Recognition and reporting of vertebral fractures in thoracic and abdominal computed tomography images - have we learnt our lesson?

Abstract

The reporting rate of vertebral fractures (VFs) identified on routine thoracic and abdominal CT scans was evaluated. Only 14.7% of VFs were documented in the impression section of the radiology report. These findings indicate that the recognition and reporting of VFs on routine CT examinations have not improved over the past decade. Vertebral fractures (VFs) are the most common osteoporotic fractures, yet they are substantially underreported on routine computed tomography (CT) scans. This study aimed to quantify the detection and reporting rates of VFs on thoracic and abdominal CT scans performed for non-musculoskeletal indications. Of 8500 CT scans performed at a large Austrian tertiary-care hospital in 2023, 1500 thoracic and abdominal CT scans were randomly selected. Two musculoskeletal radiologists independently assessed vertebral bodies of the thoracic and lumbar spine using Genant's semiquantitative method. Vertebral deformities were categorised as Grade 1 (20-25% height loss), Grade 2 (25-40%), or Grade 3 (>40%). For the purpose of this study, a VF was defined as Grade ≥ 2. Findings were compared with the original radiology reports to determine detection and reporting rates. Consensus results were available for 1481 CT scans from 1364 individuals. Overall, 170 VFs (11.5%) were identified in 164 patients. Of these, 35.9% (n = 61) were lumbar, 52.4% (n = 89) were thoracic, and 11.8% (n = 20) involved both regions. Only 14.7% of all VFs were documented in the impression section of the corresponding radiology report, whereas 50.0% (85/170) were mentioned in the narrative interpretation section. Inter-reader agreement was excellent (κ = 0.94). Despite increasing awareness of osteoporosis, VFs remain underreported on routine thoracic and abdominal CT scans. Consequently, many patients may not receive appropriate osteoporosis evaluation and treatment, placing them at increased risk of subsequent fractures, disability, and increased mortality.