Vertebral body fractures of unknown origin in cancer patients receiving MDCT: reporting by radiologists and awareness by clinicians.
BACKGROUND
To evaluate prevalence, radiological reporting and clinical management of pathologic vertebral body fractures (VBFs) of unknown origin in cancer patients receiving computed tomography (CT) examinations.


METHODS
We investigated all CT examinations (over 1 year) of male and female patients with an underlying malignancy and an increased risk of osteoporosis (age 55-79 years) for the presence of VBFs. We evaluated midline sagittal CT-reformations of the spine for prevalence, fracture type, severity and location, the accuracy and style of radiological reporting, subsequent clinical management and documentation in hospital discharge letters.


RESULTS
848 patients were investigated. We found 143 VBFs in 94 (11 %) patients. 6, 49, and 45 % were grade 1, grade 2, and grade 3 fractures, respectively, while 20, 66, and 14 % were wedge, biconcave and crush fractures, respectively. 32 (34 %) radiological reports correctly classified VBFs as fractures, 25 (27 %) reports recognized VBFs, but did not type them, and VBFs were not described in 37 (39 %) reports. In 3 (3 %) patients further clinical work-up of VBFs was performed, while only 8 (9 %) hospital discharge letters contained the information of the presence of pathologic VBFs of unknown origin.


CONCLUSIONS
VBFs of unknown origin appear frequently in cancer patients, however, clinical management and documentation was found in only few cases. Moreover, especially in cancer patients consistent radiological reporting of VBFs seems important, as aetiology of VBFs could be from osteoporosis, disease progression or oncological therapy, however, reporting is still performed inconsistently.
Department of Orthopedic Surgery, Klinikum Forchheim, Krankenhausstraße 10, 91301 Forchheim, Germany.
Melanie
M
Wild
Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany.
Peter
P
Dankerl
Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany.
Matthias
M
Hammon
Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany.
Michael
M
Uder
Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany.
Rolf
R
Janka
Cancer patients; Clinical management; Osteoporosis; Pathologic fractures; Radiological reports; Vertebral body fracture