Identification of bone marrow edema of the knee: diagnostic accuracy of dual-energy CT in comparison with MRI

Foti, Giovanni; Mantovani, William; Faccioli, Niccolò; Crivellari, Giacomo; Romano, Luigi; Zorzi, Claudio; Carbognin, Giovanni

doi:10.1007/s11547-020-01267-y

Cited by 21 publications

(42 citation statements)

References 27 publications

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“…Additional windowing can also be carried out by increasing or decreasing the level of super-imposition of color-coded images in order to confirm or rule out subtler findings (Figure 2). However, in selected cases, for example in those of bone sclerosis, an alternative and widely used color-coding method, whereby spared bone is represented in violet and BME in shades of green, is preferred; this highlights an important pitfall of DECT [3,7,8]. Sclerosis is often identified on the acetabular roof, especially in patients suffering from degenerative osteoarthritis of the hip, or near to the pubis and sacroiliac joints, in the subchondral areas of knee and ankle, such as the tibial plateaus and talar dome, and adjacent to cortical bone in the upper extremities.…”

Section: Imaging Interpretationmentioning

confidence: 99%

“…In acute, post-traumatic settings, BME can be key for the identification of non-displaced fractures that are otherwise potentially missed by standard radiographs [ 2 ]. BME is often present following trauma, even in the absence of fractures [ 3 ], and subchondral BME, in particular, may prove a negative prognostic indicator for clinical outcomes [ 4 , 5 ]. Furthermore, additional imaging findings, such as ligamentous injuries, cartilage loss, or osteochondral lesions (OCL), may assist in diagnosis and prognostic assessment [ 3 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…BME is often present following trauma, even in the absence of fractures [ 3 ], and subchondral BME, in particular, may prove a negative prognostic indicator for clinical outcomes [ 4 , 5 ]. Furthermore, additional imaging findings, such as ligamentous injuries, cartilage loss, or osteochondral lesions (OCL), may assist in diagnosis and prognostic assessment [ 3 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, while DECT images can be used to identify BME, standard CT images can help in identifying subtle morphological changes that could prove key for diagnosis, thus increasing the reliability and reading confidence amongst less experienced readers, and reducing the overall reading time in general [ 14 ]. A further benefit is the possible detection of imaging findings associated with BME, such as OCL or hip avascular necrosis [ 3 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Identification of Traumatic Bone Marrow Oedema: The Pearls and Pitfalls of Dual-Energy CT (DECT)

et al. 2021

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Dual-energy computed tomography (DECT) has been reported to successfully identify bone marrow oedema (BME) in various traumatic settings. DECT has multiple strengths, including the availability of both a 3D view of the anatomical area studied and of high-resolution dual energy specific maps super-imposed onto conventional grayscale morphological images. Windowing can be used to enhance the visualization of BME by increasing the level of the super-imposed images. Conversely, by decreasing the level of the super-imposition of color-coded images, it is possible to progressively enhance the visualization of fine anatomical details, which is useful for diagnosing associated imaging findings. Importantly, bone sclerosis may represent an important pitfall for DECT, potentially generating both false positive and false negative findings by locally altering CT numbers. The aim of this paper was to evaluate the strengths and limitations of DECT in accurately detecting traumatic BME, by considering practical approaches to imaging at several anatomical sites.

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Section: Imaging Interpretationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Identification of Traumatic Bone Marrow Oedema: The Pearls and Pitfalls of Dual-Energy CT (DECT)

et al. 2021

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“…A total of 237 articles were identi ed by searching databases and removing duplicates. After initial screening of titles and abstracts, 64 articles were further assessed by scrutinizing the full texts against the predesigned criteria, and 9 articles [11][12][13][14][15][16][17][18][19] were eventually included in analysis.…”

Section: Literature Searchmentioning

confidence: 99%

Diagnostic Accuracy of Dual-energy CT for Bone Marrow Edema in Patients with Acute Knee Injuries: A Systematic Review and Meta-analysis

