The META score for differentiating metastatic from osteoporotic vertebral fractures: an independent agreement assessment

Publication date: November 2018

Source: The Spine Journal, Volume 18, Issue 11

Author(s): Pablo Besa, Julio Urrutia, Mauricio Campos, Sebastián Mobarec, Juan Pablo Cruz, Pablo Cikutovic, Gonzalo Diaz

Abstract

Background Context

Differentiating osteoporotic vertebral fractures (OVFs) from metastatic vertebral fractures (MVFs) is an important clinical challenge. A novel magnetic resonance imaging (MRI)-based score (the META score) was described, aiming to differentiate OVF from MVF. This score showed an almost perfect agreement by the group developing it, but an independent agreement evaluation is pending.

Purpose

We aimed to perform an independent inter- and intraobserver agreement evaluation of the META score and to test the score's capability of differentiating OVF from MVF.

Study design

This is an agreement study of the META score.

Methods

Sixty-four patients with confirmed OVF or MVF were assessed by six independent evaluators (three spine surgeons and three fellowship-trained radiologists) using the META score. We used the intraclass correlation coefficient (ICC) to determine the overall inter-and intraobserver agreement, and the kappa statistic (κ) to express the agreement for each individual score criterion. The score accuracy was determined by calculating the area under the receiver operating characteristic curve. Finally, we used κ to evaluate the agreement among raters to determine whether the fracture was OVF or MVF.

Results

The overall interobserver agreement was poor [ICC=0.10 (0.02–0.20)]; spine surgeons [ICC=0.75 (0.66–0.83)] had better agreement than radiologists did [ICC=0.05 (−0.08 to 0.21)]. The intraobserver agreement was poor [ICC=0.17 (0.01–0.32)]; both spine surgeons [ICC=0.21 (0.05–0.41)] and radiologists had a poor agreement [ICC=0.03 (−0.29 to 0.27)]. The agreement for each specific criterion varied from κ=0.24 to κ=0.60. The area under the receiver operating characteristic curve was 0.58 (0.64 for spine surgeons and 0.52 for radiologists, p<.01).

Conclusions

The interobserver agreement using the META score was adequate for spine surgeons but not for other potential users (radiologists); the intraobserver agreement was poor. Further studies are thus necessary before the use of this score is recommended.

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