Dual-energy CT: a new imaging modality for bone marrow oedema in rheumatoid arthritis

Jans, Lennart; Kock, Isabelle De; Herregods, Nele; Verstraete, Koenraad; Bosch, Filip Van den; Carron, Philippe; Oei, E.H.; Elewaut, Dirk; Jacques, Peggy

doi:10.1136/annrheumdis-2018-213152

Cited by 38 publications

(44 citation statements)

References 9 publications

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“…To date, few studies have reported on the use of this technique to directly depict (a) trauma-associated bone marrow edema in the extremities (9,10) or spine (11)(12)(13)(14)22,23) or (b) malignant bone marrow infiltration (15,16,24). However, to our knowledge, this is the first and largest prospective study to address the bone marrow edema associated with inflammatory rheumatic disorders when using dual-energy CT (25,26).…”

Section: Quantitative Analysis Of Bone Marrow Ct Numbersmentioning

confidence: 99%

Axial Spondyloarthritis: Dual-Energy Virtual Noncalcium CT in the Detection of Bone Marrow Edema in the Sacroiliac Joints

Zhang

Shi

et al. 2019

Radiology

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I n the management of symptomatic axial spondyloarthritis (axSpA), it is important to accurately monitor current disease activity and the extent of structural damage (1). Recent European League Against Rheumatism recommendations on the use of MRI in patients with axSpA show that this imaging modality should be considered for use in the detection of both subchondral bone marrow edema and structural lesions (2-4). Although MRI is especially capable of directly depicting bone marrow edema not detected with other imaging modalities, it is more time consuming and expensive than would be reasonable for routine use (5-7). Although conventional CT is generally regarded as a more reliable method with which to detect structural sacroiliac joint lesions, such as minute erosions, and although it is relatively affordable, highly available, and requires shorter examination times than MRI, it is not widely used because it cannot be used to assess bone marrow edema (2,8). Dual-energy CT is an imaging technique that enables detection of traumatic bone marrow edema (9-14) and plasma cell infiltration of bone marrow (15,16) with high sensitivity and specificity if the patients were examined with a dual-energy mode. Dual-energy CT acquires two CT data sets at different energy levels simultaneously, and it can subsequently quantify and remove the individual chemical elements, like calcium, from those data sets. Postprocessing software is then used to remove calcium in trabecular bone by using the virtual noncalcium subtraction process, thus creating virtual noncalcium (VNCa) images (9-12). Increased water content (edema) or cellular components (multiple myeloma or bone metastases) in the bone marrow can be seen on VNCa images. We hypothesized that dual-energy CT with visual analysis of color-coded images and quantitative regionof-interest (ROI)-based density measurements could enable detection of sacroiliac joint bone marrow edema in participants with axSpA, with precision comparable to that of MRI. Thus, the purpose of our study was to determine the diagnostic performance of a dual-energy CT VNCa technique in the detection and depiction of the

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Section: Quantitative Analysis Of Bone Marrow Ct Numbersmentioning

confidence: 99%

Axial Spondyloarthritis: Dual-Energy Virtual Noncalcium CT in the Detection of Bone Marrow Edema in the Sacroiliac Joints

Zhang

Shi

et al. 2019

Radiology

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“…Additionally, they showed that BME detection both in the appendicular skeleton and the spine has a very good diagnostic performance, with sensitivity and specificity of 84% and 93%, respectively, for appendicular bones, and 84% and 98% for the spine. BME detection is also helpful in nontraumatic cases such as the hands in acute inflammatory arthritis, 19,20 BME in sacroiliitis, 21 osteoporotic vertebral compression fracture, 2,22,23 osteomyelitis, and bone tumors. 3,24 In any oncologic imaging center, differentiating between osseous metastatic disease and benign osseous lesions is a common dilemma.…”

Section: Virtual Non-calcium Imagesmentioning

confidence: 99%

“…However, the presence of BME improves detection by drawing attention to the affected area. 2,22 BME detection was shown to be useful in nontraumatic cases, such as BME detection of active rheumatoid arthritis in the hands, 19 BME in sacroillitis, 21 osteomyelitis, and bone tumors. 3,25…”

Section: Tip 6: Bone Marrow Edema Detectionmentioning

confidence: 99%

“…Qualitative tissue decomposition of the BME algorithm results in color-coded areas with altered bone marrow composition. 3,19,25,58 Quantitative tissue decomposition of the BME algorithm has the potential to enhance the visibility of the entire osseous metastatic burden. Lytic bone metastasis can also show enhancement due to hypervascular malignant soft tissue within the destroyed bone.…”

Section: Tip 7: Bone Marrow Lesion Detectionmentioning

confidence: 99%

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Top-Ten Tips for Dual-Energy CT in MSK Radiology

Walstra

Hickle

Duggan

et al. 2019

Semin Musculoskelet Radiol

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Dual-energy computed tomography (DECT) has the potential to detect musculoskeletal pathology with greater sensitivity than conventional CT alone at no additional radiation dose to the patient. It therefore has the potential to reduce the need for further diagnostic imaging or procedures (e.g., joint aspirations in the case of gout or magnetic resonance imaging to confirm undisplaced fractures).DECT is a well-established technique for the detection of gout arthropathy. Multiple newer applications have shown clinical potential including bone marrow edema detection and metal artifact reduction. Collagen analysis, bone marrow lesion detection, and iodine mapping in CT arthrography are areas of possible future application and development.This article outlines 10 tips on the use of DECT imaging of the musculoskeletal system, explaining the technique and indications with practical suggestions to help guide the radiologist.

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“…Although DECT has been predominantly studied in traumatic bone marrow edema, promising nontraumatic applications were identified including in inflammatory arthropathies 67 where bone marrow edema, a feature of early disease, is a predictor of radiographic progression.…”

Section: Bone Marrow Edema Imagingmentioning

confidence: 99%

Musculoskeletal Imaging: Current Practice and Future Directions

Farrell

Adams

Walsh

et al. 2018

Semin Musculoskelet Radiol

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Musculoskeletal (MSK) radiology plays a crucial role in the diagnosis and management of MSK disorders and has rapidly expanded in tandem with advances in technology and improved access to imaging. Although anatomical imaging remains the mainstay of MSK radiology, significant progress has been made in functional and molecular imaging as well as in hybrid imaging with an expanding armament of technologies becoming available or in development. A vast array of research is occurring in MSK imaging, and this review article highlights some of the most promising current and future clinical applications in development in each of the major imaging modalities. Identifying the clinical utility of these technologies in an era of rising health care costs is an important challenge for MSK radiologists.

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Dual-energy CT: a new imaging modality for bone marrow oedema in rheumatoid arthritis

Cited by 38 publications

References 9 publications

Axial Spondyloarthritis: Dual-Energy Virtual Noncalcium CT in the Detection of Bone Marrow Edema in the Sacroiliac Joints

Axial Spondyloarthritis: Dual-Energy Virtual Noncalcium CT in the Detection of Bone Marrow Edema in the Sacroiliac Joints

Top-Ten Tips for Dual-Energy CT in MSK Radiology

Musculoskeletal Imaging: Current Practice and Future Directions

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