Diagnostic accuracy of dual-energy CT and virtual non-calcium techniques to evaluate bone marrow edema in vertebral compression fractures

Foti, Giovanni; Beltramello, Alberto; Catania, Matteo; Rigotti, Stefano; Serra, Gerardo; Carbognin, Giovanni

doi:10.1007/s11547-019-00998-x

Cited by 27 publications

(22 citation statements)

References 22 publications

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“…The ability of the material decomposition (ie, the identification and separation of different chemical elements) in DECT increases with lower spectral overlap (48). Therefore, a wider separation between the energies of the two tubes can improve DECT sensitivity to detect BME (40).…”

Section: Discussionmentioning

confidence: 99%

DECT in Detection of Vertebral Fracture–associated Bone Marrow Edema: A Systematic Review and Meta-Analysis with Emphasis on Technical and Imaging Interpretation Parameters

Sherbaf

Sair²,

Shakoor³

et al. 2021

Radiology

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Background: Dual-energy CT (DECT) shows promising performance in detecting bone marrow edema (BME) associated with vertebral body fractures. However, the optimal technical and image interpretation parameters are not well described.Purpose: To conduct a systematic review and meta-analysis to determine the diagnostic performance of DECT in detecting BME associated with vertebral fractures (VFs), using different technical and image interpretation parameters, compared with MRI as the reference standard. Materials and Methods:A systematic literature search was performed on July 9, 2020, to identify studies evaluating DECT performance for in vivo detection of vertebral BME. A random-effects model was used to derive estimates of the diagnostic accuracy parameters of DECT. The impact of relevant covariates in technical, image interpretation, and study design parameters on the diagnostic performance of DECT was investigated using subgroup analyses.Results: Seventeen studies (with 742 of 2468 vertebrae with BME at MRI) met inclusion criteria. Pooled estimates of sensitivity, specificity, and area under the curve of DECT for vertebral body BME were 89% (95% CI: 84%, 92%), 96% (95% CI: 92%, 98%), and 96% (95% CI: 94%, 97%), respectively. Single-source consecutive scanning showed poor specificity (78%) compared with the dual-source technique (98%, P , .001). Specificity was higher using bone and soft-tissue kernels (98%) compared with using only soft-tissue kernels (90%, P = .001). Qualitative assessment had a better specificity (97%) versus quantitative assessment (90%) of DECT images (P = .01). Experienced readers showed considerably higher specificity (96%) compared with trainees (79%, P = .01). DECT sensitivity improved using a higher difference between low-and high-energy spectra (90% vs 83%, P = .04). Conclusion:Given its high specificity, the detection of vertebral bone marrow edema with dual-energy CT (DECT) associated with vertebral fracture may obviate confirmatory MRI in an emergency setting. Technical parameters, such as the dual-source technique, both bone and soft-tissue kernels, and qualitative assessment by experienced readers, can ensure the high specificity of DECT.

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Section: Discussionmentioning

confidence: 99%

DECT in Detection of Vertebral Fracture–associated Bone Marrow Edema: A Systematic Review and Meta-Analysis with Emphasis on Technical and Imaging Interpretation Parameters

Sherbaf

Sair²,

Shakoor³

et al. 2021

Radiology

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“…26 ). The risk factors associated with insufficiency fractures are advanced age, post-menopausal state, osteoporosis and lower body mass index [ 70 , 98 , 99 ]. Sapienza and colleagues [ 100 ] analyzed 21 studies including 3929 patients treated by RT for gynecologic cancers and found that 14% developed insufficiency fractures.…”

Section: Imaging Findingsmentioning

confidence: 99%

Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe

et al. 2021

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Newer biologic drugs and immunomodulatory agents, as well as more tolerated and effective radiation therapy schemes, have reduced treatment toxicity in oncology patients. However, although imaging assessment of tumor response is adapting to atypical responses like tumor flare, expected changes and complications of chemo/radiotherapy are still routinely encountered in post-treatment imaging examinations. Radiologists must be aware of old and newer therapeutic options and related side effects or complications to avoid a misinterpretation of imaging findings. Further, advancements in oncology research have increased life expectancy of patients as well as the frequency of long-term therapy-related side effects that once could not be observed. This pictorial will help radiologists tasked to detect therapy-related complications and to differentiate expected changes of normal tissues from tumor relapse.

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Section: Spine and Dentalmentioning

confidence: 99%

“…77 Additional studies published after this meta-analysis assessing edema in vertebral compression fractures with VNCa demonstrated very similar sensitivities (between 85% and 98%) and specificities (between 92% and 99%), with an area under the receiver-operating characteristic curve ranging from 0.88 to 0.97. [78][79][80][81] In addition to detecting marrow edema, VNCa color map overlay images have been found to have higher overall sensitivity and specificity (91% and 92%, respectively) than standard CT for detecting lumbar disk herniation, using MRI as a reference standard 82 (Figure 6). In patients with vertebral fractures, color overlay collagen maps created using three-material decomposition techniques were found to be both sensitive (0.85) and specific (0.75) for disk injuries, with sensitivity varying from 0.80 to 0.98 depending on severity of disk injury.…”

Section: Bone Marrow and Disk Assessmentmentioning

confidence: 99%

A Review of the Applications of Dual-Energy CT in Acute Neuroimaging

et al. 2020

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Dual-energy computed tomography (CT) is a promising tool with increasing availability and multiple emerging and established clinical applications in neuroradiology. With its ability to allow characterization of materials based on their differential attenuation when imaged at two different energy levels, dual-energy CT can help identify the composition of brain, neck, and spinal components. Virtual monoenergetic imaging allows a range of simulated single energy-level reconstructions to be created with postprocessing. Low-energy reconstructions can aid identification of edema, ischemia, and subtle lesions due to increased soft tissue contrast as well as increasing contrast-to-noise ratios on angiographic imaging. Higher energy reconstructions can reduce image artifact from dental amalgam, aneurysm clips and coils, spinal hardware, dense contrast, and dense bones. Differentiating iodine from hemorrhage may help guide management of patients after thrombectomy and aid diagnosis of enhancing tumors within parenchymal hemorrhages. Iodine quantification may predict hematoma expansion in aneurysmal bleeds and outcomes in traumatic brain injury. Calcium and bone subtraction can be used to distinguish hemorrhage from brain parenchymal mineralization as well as improving visualization of extra-axial lesions and vessels adjacent to dense plaque or skull. This article reviews the basics of dual-energy CT and highlights many of its clinical applications in the evaluation of acute neurological presentations.

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Diagnostic accuracy of dual-energy CT and virtual non-calcium techniques to evaluate bone marrow edema in vertebral compression fractures

Cited by 27 publications

References 22 publications

DECT in Detection of Vertebral Fracture–associated Bone Marrow Edema: A Systematic Review and Meta-Analysis with Emphasis on Technical and Imaging Interpretation Parameters

DECT in Detection of Vertebral Fracture–associated Bone Marrow Edema: A Systematic Review and Meta-Analysis with Emphasis on Technical and Imaging Interpretation Parameters

Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe

A Review of the Applications of Dual-Energy CT in Acute Neuroimaging

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