Original Article
In Vivo Intrarater and Interrater Precision of Measuring Apparent Bone Mineral Density in Vertebral Subregions Using Supine Lateral Dual-Energy X-Ray Absorptiometry

https://doi.org/10.1385/JCD:8:3:314Get rights and content

Abstract

Analysis of apparent bone mineral density (BMD) in the lumbar spine is commonly based on anteroposterior (AP) scanning using dual-energy X-ray absorptiometry (DXA). Although not widely used, clinically important information can also be derived from lateral scanning. Vertebral bone density, and therefore strength, can may vary in different subregions of the vertebral body. Therefore, subregional BMD measurements might be informative about fracture risk. However, the intrarater and interrater precision of in vivo subregional BMD assessments from lateral DXA remains unknown. Ten normal, young (mean: 24 yr) and 10 older (mean: 63 yr) individuals with low BMD were scanned on one occasion using an AP/lateral sequence. Each lateral scan was reanalyzed six times at L2 by three raters to determine the intrarater and interrater precision in selecting seven regions of interest (subregions). Precision was expressed using percentage coefficients of variation (% CV) and intraclass correlation coefficients (ICC). Intrarater precision ranged from ICC(1,1) 0.971 to 0.996 (% CV: 0.50–3.68) for the young cohort and ICC(1,1) 0.934 to 0.993 (% CV: 1.46–5.30) for the older cohort. Interrater precision ranged from ICC(2,1) 0.804 to 0.915 (% CV: 1.11–2.35) for the young cohort and ICC(2,1) 0.912 to 0.984 (% CV: 1.85–4.32) for the older cohort. Scanning a subgroup of participants twice with repositioning was used to assess short-term in vivo precision. At L2, short-term in vivo precision ranged from ICC(1,1) 0.867 to 0.962 (% CV: 3.38–9.61), at L3 from ICC(1,1) 0.961 to 0.988 (% CV: 2.02–5.57) and using an L2/L3 combination from ICC(1,1) 0.942 to 0.980 (% CV: 2.04–4.61). This study demonstrated moderate to high precision for subregional analysis of apparent BMD in the lumbar spine using lateral DXA in vivo.

References (36)

  • E Legrand et al.

    Trabecular bone microarchitecture, bone mineral density, and vertebral fractures in male osteoporosis

    J Bone Miner Res

    (2000)
  • D Mitra et al.

    The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density

    Rheumatology

    (2000)
  • T Sandor et al.

    Comments on the hypotheses underlying fracture risk assessment in osteoporosis as proposed by the World Health Organization

    Calcif Tissue Int

    (1999)
  • MD Antonacci et al.

    Regional variation in vertebral bone density and trabecular architecture are influenced by osteoarthritic change and osteoporosis

    Spine

    (1997)
  • DD Cody et al.

    Correlations between vertebral regional bone mineral density (rBMD) and whole bone fracture load

    Spine

    (1991)
  • MJ Flynn et al.

    The assessment of vertebral bone microarchitecture with X-ray computed tomography

    Calcif Tissue Int

    (1993)
  • DA McCubbery et al.

    Static and fatigue failure properties of thoracic and lumbar vertebral bodies and their relation to regional density

    J Biomech

    (1995)
  • TA Sandor et al.

    Global and regional variations in the spinal trabecular bone: single and dual energy examinations

    J Clin Endocr Metabol

    (1991)
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