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

Abstract

Dual-energy computed tomography (DECT) is an imaging technique widely used in traumatic settings to diagnose bone marrow oedema (BME). This paper describes the role of DECT in diagnosing BME in non-traumatic settings by evaluating its reliability in analyzing some of the most common painful syndromes. In particular, with an illustrative approach, the paper describes the possible use of DECT for the evaluation of osteochondral lesions of the knee and of the ankle, avascular necrosis of the hip, non-traumatic stress fractures, and other inflammatory and infectious disorders of the bones.

Application of double-layer detector spectral CT calcicum supression technique in the diagnosis of traumatic bone marrow edema in the knee

“…In this study, patients with traumatic knee bone marrow edema were retrospectively collected, and CaSupp technique of DSCT was used to observe knee bone marrow edema, which finally obtained a high diagnostic efficacy. A number of published studies have evaluated the application of high-low tube voltage switching single source CT or dual source CT in the diagnosis of knee bone marrow edema, with reported sensitivities ranging from 87.1 % to 96.0 % and specificity ranging from 66.9 % to 97.6 % [ 3 , 10 , 14 , 15 ]. There were also studies on the application of CaSupp technique derived from DSCT in the diagnosis of bone marrow edema in other bone of human body, such as spine, wrist, etc.…”

“…Bone marrow edema is observed in 80 % of patients with anterior cruciate ligament injury [ 1 , 2 ]. The existence of bone marrow edema is not only related to pain [ 3 ], but also has been found to be related to the damage of adjacent cartilage, affecting the subsequent healing process [ 4 ]. The early detection and identification of bone marrow edema plays an important role in determining the time point of clinical intervention, especially in the case of occult fracture [ 5 ].…”

The Clinical Utility of Lower Extremity Dual-Energy CT Angiography in the Detection of Bone Marrow Edema in Diabetic Patients with Peripheral Artery Disease

“…The VNCa image is produced by means of a three-material decomposition model, which enables bone mineral and gross calcifications removal, thus displaying the underlying bone marrow without superposition [ 27 , 28 , 29 , 30 ]. With VNCa imaging, the different attenuation values of the bone marrow reflect its water and fat content.…”

Spontaneous Bone Marrow Edema: Perfusion Abnormalities and Treatment with Surgical Decompression

“…It may not be a single pathological entity but rather several pathologies with a common MRI appearance [ 1 , 3 ]. It is a nonspecific hallmark of several nontraumatic diseases and is associated with bone and ligament trauma, osteoarthritis (OA), avascular necrosis (AVN), infections, and transient osteoporosis with different clinical symptomatologies, varying prognoses, and perhaps different clinical significance in these conditions [ 3 , 4 , 5 , 6 , 7 ]. It is also seen with no obvious associative or causative conditions, in which cases it has been termed spontaneous BME and has been distinguished clinically from AVN [ 8 ].…”