Most clinically important vertebral
body compression fractures found on abdominal multidetector computed tomography
(CT) scans would go unreported if sagittal reconstructions were not routinely
evaluated, according to a new study.
"At this point, it is routine
to evaluate sagittal reconstructions at abdominal multidetector CT (MDCT), and
whenever vertebral fractures are detected, they are reported." However,
this has not always been the case, said Travis Lauder, BS, a fourth-year
medical student at the University of Wisconsin School of Medicine and Public
Health in Madison.
"The studies we reviewed were
done before 2007, when sagittal reconstructions were not automatically
provided. We showed that without them, we missed a lot of vertebral compression
fractures in patients who underwent abdominal multidetector CT," he
explained.
Lauder presented the study results
at the American Roentgen Ray Society 2013 Annual Meeting in Washington, DC.
First results were published online February 28 in Radiology.
Lauder and his team retrospectively
analyzed 2041 consecutive patients (mean age, 70.8 years) who had undergone
abdominal multidetector CT and dual-energy x-ray absorptiometry (DXA) within 6
months of each other. The images were taken from 2000 to 2007, before sagittal
CT reconstructions were routinely obtained.
The researchers used the Genant
visual semiquantitative method to review transverse (axial) and retrospective
sagittal multidetector CT reconstructions for the presence of moderate to
severe fractures of the lower thoracic and lumbar spine. They also reviewed the
electronic medical records of these patients to determine whether the fracture
was reported at prospective CT interpretation, was known previously, or was
subsequently diagnosed.
"At least 1 moderate or severe
vertebral body compression fracture was retrospectively identified on CT in 97
patients," the researchers report. The fractures involved 1 level in 67
patients and 2 or more levels in 30 patients. In total, 141 fractures were
identified.
In patients with an unreported fracture, vertebral body
compression fracture was not recognized clinically in 64% and there was no
evidence of osteoporosis on DXA in 48%.
"DXA is still the gold
standard," Lauder noted, "but
this analysis demonstrated that a lot of these patients have false negatives on
DXA, and that the DXA test is obviously flawed."
Incidental findings are a well-known
"double-edged sword" in cross-sectional imaging, said Abraham
Dachman, MD, professor of radiology and director of the fellowship programs at
the University of Chicago in Illinois, who was asked by Medscape Medical
News to comment on the study.
"Many findings — some
previously known by the referring physician and some not — can be found on CT.
It is often difficult for the radiologist to know what findings to report, what
findings to ignore, and what incidental findings are sufficiently important to
require personal communication with the referring physician," Dr. Dachman
said.
However, this study highlights the
potential of abdominal CT to detect vertebral body compression fractures, he
noted. Coronal and sagittal reconstructions are often done by the technologist
who performs the exam using software on the CT scanner console; they do not
require dedicated workstations.
"This study did not address how
often the observation of vertebral body compression fractures changed patient
management because it was retrospective in nature," Dr. Dachman said.
"Still, it highlights the potential of CT to reveal information and
provides a rationale to radiologists who wish to routinely report this
observation."
This article appeared on Medscape
under the title, “Vertebral Fractures Go Undetected without Sagittal Views.”
The abstract and full text with CT
images for “Unreported Vertebral Body Compression Fractures at Abdominal Multidector
CT,” which was published in Radiology
in July 2013, can be read here:
For an excellent description of computed
tomography (CT) and multidetector computed tomography (MDCT), see:
For a description of an abdominal CT
scan, see:
For information on computed tomography
angiography (CTA), see:
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