title: Under-reporting of osteoporotic vertebral fractures on computed tomography.
abstract: OBJECTIVE
  Osteoporotic vertebral fractures are frequently asymptomatic. They are often not diagnosed clinically or radiologically. Despite this, prevalent osteoporotic vertebral fractures predict future osteoporotic fractures and are associated with increased mortality and morbidity. Appropriate management of osteoporosis can reduce future fracture risk. Fractures on lateral chest radiographs taken for other conditions are frequently overlooked by radiologists. Our aim was to assess the value of computed tomography (CT) in the diagnosis of vertebral fracture and identify the frequency with which significant fractures are missed.
  
  
  METHODS
  The thoracic CT scans of 100 consecutive male and 100 consecutive female patients over 55 years were reviewed. CT images were acquired on General Electric Lightspeed multi-detector (MD) CT scanners (16 or 32 row) using 1.25mm slice thickness. Midline sagittal images were reconstructed from the 3D volume images. The presence of moderate (25-40% height loss) or severe (>40% height loss) vertebral fractures between T1 and L1 was determined using an established semi-quantitative method and confirmed by morphological measurement. Results were compared with the formal CT report.
  
  
  RESULTS
  Scans of 192 patients were analysed (95 female; 97 male); mean age 70.1 years. Thirty-eight (19.8%) patients had one or more moderate to severe vertebral fractures. Only 5 (13%) were correctly reported as having osteoporotic fractures in the official report. The sensitivity of axial CT images to vertebral fracture was 0.35.
  
  
  CONCLUSIONS
  Incidental osteoporotic vertebral fractures are under-reported on CT. The sensitivity of axial images in detecting these fractures is poor. Sagittal reformations are strongly recommended to improve the detection rate.
authors.affiliation: Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester, UK. alexandra.firth@virgin.net
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Williams
authors.forename: Aisha
authors.initials: A
authors.lastname: Al-Busaidi
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Sparrow
authors.forename: Judith E
authors.initials: JE
authors.lastname: Adams
authors.forename: Richard W
authors.initials: RW
authors.lastname: Whitehouse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005189:False Positive Reactions; D005260:Female; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000000981:diagnostic imaging*; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods*