Inter-observer and inter-examination variability of manual vertebral bone attenuation measurements on computed tomography

Pompe, E., de Jong, P. A., de Jong, W. U., Takx, R. A. P., Eikendal, A. L. M., Willemink, M. J., Oudkerk, M., Budde, R. P. J., Lammers, J-W. J. & Hoesein, F. A. A. M., Sep-2016, In : European Radiology. 26, 9, p. 3046-3053 8 p.

Research output: Contribution to journalArticleAcademicpeer-review

  • Esther Pompe
  • Pim A. de Jong
  • Werner U. de Jong
  • Richard A. P. Takx
  • Anouk L. M. Eikendal
  • Martin J. Willemink
  • Matthijs Oudkerk
  • Ricardo P. J. Budde
  • Jan-Willem J. Lammers
  • Firdaus A. A. Mohamed Hoesein

To determine inter-observer and inter-examination variability of manual attenuation measurements of the vertebrae in low-dose unenhanced chest computed tomography (CT).

Three hundred and sixty-seven lung cancer screening trial participants who underwent baseline and repeat unenhanced low-dose CT after 3 months because of an indeterminate lung nodule were included. The CT attenuation value of the first lumbar vertebrae (L1) was measured in all CTs by one observer to obtain inter-examination reliability. Six observers performed measurements in 100 randomly selected CTs to determine agreement with limits of agreement and Bland-Altman plots and reliability with intraclass correlation coefficients (ICCs). Reclassification analyses were performed using a threshold of 110 HU to define osteoporosis.

Inter-examination reliability was excellent with an ICC of 0.92 (p <0.001). Inter-examination limits of agreement ranged from -26 to 28 HU with a mean difference of 1 +/- 14 HU. Inter-observer reliability ICCs ranged from 0.70 to 0.91. Inter-examination variability led to 11.2 % reclassification of participants and inter-observer variability led to 22.1 % reclassification.

Vertebral attenuation values can be manually quantified with good to excellent inter-examination and inter-observer reliability on unenhanced low-dose chest CT. This information is valuable for early detection of osteoporosis on low-dose chest CT.

aEuro cent Vertebral attenuation values can be manually quantified on low-dose unenhanced CT reliably.

aEuro cent Vertebral attenuation measurements may be helpful in detecting subclinical low bone density.

aEuro cent This could become of importance in the detection of osteoporosis.

Original languageEnglish
Pages (from-to)3046-3053
Number of pages8
JournalEuropean Radiology
Issue number9
Publication statusPublished - Sep-2016


  • Bone mineral density, Computed tomography, Osteoporosis, Inter-observer variability, Intra-observer variability, OBSTRUCTIVE PULMONARY-DISEASE, MINERAL DENSITY, LUNG-CANCER, ASSESSING AGREEMENT, QUANTITATIVE CT, OSTEOPOROSIS, FRACTURES, SCANS, RISK, COPD

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