Three-material decomposition with dual-layer spectral CT compared to MRI for the detection of bone marrow edema in patients with acute vertebral fractures

Benedikt J. Schwaiger, Alexandra S. Gersing, Johannes Hammel, Kai Mei, Felix K. Kopp, Jan S. Kirschke, Ernst J. Rummeny, Klaus Wörtler, Thomas Baum, Peter B. Noël

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Objectives: To assess whether bone marrow edema in patients with acute vertebral fractures can be accurately diagnosed based on three-material decomposition with dual-layer spectral CT (DLCT). Materials and methods: Acute (n = 41) and chronic (n = 18) osteoporotic thoracolumbar vertebral fractures as diagnosed by MRI (hyperintense signal in STIR sequences) in 27 subjects (72 ± 11 years; 17 women) were assessed with DLCT. Spectral data were decomposed into hydroxyapatite, edema-equivalent, and fat-equivalent density maps using an in-house-developed algorithm. Two radiologists, blinded to clinical and MR findings, assessed DLCT and conventional CT independently, using a Likert scale (1 = no edema; 2 = likely no edema; 3 = likely edema; 4 = edema). For DLCT and conventional CT, accuracy, sensitivity, and specificity for identifying acute fractures (Likert scale, 3 and 4) were analyzed separately using MRI as standard of reference. Results: For the identification of acute fractures, conventional CT showed a sensitivity of 0.73–0.76 and specificity of 0.78–0.83, whereas the sensitivity (0.93–0.95) and specificity (0.89) of decomposed DLCT images were substantially higher. Accuracy increased from 0.76 for conventional CT to 0.92–0.93 using DLCT. Interreader agreement for fracture assessment was high in conventional CT (weighted κ [95% confidence interval]; 0.81 [0.70; 0.92]) and DLCT (0.96 [0.92; 1.00]). Conclusions: Material decomposition of DLCT data substantially improved accuracy for the diagnosis of acute vertebral fractures, with a high interreader agreement. This may spare patients additional examinations and facilitate the diagnosis of vertebral fractures.

Original languageEnglish
Pages (from-to)1533-1540
Number of pages8
JournalSkeletal Radiology
Volume47
Issue number11
DOIs
StatePublished - 1 Nov 2018
Externally publishedYes

Keywords

  • Dual-layer spectral computed tomography
  • Osteoporosis
  • Spine
  • Vertebral fractures

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