Diagnostic performance of dual-energy computed tomography for detection of acute spinal fractures

Jeong, Sooyeon; Jeon, Se-Jeong; Seol, Myungjin; Ahn, Tae Young; Juhng, Seon Kwan

doi:10.1007/s00256-020-03450-8

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…The strength of our study is pooling estimates of a larger number of studies (n = 17) and performing several subgroup analyses to explore pertinent factors that can optimize the diagnostic performance of DECT. Among the included studies, four techniques were available to obtain DECT images, as follows: (a) single-source consecutive scanning (33,34,39,44), (b) single-source fast kilovoltage switching (41,43), (c) dual-source DECT (29)(30)(31)(32)35,36,40,42,45), and (d) dual-layer DECT (37,38). Among these techniques, consecutive scanning has the advantage of high availability because of a more basic hardware requirement.…”

Section: Figurementioning

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: Figurementioning

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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“…Accordingly, Shinohara et al. ( 17 ) used color-coded virtual non-calcium (VNCa) images to detect edematous changes in the IVD and have recently reported highly accurate detection of degenerative IVD changes compared with MRI. Especially in patients with contraindications to MRI such as cardiac devices or claustrophobia, DECT can therefore be a valuable alternative.…”

Section: Discussionmentioning

confidence: 99%

“…DECT of the IVD is currently being used in imaging spinal fractures ( 14 – 16 ). Virtual non-calcium (VNCa) reconstruction of DECT scans has been shown to allow accurate description of disc morphology in degenerative disc disease ( 17 ). Alternatively, cMaps can be generated using three-material decomposition for collagen/chondroitin.…”

Section: Introductionmentioning

confidence: 99%

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Visualizing patterns of intervertebral disc damage with dual-energy computed tomography: assessment of diagnostic accuracy in an ex vivo spine biophantom

et al. 2021

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Background Previously, dual-energy computed tomography (DECT) has been established for imaging spinal fractures as an alternative modality to magnetic resonance imaging (MRI). Purpose To analyze the diagnostic accuracy of DECT in visualizing intervertebral disc (IVD) damage. Material and Methods The lumbar spine of a Great Dane dog was used as an ex vivo biophantom. DECT was performed as sequential volume technique on a single-source CT scanner. IVDs were imaged before and after an injection of sodium chloride solution and after anterior discectomy in single-source sequential volume DECT technique using 80 and 135 kVp. Chondroitin/Collagen maps (cMaps) were reconstructed at 1 mm and compared with standard CT. Standardized regions of interest (ROI) were placed in the anterior anulus fibrosus, nucleus pulposus, and other sites. Three blinded readers classified all images as intact disc, nucleus lesion, or anulus lesion. Additionally, clinical examples from patients with IVD lesions were retrospectively identified from the radiological database. Results Interrater reliability was almost perfect with a Fleiss kappa of 0.833 (95% confidence interval [CI] 0.83–0.835) for DECT, compared with 0.780 (95% CI 0.778–0.782) for standard CT. For overall detection accuracy of IVD, DECT achieved 91.0% sensitivity (95% CI 83.6–95.8) and 92.0% specificity (95% CI 80.8–97.8). Standard CT showed 91.0% sensitivity (95% CI 83.6–95.8) and 78.0% specificity (95% CI 64.0–88.5). Conclusion DECT reliably identified IVD damage in an ex vivo biophantom. Clinical examples of patients with different lesions illustrate the accurate depiction of IVD microstructure. These data emphasize the diagnostic potential of DECT cMaps.

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“…While single-energy CT is not able to remove bone trabeculations and to uncover subtle bone marrow attenuation changes, DECT allows for BME assessment [20,[49][50][51][52][53][54][55]. Moreover, its rapid acquisition time lends it favorably to emergency settings [46].…”

Section: Spine Fracturesmentioning

confidence: 99%

Virtual non-calcium dual-energy CT: clinical applications

et al. 2021

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Dual-energy CT (DECT) has emerged into clinical routine as an imaging technique with unique postprocessing utilities that improve the evaluation of different body areas. The virtual non-calcium (VNCa) reconstruction algorithm has shown beneficial effects on the depiction of bone marrow pathologies such as bone marrow edema. Its main advantage is the ability to substantially increase the image contrast of structures that are usually covered with calcium mineral, such as calcified vessels or bone marrow, and to depict a large number of traumatic, inflammatory, infiltrative, and degenerative disorders affecting either the spine or the appendicular skeleton. Therefore, VNCa imaging represents another step forward for DECT to image conditions and disorders that usually require the use of more expensive and time-consuming techniques such as magnetic resonance imaging, positron emission tomography/CT, or bone scintigraphy. The aim of this review article is to explain the technical background of VNCa imaging, showcase its applicability in the different body regions, and provide an updated outlook on the clinical impact of this technique, which goes beyond the sole improvement in image quality.

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Diagnostic performance of dual-energy computed tomography for detection of acute spinal fractures

Cited by 7 publications

References 9 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

Visualizing patterns of intervertebral disc damage with dual-energy computed tomography: assessment of diagnostic accuracy in an ex vivo spine biophantom

Virtual non-calcium dual-energy CT: clinical applications

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