Restricted Usefulness of Chest Radiograph for Scoliosis Screening.

초록

Purpose: Chest x-ray have used screening programs of scoliosis in school, it has inheritantly problems of ignoring some information in lumbar spine. To overcome this problems, we have applied thoracolumbar standing radiography in whole patients taken chest x-ray. This study present some usefulness and limitation of chest x-ray programs in scoliosis screenings based on this comparing data. Methods: In this study, 419 males were prospectively checked both chest radiographs and thoraco-lumbar standing radiographs(TLSR) in the examination for conscription at Regional Military Manpower Administration of Seoul from April 2008 to May 2010. We compared the types of spinal curves and the degrees Cobb angle which were measured in chest radiographs and thoraco-lumbar spine standing radiographs, considered the meaningful difference of Cobb angle as more than 5 degrees of angle difference. Results: Overall matching rate of the chest x-ray with TLSR focused in the pattern of spinal curves was about 58.2% (247 cases among total 419 cases). From the point of view to sensitivity and specificity in chest x-ray, the high sensitivity and low specificity were observed in thoracic curves, but low sensitivity and high specificity were observed in thoraco-lumbar, lumbar and double major curves. Lesser than 5 degrees of differences of Cobb angle between chest x-ray & TLSR was 263 cases (62.8%), but relatively high proportion (9.5%) of more than 10 degrees differences was observed. Coincidence of both type of spinal curve and accuracy of Cobb angle (the difference of lesser than 5 degrees of Cobb angle between CXR & TLSR) was 27.9% (117 cases among total 419 cases). Conclusions: The accuracy of chest radiographs for scoliosis screening was low and thoracic curve scoliosis was overestimated and lumbar curve scoliosis was easily missed in chest radiographs. Scoliosis screening by only chest radiographs maybe have restrictive values. Key Words: Scoliosis, Screening, Chest radiographs, Thora