Diagnostic performance of electron-density dual-energy CT in detection of cervical disc herniation in comparison with standard gray-scale CT and virtual non-calcium images

Abstract

Objectives To assess the diagnostic performance of dual-energy CT (DECT) with electron-density (ED) image reconstruction compared with standard CT (SC) and virtual non-calcium (VNCa) image CT reconstruction for detecting cervical disc herniation. Methods This cross-sectional study was approved by the IRB. We enrolled 64 patients (336 intervertebral discs from C2/3 to C7/T1; mean age, 55 years; 17 women and 47 men) who underwent DECT with spectral reconstruction and 3-T MRI within 2 weeks between January 2018 and June 2020. Four radiologists independently evaluated the first image set of randomized SC, VNCa, and ED images to detect cervical disc herniation. After 8 weeks, the readers re-evaluated the second and the last image sets with an 8-week interval. MRI evaluations performed by two other experienced served as the reference standard. Comparing diagnostic performance between each images set was evaluated by a generalized estimating equation. Results A total of 233 cervical disc herniations were noted on MRI. For detecting cervical disc herniation, electron-density images showed higher sensitivity (94% [219/233; 95% CI, 90–97] vs. 76% [177/233; 70–81] vs. 69% [160/233; 62–76]) ( p < 0.001) and similar specificity (90% [93/103; 83–95] vs. 89% [92/103; 82–96] vs. 90% [93/103; 83–95]) ( p > 0.05) as SC and VNCa images, respectively. Inter-reader agreement for cervical disc herniation calculated among the four readers was moderate for all image sets ( κ = 0.558 for ED, κ = 0.422 for SC, and κ = 0.449 for VNCa). Conclusion DECT with ED reconstruction can improve cervical disc herniation detection and diagnostic confidence compared with SC and VNCa images. Key Points • Intervertebral discs with high material density are well visualized on electron-density images obtained from dual-energy CT. • Electron-density images showed much higher sensitivity and diagnostic accuracy than standard CT and virtual non-calcium images for the detection of cervical disc herniation. • Electron-density images can have false-negative results, especially for disc herniation with high signal intensity on T2W images and can show pseudo-disc extrusion at the lower cervical spine. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08374-y.

Dual Energy Computed Tomography Collagen Material Decomposition for Detection of Lumbar Spine Disc Extrusion and Sequestration: A Comparative Study With Greyscale Computed Tomography

“…33 A retrospective study of cervical disc herniation found improved sensitivity using an electron-density DECT technique. 34 Pumberger et al, the first study of DECT collagen imaging of the spine, created virtual collagen maps to help identify disc injury in the setting of thoracic or lumbar vertebral fracture in 67 patients. 22 Comparing our data relative to the literature is challenging.…”

Dual-Energy CT in Cardiothoracic Imaging: Current Developments

“…However, with the implementation of DECT, it is possible to use the high spatial resolution of CT and provide good visualization of vertebral discs and ligaments [ 3 , 46 ]. Booz et al reported excellent sensitivity and specificity compared to MRI as the gold standard for disc herniation in the cervical spine and 95% confidence intervals of 91–98% for unenhanced DECT [ 48 , 62 ], which was confirmed by Shim et al in 2022 with sensitivity levels of 94% and specificity of 90% [ 63 ]. In 2022 Koch et al also described excellent sensitivity of 94% and a specificity of 95% compared to MRI in portal venous phase DECT in thoracic disc herniation [ 64 ].…”

Characterization of Normal Bone in the Equine Distal Limb with Effective Atomic Number and Electron Density Determined with Single-Source Dual Energy and Detector-Based Spectral Computed Tomography

“…In the human musculoskeletal system, reports on the use of EAN and ED maps are sparse. Electron density images improved cervical disc herniation detection and diagnostic confidence of CT [18]. In the human knee, EAN and ED values significantly differed between calcium pyrophosphate depositions and calcium hydroxyapatite in subchondral and trabecular bone [19].…”