights. Vertebral morphometry may be performed on conventional spinal radiographs (MRX: morphometric x-ray radiography) or on images obtained from dual x-ray absorptiometry (DXA) scans (MXA: morphometric x-ray absorptiometry).
Morphometric definition of vertebral fractures
There is no gold standard for osteoporotic fracture. Definition of vertebral fracture is based on the differences in anterior, middle, or posterior vertebral heights within a vertebra, or between adjacent vertebrae.44, 45
However, there is variation in vertebral body (VB) size and shape at different levels of the spine for the construction of thoracolumbar curvatures, which reduce bending moments created by upright posture and so provide stability during motion.46 The VB is anteriorly wedged
Comparison of SQ and MRX for the identification of vertebral fractures in osteoporosis
Some comparative studies67, 68, 69 found a high concordance between different MRX approaches and the visual SQ method in the evaluation of prevalent vertebral fractures defined as moderate or severe (Fig. 6). In these cases there was a strong association with clinical parameters (bone mineral density, height loss, back pain, incidence of subsequent deformities). There were discrepancies between SQ and quantitative morphometry approaches in the detection of mild fractures as classified by an
Vertebral fracture assessment by dual-energy X-ray absorptiometry
Vertebral fracture assessment (VFA) is the correct term for designating the assessment of lateral spine views acquired by DXA to detect vertebral fractures, using new-generation densitometers of 2 major manufacturers: Hologic, Inc (Bedford, MA, USA) and GE Medical Systems (Lunar, Madison, WI, USA). DXA scan of the spine is performed either by using a rotating arm (Hologic QDR 4500A, QDR Delphi, GE-Lunar Expert) with the patient lying supine or by placing the patient on in the left decubitus
Comparison between conventional radiography and DXA images
The main attraction of DXA is that the effective dose-equivalent to the patient is considerably lower (42 μSv) than for conventional radiography (500 μSv).79, 80 When using the scanning fan-beam geometry of DXA devices, the X-ray beam is parallel to the endplates, instead of being fan-shaped as during conventional radiography, which eliminates problems related to image amplification and geometric distortion.81 Whereas the DXA technique is able to acquire the entire spine in a single image, in
Clinical applications of VFA
To identify vertebral fractures on DXA images the visual SQ method and vertebral morphometry (MXA) are used, as on radiographs.
Several studies have been performed to compare the DXA images to the gold standard lateral spine radiographs for the detection of vertebral fracture. First, in a large study it has been demonstrated that reference ranges of vertebral heights derived from standard radiographs could not be applied to VFA on DXA images, in view of the observed differences between their MXA
Can vertebral morphometry predict a vertebral fracture?
The aim of osteoporosis treatment is to decrease the risk of fracture, particularly in individuals at high risk. Although bone mass is an important determinant of the risk of fracture, other factors contribute to skeletal fragility. There are several clinical factors (age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis, and the use of oral glucocorticoids) that, in conjunction with BMD, can be integrated to provide estimates of 10-year
Summary
For epidemiologic studies and clinical drug trials in osteoporosis research, and to minimize subjective biases intrinsic to qualitative readings and homogenize data analysis, visual SQ assessment of the radiographs by a trained and experienced observer is the gold standard method to detect vertebral fractures.109, 110 In clinical practice, the preferred method is also radiographic SQ assessment, because an expert eye can better distinguish between true fractures and vertebral anomalies than can
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Cited by (60)
Thoracic and Lumbosacral Spine Anatomy
2022, Neuroimaging Clinics of North AmericaCitation Excerpt :The endplates are asymmetric, with the cranial endplate more concave and denser than the corresponding caudal endplate.14 Vertebral body height is affected by multiple intrinsic factors of the spine such as trabecular architecture, disc integrity, scoliosis, and bone density.15 Patient factors contributing to alterations of vertebral body height include age, gender, smoking, alcohol intake, prior fracture, and corticosteroid use.16,17
Baseline anthropometric indices predict change in vertebral size in early adulthood – A 10-year follow-up MRI study
2020, BoneCitation Excerpt :Finally, mean width and depth were calculated by averaging the respective measurements across levels. Mean values were used to account for the natural variety in vertebral shape among healthy individuals [18,19]. Vertebral CSA was calculated using the previously validated ellipsoid formula [20,21] CSA = π × a/2 × b/2, where a = mean width and b = mean depth.
Vertebral fracture identification
2020, Marcus and Feldman’s OsteoporosisOsteoporotic Vertebral Fracture Prevalence in Elderly Chinese Men and Women: A Comparison of Endplate/Cortex Fracture–Based and Morphometrical Deformity–Based Methods
2019, Journal of Clinical DensitometryCitation Excerpt :The concordance across these methods still remains a matter of debate (19–21). Quantitative morphometry uses ratios derived from direct vertebral body height measurements to define fractures (18,22,23). Genant et al proposed a visual grading that relies on subjective assessment of vertebral deformity (VD), also called semiquantitative method, which aims to exclude physiological variants in vertebral shape and nonfracture vertebral deformities (24,25).
Osteoporosis, bone mineral density and CKD–MBD complex (I): Diagnostic considerations
2018, NefrologiaCitation Excerpt :The risk of hip fracture in CKD, however, is clearly higher than in the general population,17 being 3- to 4-fold higher in dialysis patients vs. the general population and patients without dialysis.78,79 This, of course, is the most serious consequence of OP, since it is associated with an increased risk of new fractures and premature death, and underscores the importance of performing interventions to reduce this risk.14,56,64,90,93 In routine clinical practice, diagnosis of OP is based on the measurement of BMD by DEXA.2,14,94