Title: December 2017 – Lumbar Segmentation Conundrum

Submitted By: Lawrence Jankowski CBDT
Affiliation: Illinois Bone and Joint Institute, LLC
Morton Grove, Illinois USA

Patient History:
A 55 year old female patient, last menstrual period 2 years ago, with positive family history of maternal hip fracture (age 79). Medical history includes left wrist fracture from fall in icy parking lot 1 year ago onto a concrete barrier. No other risk factors for osteoporosis. Two different vertebral labeling schema of the spine DXA were provided by the technologist for the interpreting physician to choose from (Fig 1) as well as the right hip (Fig.2)


Figure 1:Two different analyses of the lumbar spine were provided by the technologist to the interpeting physician to choose from as it was unclear from the spine image as which vertebral labeling schema was correct.

Figure 2: Right hip scan of same patient.

Questions:

  1. What is the etiology of the most salient visual finding in the spine scan image?
  2. Which, if either, of the above analyses of the spine scan would you accept?

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