Spine Discordance

Case Description:

There is sclerosis and discordance at L4, so L4 is omitted from analysis.
The ISCD consensus guidelines indicated that “anatomically abnormal vertebrae may be excluded from analysis if: 1) They are clearly abnormal and non-assessable within the resolution of the system; or 2) there is more than a 1.0 T-score difference between the vertebra in question and the adjacent vertebra (Consensus guidelines below in references)”. Hansen et al. (JBMR 2005) however found that the ISCD vertebral body exclusion criteria are difficult to apply. An atlas, improves interobserver agreement related to vertebral body exclusion (Hansen J Clin Densitom 2007). Tsang and Leslie (JBMR 2007) studied the concordance of physician and computer models to exclude vertebral levels and both physician and computer exclusion of vertebral levels led to an improvement in fracture prediction.

Credit:

Sarah L Morgan, MD, RD, CCD, The University of Alabama at Birmingham

References:

• International Society of Clinical Densitometry Densitometry,. 2019 ISCD Official Positions – Adult /learn/official-positions/
• Hansen, K.E., et al., Interobserver reproducibility of criteria for vertebral body exclusion. J Bone Miner Res, 2005. 20(3): p. 501-8.
• Hansen, K.E., et al., An atlas improves interobserver agreement regarding application of the ISCD vertebral body exclusion criteria. J Clin Densitom, 2007. 10(4): p. 359-64.
• Tsang, J.F. and W.D. Leslie, Exclusion of focal vertebral artifacts from spine bone densitometry and fracture prediction: a comparison of expert physicians, three computer algorithms, and the minimum vertebra. J Bone Miner Res, 2007. 22(6): p. 789-98.