Diagnostic disagreement of imaging quantitative sonography of the calcaneus with dual X-ray absorptiometry of the spine and femur.
OBJECTIVE
This study evaluates the diagnostic agreement between imaging quantitative sonography of the calcaneus and dual X-ray absorptiometry of the spine and femur for diagnosing osteoporosis.


METHODS
In 498 female patients (56 +/- 18 years old), bone mineral density measurements by dual X-ray absorptiometry of the lumbar spine (posteroanterior, L1--L4) and the proximal femur and imaging quantitative sonography of the calcaneus were performed. The percentage of patients having T-scores less than or equal to a threshold of -2.5 standard deviations below a young normal reference was used to compare quantitative sonography with dual X-ray absorptiometry. The diagnostic agreement was assessed using kappa scores.


RESULTS
Approximately 30% of the patients had a T-score less than or equal to -2.5 standard deviations as assessed by imaging quantitative sonography (broadband ultrasound attenuation), 26.5% as assessed by dual X-ray absorptiometry of the spine, and 16.7--56.4% as assessed by dual X-ray absorptiometry of the different regions of interest at the femur. Kappa analysis showed that severe diagnostic disagreement exists among broadband ultrasound attenuation and dual X-ray absorptiometry (kappa = 0.28-0.42).


CONCLUSIONS
Considerable diagnostic disagreement exists between imaging quantitative sonography and dual X-ray absorptiometry of the spine and femur. The disagreement is in the same range as that reported recently in comparisons of dual X-ray absorptiometry and nonimaging quantitative sonography. In general, no distinct advantage for imaging quantitative sonography could be found when compared with other techniques.
Krestan
C R
CR
Universitätsklinik für Radiodiagnostik, Osteologie, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Grampp
S
S
Resch-Holeczke
A
A
Henk
C B
CB
Imhof
H
H
Resch
H
H
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002111:Calcaneus / Q000000981:diagnostic imaging*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D013131:Spine / Q000000981:diagnostic imaging*; D014463:Ultrasonography