Application of tomosynthesis for vertebral compression fracture diagnosis and bone healing assessment in fracture liaison services

Hsuan-Yu Chen; Tuoh Wu; Sheng-Pin Tseng; Chia-Yu Lin; Chih-Wei Chen; Tze-Hong Wong; Yuh-Fen Wei; Ya-Fang Chen

doi:10.3389/fmed.2022.910130

Application of tomosynthesis for vertebral compression fracture diagnosis and bone healing assessment in fracture liaison services

Front Med (Lausanne). 2022 Sep 16:9:910130. doi: 10.3389/fmed.2022.910130. eCollection 2022.

Authors

Hsuan-Yu Chen^{1

2}, Tuoh Wu^{2

3}, Sheng-Pin Tseng⁴, Chia-Yu Lin⁴, Chih-Wei Chen¹, Tze-Hong Wong², Yuh-Fen Wei⁵, Ya-Fang Chen^{5

6}

Affiliations

¹ Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
² Department of Orthopedics, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan.
³ Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
⁴ Health Physics Division, Institute of Nuclear Energy Research, Atomic Energy Council, Taoyuan, Taiwan.
⁵ Department of Medical Imaging, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan.
⁶ Department of Medical Imaging, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.

Abstract

Early identification of vertebral compression fractures (VCFs) is crucial for successful secondary fracture prevention. Tomosynthesis, a low-dose tomographic imaging technique, may facilitate the evaluation and long-term follow-up of VCFs in patients with osteoporosis. Herein, we compared the performances of plain radiography and tomosynthesis for VCF diagnosis and healing assessment in patients enrolled in fracture liaison services in our hospital. Forty-nine patients with new VCFs at the T10-L5 levels were prospectively recruited between August 2018 and May 2020; all patients underwent thoracolumbar plain radiography and tomosynthesis. We evaluated the accuracy of the VCF diagnosis, image quality, and VCFs healing process. Tomosynthesis identified 90 levels of VCF in 49 patients, while plain radiography revealed only 87.8% (79/90) of them. There were 44.9% (22/49) patients with neglected chronic VCFs as seen on tomosynthesis. Tomosynthesis images had improved VCF diagnostic accuracy up to 12.2% and showed significantly more anatomic details than plain radiography. For diagnosis of VCFs, the performance of plain radiographs was poorer than that of tomosynthesis images (plain radiographs: sensitivity 84%, specificity 93.5%, false positive rate 6.5%, and false negative rate 16%; tomosynthesis: sensitivity 93.2%, specificity 100%, false positive rate 0%, and false negative 6.8%), using magnetic resonance imaging (MRI) as gold standard. The Kappa coefficient between Tomosynthesis and MRI is 0.956 while between radiography and MRI is 0.704. Tomosynthesis showed significantly more anatomic details than plain radiography and all the examiners revealed a clear preference for tomosynthesis. Tomosynthesis scored 3.3 times higher on the fracture healing assessment at the 3-month follow-up than plain radiographs. Tomosynthesis is a promising tool for VCF screening and diagnosis in patients with osteoporosis and for monitoring fracture healing status at a low radiation dose and cost.

Keywords: cost-effective; fracture liaison service; osteoporosis; precision; tomosynthesis; vertebral compression fractures.