Philipose Getachew Mulugeta BA, Presenter: Nothing to Disclose

J. Herman Kan MD, Abstract Co-Author: Nothing to Disclose

Marta Hernanz-Schulman MD, Abstract Co-Author: Nothing to Disclose

Martin Ivanov Jordanov MD, Abstract Co-Author: Nothing to Disclose

Chang Yu PhD, Abstract Co-Author: Nothing to Disclose

Radiologists often report suspicion for osteopenia when reviewing skeletal radiographs. In the era of digital radiography, post-processing may potentially decrease the ability to consistently determine the presence of osteopenia. Our purpose is to determine the reliability of osteopenia diagnosis in children, based on digital radiographs of the appendicular skeleton compared to the DEXA studies.

IRB approved retrospective study. 58 consecutive patients (45% male, mean age 12 years [4-18]) with x-ray of appendicular bone within 6 months of index DEXA study from 2004-2009 were included. Severe osteopenia was defined as Z-score lower than -2.0; mild as Z score between -2 and -1. Normal mineralization was a Z score of -1 or higher. Two radiologists with expertise in pediatric and musculoskeletal radiology were instructed to grade x-rays as normal bone density, or as osteopenia, mild or severe, blinded to DEXA values. The sensitivity and specificity of reviewer’s visual determination of osteopenia was calculated in comparison with lumbar DEXA Z-score values.

12 patients had severe osteopenia, 12 patients mild; mineralization was normal in 34 patients. The reviewers’ sensitivity for categorization of severe osteopenia (Z-score below -2.0) was 33%; for mild osteopenia (Z-score -2 to -1) was 42%, and for normal mineralization (Z-score above -1) was 80%. The two readers agreed in the diagnosis of osteopenia only 33% of the time, but agreed 86% of the time in the diagnosis of normal mineralization.

In the pediatric population, the visual diagnosis of osteopenia based on plain films of appendicular skeleton has low sensitivity, although there is much better sensitivity for determination of normal mineralization.

Visual diagnosis of osteopenia based on digital radiography is unreliable and should not be used as a guide to initiate treatment or further diagnostic testing.

Mulugeta, P, Kan, J, Hernanz-Schulman, M, Jordanov, M, Yu, C, Determination of Osteopenia on Digital Plain Film X-ray Compared with a DEXA Reference Standard.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9015875.html