A careful evaluation of scout CT lateral radiograph may prevent unreported vertebral fractures

Purpose: Our aim was to review Scout CT Lateral Radiographs (sCT) to reveal vertebral fractures unreported by radiologists. Methods and Materials: We retrospectively reviewed 234 CT examinations. Our investigation was first focused on sCT data and subsequently confirmed by multiplanar sagittal reconstructions when a vertebral fracture was found. The target spine segment was T4-L4 for whole-body, T9-L4 for lumbar and T4-L2 for thoracic CT scans. A semiquantitative diagnostic approach (followed by a morphometric one) was used. When a fracture was detected a wide clinical anamnesis of the patient was sought to understand whether fractures or osteoporosis were already known. Time spent per single sCT reading session was recorded. Results: We considered 121 whole-body, 54 thoracic and 59 abdominal CT scans. In 25 patients (25/234 -10.7%) the evaluation of the appropriate spine segment on sCT was incomplete or limited for patient/technical-based conditions. In 37 patients (37/234 - 15.8%, 19 males - 18 females, age 63±12years) 50 vertebral fractures were detected (27 mild, 21 moderate, 2 severe). Among 37 fractured patients only 10 were detected by radiologists. In 9/37 patients (24.3%; 7/10 - 70.0% among "officially" detected patients) a condition of osteoporosis was previously settled or suspected. Mean time spent to evaluate a single sCT was 1 minute and 25 seconds. Conclusion: The perception and sensibility to vertebral fractures among radiologists are still poor when a vertebral fracture assessment is not the aim of the examination. Little time spent for the evaluation of sCT could improve our accuracy