BACKGROUND There is significant inter and intraobserver variability in diagnosing vertebral fractures in children. PURPOSE We aimed to evaluate the diagnostic accuracy of morphometric vertebral fracture analysis (MXA) using a 33-point software program designed for adults, on dual-energy x-ray absorptiometry (DXA) images of children. MATERIALS AND METHODS Lateral spine DXA images of 420 children aged between 5 and 18 years were retrospectively reviewed. Vertebral fracture assessment (VFA) by an expert pediatric radiologist using Genant's semiquantitative scoring system served as the gold standard. All 420 DXA scans were analyzed by a trained radiographer, using semi-automated software (33-point morphometry). VFA of a random sample of 100 DXA was performed by an experienced pediatric clinical scientist. MXA of a random sample of 30 DXA images were analyzed by three pediatric radiologists and the pediatric clinical scientist. Diagnostic accuracy and inter and intraobserver agreement (kappa statistics) were calculated. RESULTS Overall sensitivity, specificity, false positive (FP) and false negative (FN) rates for the radiographer using the MXA software were 80%, 90%, 10%, and 20% respectively and for mild fractures alone were 46%, 92%, 8%, and 54% respectively. Overall sensitivity, specificity, FP, and FN rates for the four additional observers using MXA were 89%, 79%, 21%, and 11% respectively and for mild fractures alone were 36%, 86%, 14%, and 64% respectively. Agreement between two expert observers was fair to good for VFA and MXA [kappa = 0·29 to 0·76 (95% CI: 0·17-0·88) and 0·29 to 0·69 (95% CI: 0·17-0·83)] respectively. CONCLUSION MXA using a 33-point technique developed for adults is not a reliable method for the identification of mild vertebral fractures in children. A pediatric standard is required which not only incorporates specific vertebral body height ratios but also the age-related physiological changes in vertebral shape that occur throughout childhood.

中文翻译：

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使用33点软件程序对儿童进行形态测量椎体骨折分析（MXA）的诊断性能

背景在诊断儿童椎骨骨折方面存在显着的观察者间和观察者内变异性。目的 我们旨在使用专为成人设计的 33 点软件程序对儿童的双能 X 射线吸收测量 (DXA) 图像评估形态测量椎体骨折分析 (MXA) 的诊断准确性。材料和方法 回顾性分析了 420 名 5 至 18 岁儿童的脊柱侧向 DXA 图像。由儿科放射科专家使用 Genant 的半定量评分系统进行的椎骨骨折评估 (VFA) 作为金标准。所有 420 次 DXA 扫描均由训练有素的放射技师使用半自动软件（33 点形态测量法）进行分析。由经验丰富的儿科临床科学家对 100 个 DXA 的随机样本进行 VFA。三名儿科放射科医生和儿科临床科学家对 30 张 DXA 图像的随机样本的 MXA 进行了分析。计算诊断准确性和观察者间和观察者内的一致性（kappa 统计）。结果 放射线技师使用 MXA 软件的总体敏感性、特异性、假阳性 (FP) 和假阴性 (FN) 率分别为 80%、90%、10% 和 20%，仅轻度骨折为 46%、92% 、8% 和 54%。使用 MXA 的另外四位观察者的总体敏感性、特异性、FP 和 FN 率分别为 89%、79%、21% 和 11%，仅轻度骨折的总体敏感性、特异性、FP 和 FN 率分别为 36%、86%、14% 和 64% . 两名专家观察员之间的协议对 VFA 和 MXA [kappa = 0·29 至 0·76 (95% CI: 0·17-0·88) 和 0·29 至 0·69 (95% CI: 0) ·17-0·83)]分别。结论 使用为成人开发的 33 点技术的 MXA 不是识别儿童轻度椎骨骨折的可靠方法。需要制定儿科标准，该标准不仅包括特定的椎体高度比，还包括整个儿童期发生的与年龄相关的椎体形状生理变化。