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Title: Semi-Automated veRtebral fracture Assessment in ChildrEN (SARACEN)
Author: Alqahtani, Fawaz
ISNI:       0000 0004 7964 5660
Awarding Body: University of Sheffield
Current Institution: University of Sheffield
Date of Award: 2019
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Aim: To evaluate the diagnostic accuracy and reliability in children, of morphometric vertebral fracture analysis (MXA) by using semi-automated 6-point (SpineAnalyzer™) and 33-point (AVERT™) software techniques developed for vertebral fracture diagnosis in adults, which record percentage loss of vertebral body height. Materials and Methods: (i) Retrospective analysis of 137 paediatric lateral spine radiographs (T4 to L4) by five observers using SpineAnalyzer™. (ii) Retrospective analysis of 100 (50 dual-energy x-ray absorptiometry (DXA) and 50 radiographic) images collected from Sheffield Children's Hospital, by two observers using SpineAnalyzer™ and AVERT™. For (i) and (ii) a previous consensus read of radiographs by three paediatric radiologists using a simplified algorithm-based qualitative technique served as the reference standard. (iii) 420 lateral spine DXA were retrospectively collated of children aged between 5 and 18 years. Vertebral fracture assessment (VFA) was performed by an expert paediatric radiologist and served as the reference standard. For (i), (ii) and (iii), diagnostic accuracy (sensitivity, specificity, false negative (FN) and positive (FP) rates) was calculated. Inter and intraobserver agreement levels were calculated using the kappa statistic. Results: For (i) and (ii) Low diagnostic accuracy and poor inter and intraobserver agreement were obtained. For (iii) Overall sensitivity, specificity, FP and FN rates using MXA were 89%, 79%, 21%, and 11% respectively, but for mild fractures alone were 36%, 86%, 14%, and 64% respectively. MXA reached only moderate agreement when compared to the visual semiquantitative VFA technique, with fair to moderate inter and intraobserver agreement. Conclusions: Neither AVERT™ nor SpineAnalyzer™ is satisfactorily reliable for vertebral fracture diagnosis in children. In order to facilitate the detection of mild vertebral fractures in children, a paediatric 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.
Supervisor: Offiah, Amaka Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available