{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T03:53:44Z","timestamp":1761710024984,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T00:00:00Z","timestamp":1691366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Spondylolysis is underdiagnosed and often missed in non-musculoskeletal abdominal CT imaging. Our aim was to assess the inter-reader agreement and diagnostic performance of a novel \u201cDarth Vader sign\u201d for the detection of spondylolysis in routine axial images. We performed a retrospective search in the institutional report archives through keyword strings for lumbar spondylolysis and spondylolisthesis. Abdominal CTs from 53 spondylolysis cases (41% female) and from controls (n = 6) without spine abnormalities were identified. A total of 139 single axial slices covering the lumbar spine (86 normal images, 40 with spondylolysis, 13 with degenerative spondylolisthesis without spondylolysis) were exported. Two radiology residents rated all images for the presence or absence of the \u201cDarth Vader sign\u201d. The diagnostic accuracy for both readers, as well as the inter-reader agreement, was calculated. The \u201cDarth Vader sign\u201d showed an inter-reader agreement of 0.77. Using the \u201cDarth Vader sign\u201d, spondylolysis was detected with a sensitivity and specificity of 65.0\u201388.2% and 96.2\u201399.0%, respectively. The \u201cDarth Vader sign\u201d shows excellent diagnostic performance at a substantial inter-reader agreement for the detection of spondylolysis. Using the \u201cDarth Vader sign\u201d in the CT reading routine may be an easy yet effective tool to improve the detection rate of spondylolysis in non-musculoskeletal cases and hence improve patient care.<\/jats:p>","DOI":"10.3390\/diagnostics13152616","type":"journal-article","created":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T12:35:42Z","timestamp":1691498142000},"page":"2616","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic Performance of the Darth Vader Sign for the Diagnosis of Lumbar Spondylolysis in Routinely Acquired Abdominal CT"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6317-4815","authenticated-orcid":false,"given":"Florian A.","family":"Huber","sequence":"first","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1994-0687","authenticated-orcid":false,"given":"Cynthia S.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2581-2166","authenticated-orcid":false,"given":"Hatem","family":"Alkadhi","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,7]]},"reference":[{"key":"ref_1","unstructured":"Stock, L., March, J., Afram, P., Dolan, H., Ganguly, R., and Grange, E. 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