title: META: an MRI-based scoring system differentiating metastatic from osteoporotic vertebral fractures.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) is useful for the differential diagnosis of osteoporotic vertebral fractures (OVFs) and metastatic vertebral fractures (MVFs), but no single finding is absolutely conclusive.
  
  
  OBJECTIVE
  The purpose of the present study was to create a scoring system to facilitate the correct diagnosis of MVFs by integrating several MRI findings.
  
  
  METHODS
  This is a retrospective and single-center observational study that attempts to create a diagnostic scoring system by discriminant analysis.
  
  
  METHODS
  We included 100 OVFs and 100 MVFs in thoracolumbar vertebrae of which MR images were obtained within 60 days from the suspected time of fractures.
  
  
  METHODS
  The sensitivity and specificity of known important MRI findings were assessed, and the classification accuracy of the scoring system was investigated.
  
  
  METHODS
  Seven MRI findings of these fractures were analyzed to evaluate their sensitivity and specificity. Using these findings as variables, discriminant analysis was performed in 140 fractures as a training set, and the classification accuracy was calculated in the remaining 60 fractures as a test set. Additionally, the images of these 60 fractures were reviewed by another blinded reviewer to investigate the interobserver reliability of each finding.
  
  
  RESULTS
  All findings had high specificity with low-to-moderate sensitivity. Eight variables were selected in the final discriminant function. A simpler scoring system (MRI Evaluation Totalizing Assessment [META]) was created by approximating the coefficients and the constant term by integral numbers. The classification accuracy was calculated to be 96.6% in the test set. The interobserver reliability of the key findings varied, but the final discrimination conducted by META had the high agreement between the two reviewers (κ=0.93).
  
  
  CONCLUSIONS
  This novel scoring system, META, could prove to be a useful tool for the differential diagnosis of OVFs and MVFs. It is simple and physician friendly, yet highly accurate.
authors.affiliation: Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Orthopaedic Surgery and Musculoskeletal Oncology, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan. Electronic address: skatou-tky@umin.org.
authors.forename: So
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Oncology, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hozumi
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Oncology, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
authors.forename: Kiyofumi
authors.initials: K
authors.lastname: Yamakawa
authors.affiliation: Division of Clinical Research Support, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Saito
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Oncology, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Oncology, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
authors.forename: Taiji
authors.initials: T
authors.lastname: Kondo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology*; D013125:Spinal Neoplasms / Q000150:complications* / Q000473:pathology; D013131:Spine / Q000473:pathology*
keywords: Compression fracture; Differential diagnosis; Discriminant analysis; Magnetic resonance imaging; Metastatic vertebral fracture; Osteoporotic vertebral fracture