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. 2017 Feb;27(2):491-497.
doi: 10.1007/s00330-016-4392-5. Epub 2016 May 31.

Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly

Mats Geijer  1   2 , Eirikur Gunnlaugsson  3 , Simon Götestrand  3 , Lars Weber  4   5 , Håkan Geijer  6
Affiliations

Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly

Mats Geijer et al. Eur Radiol. 2017 Feb.

Abstract

Objectives: Thoracic spine radiography becomes more difficult with age. Tomosynthesis is a low-dose tomographic extension of radiography which may facilitate thoracic spine evaluation. This study assessed the added value of tomosynthesis in imaging of the thoracic spine in the elderly.

Methods: Four observers compared the image quality of 50 consecutive thoracic spine radiography and tomosynthesis data sets from 48 patients (median age 67 years, range 55-92 years) on a number of image quality criteria. Observer variation was determined by free-marginal multirater kappa. The conversion factor and effective dose were determined from the dose-area product values.

Results: For all observers significantly more vertebrae were seen with tomosynthesis than with radiography (mean 12.4/9.3, P < 0.001) as well as significantly more fractures (mean 0.9/0.7, P = 0.017). The image quality score for tomosynthesis was significantly higher than for radiography, for all evaluated structures. Tomosynthesis took longer to evaluate than radiography. Despite this, all observers scored a clear preference for tomosynthesis. Observer agreement was substantial (mean κ = 0.73, range 0.51-0.94). The calibration or conversion factor was 0.11 mSv/(Gy cm2) for the combined examination. The resulting effective dose was 0.87 mSv.

Conclusion: Tomosynthesis can increase the detection rate of thoracic vertebral fractures in the elderly, at low added radiation dose.

Key points: • Tomosynthesis helps evaluate the thoracic spine in the elderly. • Observer agreement for thoracic spine tomosynthesis was substantial (mean κ = 0.73). • Significantly more vertebrae and significantly more fractures were seen with tomosynthesis. • Tomosynthesis took longer to evaluate than radiography. • There was a clear preference among all observers for tomosynthesis over radiography.

Keywords: Fracture; Image quality; Radiography; Thoracic vertebrae; Tomography; X-ray.

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