Diagnosis of Osteoporotic Vertebral Fractures: Importance of Recognition and Description by Radiologists

Leon Lenchik; Lee F. Rogers; Pierre D. Delmas; Harry K. Genant


Am J Roentgenol. 2004;183(4) 

In This Article

Assessment of Fractures on DXA Images

Lateral spine images obtained with fan-beam dual-energy X-ray absorptiometry (DXA) systems (Fig. 14A, 14B) offer a potential alternative to radiographs for vertebral fracture diagnosis because vertebral fracture status is frequently unknown at the time of patient evaluation with bone densitometry.

Figure 14a.

Alternative to radiography for diagnosing vertebral fractures. Lateral dual-energy X-ray absorptiometry image shows mild thoracic wedge fracture.

Figure 14b.

Alternative to radiography for diagnosing vertebral fractures. Lateral radiograph of thoracic spine confirms fracture seen in A.

Several clinical studies have shown the feasibility of visual evaluation of lateral DXA spine images.[67–70] A study of 161 postmenopausal women who had lateral radiographs assessed using the Genant method reported that the DXA images permitted visual assessment of 95% of all vertebrae.[70] Among the vertebrae that could be visualized, there was 92% sensitivity and 96% specificity for detection of moderate-to-severe fractures. A strong overall agreement was found between visual evaluation of DXA images and radiographic results.

The same standardized approach to reporting vertebral fractures described previously should be applied to lateral DXA images. However, some degree of caution is warranted when using lateral DXA images for assessment of vertebral fractures for the following reasons: Many fractures seen on DXA should be confirmed with standard radiographs to exclude the possibility of a pathologic fracture, and patients with indeterminate DXA images (common in the upper thoracic spine) should be referred for radiography.


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