Disk injury in patients with vertebral fractures—a prospective diagnostic accuracy study using dual-energy computed tomography

Pumberger, Matthias; Fuchs, Michael; Engelhard, Nils; Hermann, Kay-Geert A.; Putzier, Michael; Makowski, Marcus R.; Hamm, Bernd; Diekhoff, Torsten

doi:10.1007/s00330-018-5963-4

Cited by 21 publications

(16 citation statements)

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“…We previously reported on a patient with spondylodiscitis in whom we demonstrated pronounced loss of signal in cMaps reflecting the extent of disc destruction [23]. We were also able to show that DECT can be sensitive to microstructural disc injuries in patients with vertebral compression fractures [17]. More recently, we were able to show the IVD morphology on cMaps with excellent correlation between DECT and MRI in disc herniation [24].…”

Section: Discussionsupporting

confidence: 64%

“…Dual-energy computed tomography (DECT) may facilitate depiction of the characteristic properties of collagen with relatively high attenuation of the densely packed fibers and a relatively low effective atomic number, thus improving visualization of tendons, ligaments, and other collagen-rich structures [16]. Recent studies suggest that DECT is also useful in depicting the morphology and microstructural changes of IVDs [17,18]. Additionally, virtual non-calcium (VnCa) maps have been shown to increase diagnostic performance and confidence for depicting lumbar disc herniation as compared with standard CT [19].…”

Section: Introductionmentioning

confidence: 99%

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Age-dependent microstructural changes of the intervertebral disc: a validation of proteoglycan-sensitive spectral CT

et al. 2021

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Objective To analyze the two major components of the intervertebral disc (IVD) in an ex vivo phantom, as well as age-related changes in patients. Methods Collagen and chondroitin sulfate were imaged at different concentrations in agar solution. Age-related changes in disc density were retrospectively analyzed in normal-appearing discs in dual-energy computed tomography (DECT) images from a patient cohort with various spinal pathologies (n = 136). All computed tomography (CT) scans were acquired using single-source DECT at 80 and 135 kVp with automatic exposure calculation. In 136 patients, the attenuation of normal-appearing discs on collagen/chondroitin maps (cMaps) correlated with the patients’ age with Pearson’s r using standardized regions of interest in the anterior anulus fibrosus (AAF) and nucleus pulposus (NP). Results DECT collagen mapping revealed concentration-dependent Hounsfield units (HU) of IVD components. For collagen, we found Pearson’s r = 0.9610 (95% CI 0.6789–0.9959), p = 0.0023 at 120 kVe, and r = 0.8824 (95% CI 0.2495–0.9871), p = 0.0199 in cMap. For chondroitin sulfate, Pearson’s r was 0.9583 (95% CI 0.6603–0.9956), p = 0.0026 at 120 kVp, and r = 0.9646 (95% CI 0.7044–0.9963), p = 0.0019 in cMap. Analysis of normal-appearing IVDs revealed an inverse correlation of density with age in the AAF: Pearson’s r = − 0.2294 at 135 kVp (95% CI − 0.4012 to − 0.04203; p=0.0141) and r = − 0.09341 in cMap (95% CI − 0.2777 to 0.09754; p = 0.0003). In the NP, age and density did not correlate significantly at 135 kVp (p = 0.9228) and in cMap (p = 0.3229). Conclusions DECT-based collagen mapping allows microstructural analysis of the two main intervertebral disc components—collagen and chondroitin sulfate. IVD density declines with age, presumably due to a reduction in collagen and chondroitin sulfate content. Age-related alterations of disc microstructure appear most pronounced in the AAF. Key Points • DECT-based collagen mapping allows precise analysis of the two main intervertebral disc components—collagen and chondroitin sulfate. • Intervertebral disc (IVD) density declines with age, presumably due to a reduction in collagen and chondroitin sulfate content. • Age-related alterations of disc microstructure are most pronounced in the anterior anulus fibrosus (AAF).

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Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Age-dependent microstructural changes of the intervertebral disc: a validation of proteoglycan-sensitive spectral CT

et al. 2021

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“…To date, DECT has predominantly been investigated for its ability to detect malignant bone marrow infiltration, posttraumatic bone marrow lesions, or traumatic intervertebral disk injuries [ 6 , 12 – 14 ]. Especially in patients with vertebral compression fractures, several studies have underlined the added value of DECT compared with conventional CT imaging [ 4 , 5 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Dual-energy computed tomography (DECT) is a fairly new CT technique but is already included in guidelines for imaging in gout [ 3 ]. More recently, it has also been introduced for the detection of bone marrow edema in the spine, e.g., in patients with vertebral fractures [ 4 – 6 ]. DECT uses a so-called three-material decomposition algorithm to detect calcium; the same principle can be used to identify collagenous structures such as the intervertebral disk [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Vertebral disk morphology of the lumbar spine: a retrospective analysis of collagen-sensitive mapping using dual-energy computed tomography

et al. 2020

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Objectives To investigate the diagnostic accuracy of collagen-sensitive maps derived from dual-energy computed tomography (DECT) for the detection of lumbar disk pathologies in a feasibility setting. Materials and methods We retrospectively reviewed magnetic resonance imaging (MRI), computed tomography (CT), and DECT datasets acquired in patients who underwent periradicular therapy of the lumbar spine from June to December 2019. Three readers scored DECT collagen maps, conventional CT, and MRI for presence, type, and extent of disk pathology. Contingency table analyses were performed to determine diagnostic accuracy using MRI as standard of reference. Interrater agreement within and between imaging modalities was evaluated by computing intraclass correlation coefficients (ICCs) and Cohen’s kappa. Correlation between sum scores of anteroposterior disk displacement was determined by calculation of a paired t test. Results In 21 disks in 13 patients, DECT had a sensitivity of 0.87 (0.60–0.98) and specificity of 1.00 (0.54–1.00) for the detection of disk pathology. Intermodality agreement for anteroposterior disk displacement was excellent for DECT (ICC 0.963 [0.909–0.985]) and superior to CT (ICC 0.876 [0.691–0.95]). For anteroposterior disk displacement, DECT also showed greater within-modality interrater agreement (ICC 0.820 [0.666–0.916]) compared with CT (ICC 0.624 [0.39–0.808]). Conclusion Our data suggest that collagen-sensitive imaging has an added benefit, allowing more accurate evaluation of the extent of disk displacement with higher interrater reliability. Thus, DECT could provide useful diagnostic information in patients undergoing CT for other indications or with contraindications to MRI.

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“…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. 83…”

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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Disk injury in patients with vertebral fractures—a prospective diagnostic accuracy study using dual-energy computed tomography

Cited by 21 publications

References 29 publications

Age-dependent microstructural changes of the intervertebral disc: a validation of proteoglycan-sensitive spectral CT

Age-dependent microstructural changes of the intervertebral disc: a validation of proteoglycan-sensitive spectral CT

Vertebral disk morphology of the lumbar spine: a retrospective analysis of collagen-sensitive mapping using dual-energy computed tomography

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

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