Incidental vertebral fractures on multidetector CT images of the chest: prevalence and recognition

To investigate the prevalence, demographics, fracture site, and the rate of vertebral fracture recognition by radiologists on multidetector computed tomography (MDCT) images of the chest.

The images of 200 consecutive patients who underwent a MDCT examination of the chest over a 4-month period were reviewed. The thoracic spine, viewed using bone windows in sagittal reformats, was reviewed in consensus by three radiologists. Vertebral fractures were assessed using a validated semi-quantitative method.

The mean age was 61 years (range 18-92 years); 48% were female. There were 70 (35%) fractures, of which 51 (73%) were mild grade 1 fractures, 13 (19%) moderate grade 2 fractures, and six (9%) severe grade 3 fractures. Fractures commonly affected patients above the age of 50. The most common site was in the lower thoracic region (53%). The overall recognition rate on the radiologists' reports was 6 (9%).

One in three patients who underwent MDCT of the chest had vertebral fractures. There is significant underreporting of these fractures, and the importance of fracture identification should be emphasized to avoid under-diagnosis.