Incidental vertebral compression fractures in imaging studies: Lessons not learned by radiologists

Figure 1 Incidental vertebral compression fractures on chest radiograph. A: Lateral radiograph of the chest of a 65 year old woman studied for persistent cough. No relevant pulmonary abnormality and mild cardiomegaly were noted in the frontal radiograph (not shown); B: Close up on the vertebral column shows the presence of a mild grade biconcave fracture of T6, severe grade wedge fracture of T8 and moderate grade fracture of T9 (arrows).

Figure 2 Incidental vertebral fractures on multidetector computed tomography. A: Sagittal multiplanar reconstruction of the thoracic spine from a chest multidetector computed tomography (MDCT) study performed to rule out pulmonary nodules in a 74 year old woman. Moderate and severe grade wedge fractures of T7 and T8 are seen; B: Incidental moderate grade wedge fracture of T12 and mild grade L1 fracture depicted in an MDCT angiography study of the abdominal aorta in an 82 year old man; C: Another wedge fracture of T12 in a different patient. Use of electronic calipers reveals a 9 mm loss of vertebral anterior height (39.1%). A retropulsed superior endplate fragment is also noted.

Figure 3 Radiologists reporting rates of incidental vertebral fractures over time. The continuous line on the graph shows a worsening tendency towards underreporting with older studies having better results than recent ones. The dashed line indicates the overall mean reporting rate of the 12 studies that were reviewed. Flags indicate the country where each study was performed.