Yonsei Med J.  2012 Nov;53(6):1183-1189. 10.3349/ymj.2012.53.6.1183.

Usefulness of Chest Radiographs for Scoliosis Screening: A Comparison with Thoraco-Lumbar Standing Radiographs

• Oh CH
• Kim CG
• Lee MS
• Yoon SH
• Park HC
• Park CO

• KMID: 1414262
• DOI: http://doi.org/10.3349/ymj.2012.53.6.1183

Abstract

PURPOSE
The purposes of this study were to evaluate the usefulness and limitations of chest radiographs in scoliosis screening and to compare these results with those of thoraco-lumbar standing radiographs (TLSR).
MATERIALS AND METHODS
During Korean conscription, 419 males were retrospectively examined using both chest radiographs and TLSR to confirm the scoliosis and Cobb angle at the Regional Military Manpower. We compared the types of spinal curves and Cobb angles as measured from different radiographs.
RESULTS
In the pattern of spinal curves, the overall matching rate of chest radiographs using TLSR was about 58.2% (244 of 419 cases). Cobb angle differences between chest radiographs and TLSR with meaningful difference was observed in 156 cases (37.2%); a relatively high proportion (9.5%) of Cobb angle differences more than 10 degrees was also observed. The matching rate of both spinal curve types and Cobb angle accuracy between chest radiographs and TLSR was 27.9% (117 among 419 cases). Chest radiographs for scoliosis screening were observed with 93.94% of sensitivity and 61.67% of specificity in thoracic curves; however, less than 40% of sensitivity (38.27%, 20.00%, and 25.80%) and more than 95% of specificity (97.34%, 99.69%, and 98.45%) were observed in thoraco-lumbar, lumbar, and double major curves, respectively.
CONCLUSION
The accuracy of chest radiographs for scoliosis screening was low. The incidence of thoracic curve scoliosis was overestimated and lumbar curve scoliosis was easily missed by chest radiography. Scoliosis screening using chest radiography has limited values, nevertheless, it is useful method for detecting thoracic curve scoliosis.

Keyword

Scoliosis; screening; chest radiographs; thoraco-lumbar standing radiographs

MeSH Terms

Adult
Humans
Male
Radiography, Thoracic/methods
Retrospective Studies
Scoliosis/*diagnosis/*radiography
Young Adult

Figure

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  Fig. 1 Different scoliosis curve pattern according to chest radiographs and thoraco-lumbar standing radiographs (TLSR). (A) Shows screened case as right thoracic curve scoliosis in chest radiographs, but it was confirmed as double major curve convexity right to left by TLSR. (B) Shows a lumbar curve scoliosis case who was screened as normal spinal curvature in chest radiographs.

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  Fig. 2 A scatterplot with raw data and corresponding fitted regression line showing the distribution and relation of Cobb angle between chest radiographs and TLSR (r=0.903). TLSR, thoraco-lumbar standing radiographs.

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  Fig. 3 Congenital vertebral abnormalities with hemivertebra of the 4th lumbar spine. The right lumbar curve on TLSR was misinterpreted as left lumbar curve on chest radiographs due to restricted field of sight. TLSR, thoraco-lumbar standing radiographs.

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