Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA.
Radiology. 2013 Jul;268(1):120-6. doi: 10.1148/radiol.13121632. Epub 2013 Feb 28.
To retrospectively assess the prevalence and clinical outcomes of unreported vertebral compression fractures at abdominal computed tomography (CT).
This HIPAA-compliant study had institutional review board approval; the need for informed consent was waived for this retrospective analysis. A total of 2041 consecutive adult patients (1640 women, 401 men; age range, 19-94 years) underwent both abdominal multidetector CT and dual-energy x-ray absorptiometry (DXA) within 6 months of each other between 2000 and 2007, before sagittal CT reconstructions were obtained routinely. Transverse (axial) and retrospective sagittal multidetector CT reconstructions were reviewed for the presence of moderate or severe vertebral body compression fractures of the lower thoracic and lumbar spine by using the Genant visual semiquantitative method. Twenty-six patients were excluded for evidence of pathologic fracture or for technical factors limiting compression fracture detection. Electronic medical records were reviewed for patients with moderate or severe compression fractures to determine whether the fracture was reported at prospective CT interpretation, was known previously, or was diagnosed subsequently. Correlation was made with central DXA T scores. Statistical analysis was performed with the Student t test and Fisher exact test.
At least one moderate or severe vertebral body compression fracture was identified retrospectively at CT in 97 patients (mean age, 70.8 years). Fractures involved one level in 67 and multiple levels in 30 patients, for a total of 141 fractures. In 81 (84%) patients, prospective CT diagnosis was not made. Patients in whom fractures were reported prospectively were significantly older and were more likely to have a severe compression fracture (P < .05). In 52 (64%) patients with an unreported fracture, the vertebral compression fracture was not known clinically. In 18 patients, subsequent diagnosis of a compression fracture was determined by means of another imaging study (median interval, 7 months). At DXA, 39 (48%) of 81 patients with unreported vertebral body compression fractures had a nonosteoporotic T score (greater than -2.5).
Most clinically important vertebral body compression fractures in nontrauma patients at risk for low bone mineral density may go unreported at abdominal multidetector CT if sagittal reconstructions are not routinely evaluated.
回顾性评估腹部计算机断层扫描（CT）未报告的椎体压缩性骨折的发生率和临床结果。
本研究符合 HIPAA 规定，经机构审查委员会批准；由于这是一项回顾性分析，因此无需获得知情同意。2000 年至 2007 年期间，共 2041 例连续成年患者（1640 名女性，401 名男性；年龄 19-94 岁）在腹部多排 CT 和双能 X 线吸收法（DXA）检查后 6 个月内进行了检查，在此之前常规获得了矢状 CT 重建。使用 Genant 视觉半定量法，对横向（轴向）和回顾性矢状多排 CT 重建进行了评估，以确定是否存在下胸腰椎中度或重度椎体压缩性骨折。排除 26 例有病理骨折或技术因素限制压缩性骨折检测的患者。回顾电子病历以确定中度或重度压缩性骨折患者的骨折是否在预期 CT 解释时报告、是否先前已知或随后诊断。与中央 DXA T 评分进行相关性分析。使用学生 t 检验和 Fisher 确切检验进行统计学分析。
在 97 例患者（平均年龄 70.8 岁）中，CT 回顾性地发现至少有一处中度或重度椎体压缩性骨折。67 例患者骨折累及 1 个节段，30 例患者骨折累及多个节段，总计 141 处骨折。81 例（84%）患者的前瞻性 CT 诊断未做出。前瞻性 CT 诊断骨折的患者年龄明显较大，且更有可能发生严重的压缩性骨折（P<.05）。在 52 例（64%）未报告骨折的患者中，骨折临床上并不知晓。在 18 例患者中，通过另一种影像学检查（中位数间隔为 7 个月）确定了压缩性骨折的后续诊断。在 DXA 检查中，39 例（48%）未报告椎体压缩性骨折的患者的非骨质疏松 T 评分（大于-2.5）。
如果不常规评估矢状重建，在有低骨密度风险的非创伤患者中，腹部多排 CT 可能会漏诊大多数临床重要的椎体压缩性骨折。
