title: Diagnostic accuracy of DXA compared to conventional spine radiographs for the detection of vertebral fractures in children.
abstract: OBJECTIVE
  In children, radiography is performed to diagnose vertebral fractures and dual energy x-ray absorptiometry (DXA) to assess bone density. In adults, DXA assesses both. We aimed to establish whether DXA can replace spine radiographs in assessment of paediatric vertebral fractures.
  
  
  METHODS
  Prospectively, lateral spine radiographs and lateral spine DXA of 250 children performed on the same day were independently scored by three radiologists using the simplified algorithm-based qualitative technique and blinded to results of the other modality. Consensus radiograph read and second read of 100 random images were performed. Diagnostic accuracy, inter/intraobserver and intermodality agreements, patient/carer experience and radiation dose were assessed.
  
  
  RESULTS
  Average sensitivity and specificity (95 % confidence interval) in diagnosing one or more vertebral fractures requiring treatment was 70 % (58-82 %) and 97 % (94-100 %) respectively for DXA and 74 % (55-93 %) and 96 % (95-98 %) for radiographs. Fleiss' kappa for interobserver and average kappa for intraobserver reliability were 0.371 and 0.631 respectively for DXA and 0.418 and 0.621 for radiographs. Average effective dose was 41.9 μSv for DXA and 232.7 μSv for radiographs. Image quality was similar.
  
  
  CONCLUSIONS
  Given comparable image quality and non-inferior diagnostic accuracy, lateral spine DXA should replace conventional radiographs for assessment of vertebral fractures in children.
  
  
  CONCLUSIONS
  • Vertebral fracture diagnostic accuracy of lateral spine DXA is non-inferior to radiographs. • The rate of unreadable vertebrae for DXA is lower than for radiographs. • Effective dose of DXA is significantly lower than radiographs. • Children prefer DXA to radiographs. • Given the above, DXA should replace radiographs for paediatric vertebral fracture assessment.
authors.affiliation: Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK.|Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK.
authors.forename: E
authors.initials: E
authors.lastname: Adiotomre
authors.affiliation: Sheffield Medical School, University of Sheffield, Beech Hill Rd, Sheffield, South Yorkshire, S10 2RX, UK.
authors.forename: L
authors.initials: L
authors.lastname: Summers
authors.affiliation: School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, South Yorkshire, S1 4DA, UK.
authors.forename: A
authors.initials: A
authors.lastname: Allison
authors.affiliation: School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, South Yorkshire, S1 4DA, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Walters
authors.affiliation: Sheffield Medical School, University of Sheffield, Beech Hill Rd, Sheffield, South Yorkshire, S10 2RX, UK.
authors.forename: M
authors.initials: M
authors.lastname: Digby
authors.affiliation: Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK.
authors.forename: P
authors.initials: P
authors.lastname: Broadley
authors.affiliation: Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK.
authors.forename: I
authors.initials: I
authors.lastname: Lang
authors.affiliation: Medical Physics, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK.
authors.forename: G
authors.initials: G
authors.lastname: Morrison
authors.affiliation: Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK.
authors.forename: N
authors.initials: N
authors.lastname: Bishop
authors.affiliation: Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK.
authors.forename: P
authors.initials: P
authors.lastname: Arundel
authors.affiliation: Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK. a.offiah@sheffield.ac.uk.|Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK. a.offiah@sheffield.ac.uk.
authors.forename: A C
authors.initials: AC
authors.lastname: Offiah
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods*; D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D036301:Qualitative Research; D011829:Radiation Dosage; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D016103:Spinal Fractures / Q000000981:diagnostic imaging*
keywords: Dual energy x-ray absorptiometry; Interobserver variability; Osteoporosis; Radiography; Spinal fractures