Radiology reporting of paediatric osteoporotic vertebral fractures in Duchenne muscular dystrophy and potential impact on clinical management.

Martin, H.; Henderson A.; Allen R.; Childs A.-M.; Dunne J.; Horrocks I.; Joseph S.; Kraft J.; Ward K.; Mushtaq T.; Mason A.; Kyriakou A.; Wong S.C.

Radiology reporting of paediatric osteoporotic vertebral fractures in Duchenne muscular dystrophy and potential impact on clinical management.

All Authors

Martin, H.

Henderson A.

Allen R.

Childs A.-M.

Dunne J.

Horrocks I.

Joseph S.

Kraft J.

Ward K.

Mushtaq T.

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LTHT Author

Henderson, Amy
Childs, Anne-Marie
Ward, Katie
Kraft, Jeanette
Mushtaq, Talat

LTHT Department

Leeds Children's Hospital
Children's Neurosciences
Paediatric Radiology
Children's Endocrinology

Publication Date

2022

Item Type

Conference Abstract

Abstract

Objectives: The international consensus for DMD recommends initiation of bisphosphonate upon identification of moderate [Genant 2] or severe [Genant 3] vertebral fractures(VF), regardless of back pain. Clear radiological reporting may be important for consistency of clinical interpretation and management. This is an audit of radiology reports of lateral spine imaging for VF assessment in DMD and aims to assess potential impact on clinical diagnosis and management. Method(s): Lateral thoracolumbar spine imaging in 84 boys with DMD performed as part of clinical monitoring from two centres were included. Anonymized clinical radiology reports performed by paediatric radiologists were circulated to neuromuscular clinicians(n,2) and endocrinologists(n,2). Clinicians were asked to determine if there is VF, no VF or unclear interpretation. The endocrinologists were also asked if bisphosphonate is recommended. A single observer performed VF assessment in 37 images and re- reported them using a structured format incorporating Genant grading. The structured reports were re- circulated to the clinicians. Result(s): Abnormalities in vertebral bodies and/or end-plates were reported in 43/84(51%) clinical radiology reports. The term "fracture" was explicitly used in 25/84(30%) reports, and only in 7/43(16%) with description of vertebral bodies and/or end-plates abnormalities. 7/43(16%) included grading of vertebral abnormalities. Complete concordance in diagnostic interpretation by the four clinicians was only noted in 36/84(43%), and only in 7/43(16%) where abnormalities were described. No unclear interpretation was noted by the clinicians with the 37 structured reports. However, unclear interpretation was noted in 19/37(51%), 17/37(46%), 14/37(38%) and 8/37(22%) by clinicians 1 to 4 based on clinical radiology reports. Complete concordance in diagnostic interpretation and treatment were noted when clinicians reviewed the structured reports. Concordance in treatment plans was only observed in 17/37(46%) of clinical radiology reports. Conclusion(s): Only a third of clinical reports of spine imaging in DMD explicitly used the terminology "fracture". Grading was only noted in a small percentage. Variability in diagnostic interpretation based on clinical radiology reports by managing clinicians may lead to differing management plans. As the identification of VF is a trigger for treatment, developing reporting guidelines for paediatric VF assessment will improve care but requires wider consultation.