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CT detects more osteoporotic endplate depressions than radiograph: a descriptive comparison of 76 vertebrae

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Abstract

Summary

This study analyzed elderly women who had chest radiograph and chest CT with indications other than spine disorders. Using CT images as reference, the study demonstrates that radiograph can miss a high portion of mild endplate depression. Detection of endplate depression is confounded by the limitation of projectional overlay for radiograph.

Introduction

The definition of radiographic OVF (osteoporotic vertebral fracture) remains controversial. Some authors suggest all OVFs should demonstrate endplate fracture/depression on radiograph. Using CT image as the reference, our study tests the hypothesis that a considerable portion of endplate depressions not seen on radiograph can be detected on CT.

Methods

We retrospectively analyzed 46 female cases (age: 67–94 years) who had both chest radiography and chest CT with indications other than spine disorders. Sixty-six “vertebrae of interest” were identified on radiograph; then, CT images were read side-by-side with lateral chest radiograph.

Results

Thirty-eight vertebrae (38/66) had anterior wedging deformity with height loss of < 20% while without radiographic endplate depression. Among them, 28 vertebrae had endplate depression and 8 vertebrae had no endplate depression on CT, while 2 vertebrae with “very” minimal deformity were read as normal on CT. In 9 vertebrae (9/66) with anterior wedging and height loss of ≥ 20%, all had additional endplate depression seen on CT. Five vertebrae (5/66) had ambiguous endplate depression on radiograph, 3 had endplate depression on CT while the other 2 vertebrae in one patient were false positive due to X-ray projection. There were 14 short height vertebrae (14/66) where middle and anterior heights were reduced to the same extent while did not show apparent anterior wedging or bi-concaving. Four cases each had one short height vertebra, and all had endplate depression on CT. Another 4 cases had 2, 2, 3, and 3 adjacent short height vertebrae, respectively, and all did not show endplate depression on CT. In addition, inspection of spine CT showed 10 vertebrae in 9 cases appeared normal on radiograph while demonstrated endplate depression on CT.

Conclusion

With CT images as reference, radiograph can miss a high portion of mild endplate depressions.

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Authors and Affiliations

  1. Department of Radiology, Dongguan Traditional Chinese Medicine Hospital, Dongguan, Guangdong province, China

    E.-Z. Du

  2. Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China

    Y. X. J. Wáng

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Du, EZ., Wáng, Y.X.J. CT detects more osteoporotic endplate depressions than radiograph: a descriptive comparison of 76 vertebrae. Osteoporos Int 33, 1569–1577 (2022). https://doi.org/10.1007/s00198-022-06391-1

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