Vertebral morphometry by DXA: a comparison of supine lateral and decubitus lateral densitometers

Identification of vertebral fracture has become increasingly important in the diagnosis and management of osteoporosis. This study compares the morphometric techniques on a fan beam dual-energy X-ray absorptiometry (DXA) GE-Lunar Expert system (Expert) using a supine lateral position and a narrow fa...

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Bibliographic Details
Published in:	Journal of clinical densitometry Vol. 9; no. 3; p. 295
Main Authors:	Pearson, Derek, Horton, Barbara, Green, Desmond J, Hosking, David J, Goodby, Ann, Steel, Susan A
Format:	Journal Article
Language:	English
Published:	United States 01-07-2006
Subjects:	Absorptiometry, Photon - instrumentation Absorptiometry, Photon - methods Absorptiometry, Photon - standards Absorptiometry, Photon - statistics & numerical data Adult Aged Aged, 80 and over Bone Density Female Humans Lumbar Vertebrae - anatomy & histology Lumbar Vertebrae - diagnostic imaging Lumbar Vertebrae - metabolism Middle Aged Osteoporosis, Postmenopausal - diagnosis Osteoporosis, Postmenopausal - diagnostic imaging Osteoporosis, Postmenopausal - metabolism Spinal Fractures - diagnosis Spinal Fractures - diagnostic imaging Spinal Fractures - metabolism Spine - anatomy & histology Spine - diagnostic imaging Spine - metabolism Thoracic Vertebrae - anatomy & histology Thoracic Vertebrae - diagnostic imaging Thoracic Vertebrae - metabolism
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Summary:	Identification of vertebral fracture has become increasingly important in the diagnosis and management of osteoporosis. This study compares the morphometric techniques on a fan beam dual-energy X-ray absorptiometry (DXA) GE-Lunar Expert system (Expert) using a supine lateral position and a narrow fan beam GE-Lunar Prodigy system (Prodigy; GE Lunar, Madison, WI) that requires lateral decubitus positioning. Patient acceptability, image quality, observer, and equipment variability were determined. Study subjects were recruited from clinical referrals sent for a routine DXA study that included vertebral morphometry. Twenty-five patients underwent lateral vertebral assessment on both machines and completed a questionnaire on comfort and tolerability. Analysis was undertaken by two trained observers. Vertebral height, anterior/posterior height (A/P) and mid/posterior height (M/P) ratios, image quality, and prevalent fractures were assessed. There were no significant differences in patient comfort or image quality scores. More upper thoracic vertebrae could be assessed on the Expert, and good radiographic positioning was easier to achieve on the Expert. Inter-observer coefficients of variance percentage (CV%) of vertebral height was lower on the Prodigy (3.5% in the lumbar spine rising to 12.8% in the thoracic spine) than the Expert (4.2% to 16.9%). Inter-observer CV% for A/P and M/P ratios varied from 2.5% to 10.5% on the Prodigy compared with 3.5% to 12.3% on the Expert, depending on vertebral level. The variation between instruments was similar to the inter-observer CV% (anterior height: -0.11+/-1.65 mm; mid height: 0.54+/-1.51 mm; posterior height: 0.43+/-1.46 mm). There was good agreement between observers and between the Expert and Prodigy in identifying severe fractures, but lack of agreement in identifying moderate fractures. In conclusion, there was no clinically significant difference in patient comfort and image quality between the Expert and the Prodigy. The inter-observer variations in vertebral height and A/P and M/P ratios are similar to the variations between instruments. In making the change from the supine lateral to the decubitus lateral positioning, measurements of vertebral height are reproducible and patient comfort is not compromised.
ISSN:	1094-6950
DOI:	10.1016/j.jocd.2006.03.011