Radiologists Underreport Vertebral Fractures on Abdominal CT

Summary and Comment |
July 3, 2013

Radiologists Underreport Vertebral Fractures on Abdominal CT

  1. Allan S. Brett, MD

Accurate reporting is more likely if the radiologist looks at sagittal, as well as axial, images.

  1. Allan S. Brett, MD

Studies have shown that radiologists tend not to report vertebral fractures when interpreting computed tomography (CT) scans of the chest and abdomen, which are typically ordered for reasons other than back pain. Investigators assessed the extent of underreporting in this retrospective study of about 2000 adults (mean age, 59) who happened to have undergone both abdominal CT scanning and dual x-ray absorptiometry (to measure bone mineral density) within 6 months of each other at a major U.S. medical center. The researchers carefully reviewed sagittal reconstructions of all CT scans to identify vertebral fractures.

Ninety-seven patients (5%) had one or more moderate or severe vertebral compression fractures. In 81 of these 97 patients, the fractures were not mentioned in the radiology report. Only half the patients with vertebral fractures had osteoporotic T-scores reported on their bone density tests.


Detection of vertebral fractures on abdominal (or thoracic) CT scans is important for two reasons. First, in a small subset of patients (e.g., those with flank pain), a vertebral fracture may be responsible for the symptom that led to CT scanning. And second, reporting of a previously unknown vertebral fracture could lead to appropriate treatment to prevent future fractures. The authors could not determine how commonly the interpreting radiologists in this study looked at sagittal image reconstructions (which show fractures most accurately); fractures are easily missed if the radiologist examines only axial (transverse) images.

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose


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