Chen

Fang

et al. 2021

Preprint

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Background: The prevalence of knee injury is high and early diagnosis is significant to guide clinical treatment. MRI is recognized as the gold standard for detecting bone marrow edema (BME) in patients with acute knee injury, but limitations still exist. Dual-energy CT (DECT) is investigated as a promising alternative.Methods: We systematically retrieved studies from EMBASE, Scopus, PUBMED, and the Cochrane Library and collected gray literatures. According to PRISMA-DTA guidelines, a systematic review was performed from inception to July 31, 2021, assessing the diagnostic accuracy of DECT for detecting BME in at least 10 adult patients with acute knee injuries and with an MRI reference standard. Study details were independently extracted by two reviewers. Meta-analysis was performed using a bivariate mixed-effects regression model with subgroup analysis performed to evaluate for sources of variability. Results: Nine studies evaluating 290 patients between the ages of 23–53 with acute knee injuries undergoing DECT and MRI were included in analysis. Summary sensitivity, specificity, and AUC values for BME were 85% (95% confidence interval (CI) 77–90%), 96% (95% CI 93–97%), and 0.97 (95% CI 0.95–0.98), respectively. There were no statistically significant differences in specificity and sensitivity amongst comparative subgroups to account for presumed variability amongst studies.Conclusion: DECT is accurate for detecting BME in patients with acute knee injuries and can be used as an alternative to MRI, particularly when MRI is contraindicated or unavailable.

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Preliminary evaluation of dual-energy CT to quantitatively assess bone marrow edema in patients with diabetic foot ulcers and suspected osteomyelitis

et al. 2023

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Objectives The purpose of this study is to evaluate the value of dual-energy CT (DECT) with virtual non-calcium (VNCa) in quantitatively assessing the presence of bone marrow edema (BME) in patients with diabetic foot ulcers and suspected osteomyelitis. Methods Patients with a diabetic foot ulcer and suspected osteomyelitis that underwent DECT (80 kVp/Sn150 kVp) with VNCa were retrospectively included. Two observers independently measured CT values of the bone adjacent to the ulcer and a reference bone not related to the ulcer. The patients were divided into two clinical groups, osteomyelitis or no-osteomyelitis, based on the final diagnosis by the treating physicians. Results A total of 56 foot ulcers were identified of which 23 were included in the osteomyelitis group. The mean CT value at the ulcer location was significantly higher in the osteomyelitis group (− 17.23 ± 34.96 HU) compared to the no-osteomyelitis group (− 69.34 ± 49.40 HU; p < 0.001). Within the osteomyelitis group, the difference between affected bone and reference bone was statistically significant (p < 0.001), which was not the case in the group without osteomyelitis (p = 0.052). The observer agreement was good for affected bone measurements (ICC = 0.858) and moderate for reference bone measurements (ICC = 0.675). With a cut-off value of − 40.1 HU, sensitivity was 87.0%, specificity was 72.7%, PPV was 69.0%, and NPV was 88.9%. Conclusion DECT with VNCa has a potential value for quantitatively assessing the presence of BME in patients with diabetic foot ulcers and suspected osteomyelitis. Key Points • Dual-energy CT (DECT) with virtual non-calcium (VNCa) is promising for detecting bone marrow edema in the case of diabetic foot ulcers with suspected osteomyelitis. • DECT with VNCa has the potential to become a more practical alternative to MRI in assessing the presence of bone marrow edema in suspected osteomyelitis when radiographs are not sufficient to form a diagnosis.

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Identification of bone marrow edema of the knee: diagnostic accuracy of dual-energy CT in comparison with MRI

Cited by 21 publications

References 27 publications

Identification of Traumatic Bone Marrow Oedema: The Pearls and Pitfalls of Dual-Energy CT (DECT)

Identification of Traumatic Bone Marrow Oedema: The Pearls and Pitfalls of Dual-Energy CT (DECT)

Diagnostic Accuracy of Dual-energy CT for Bone Marrow Edema in Patients with Acute Knee Injuries: A Systematic Review and Meta-analysis

Preliminary evaluation of dual-energy CT to quantitatively assess bone marrow edema in patients with diabetic foot ulcers and suspected osteomyelitis

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