A Quantitative Assessment of Dual Energy Computed Tomography‐Based Material Decomposition for Imaging Bone Marrow Edema Associated with Acute Knee Injury

Abstract 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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Color-coded virtual non-calcium dual-energy CT for the depiction of bone marrow edema in patients with acute knee trauma: a multireader diagnostic accuracy study

European Radiology ◽

10.1007/s00330-019-06304-7 ◽

2019 ◽

Vol 30 (1) ◽

pp. 141-150 ◽

Cited By ~ 12

Author(s):

Christian Booz ◽

Jochen Nöske ◽

Lukas Lenga ◽

Simon S. Martin ◽

Ibrahim Yel ◽

...

Keyword(s):

Bone Marrow ◽

Diagnostic Accuracy ◽

Bone Marrow Edema ◽

Dual Energy ◽

Dual Energy Ct ◽

Diagnostic Accuracy Study ◽

Accuracy Study ◽

Knee Trauma ◽

Acute Knee ◽

Marrow Edema

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Dual-Energy Computed Tomography Virtual Noncalcium Imaging for the Detection of Acute Bone Marrow Edema in Vertebrae: Qualitative and Quantitative Analysis

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3363 ◽

2021 ◽

Vol 11 (3) ◽

pp. 752-759

Author(s):

Lingjing Gu ◽

Jianchao Liang ◽

Yingying Zhan ◽

Jielin Pan ◽

Yi Zhang ◽

...

Keyword(s):

Computed Tomography ◽

Bone Marrow ◽

Mr Imaging ◽

Bone Marrow Edema ◽

Dual Energy ◽

Grading System ◽

Qualitative And Quantitative ◽

Ct Value ◽

Quantitative Analyses ◽

Marrow Edema

Purpose: To evaluate the feasibility of dual-energy computed tomography (DECT) virtual noncalcium (VNCa) images for detecting vertebral bone marrow edema (BME), both in qualitative and quantitative analyses. Materials and Methods: Nineteen cases with acute spinal trauma were enrolled. DECT and MR Imaging were performed over an interval of 0–3 days within 3 weeks of injury. Both gray-scale and color-coded VNCa images were evaluated in an independent and blind manner using a three-scale grading system (2 = distinct BME, 1 = suspicious BME, and 0 = no edema) by two radiologists. CT value of bone marrow were measured for each region and subjected to receiver operating characteristic (ROC) curve analysis for diagnosis of BME on VNCa images from DECT. Subsequently, as a standard of reference, MR imaging was evaluated by a third radiologist for the presence of traumatic BME. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection of BME using VNCa images were evaluated. Kappa analysis and one-way ANOVA were performed to evaluate the consistency and variance of VNCa images in the BME. Results: For two observers, the sensitivity of VNCa images for detecting BME (grade 2) were 97.8% and 96.7%, with the specificity 76% and 72%, the PPV 93.8% and 92.7%, the NPV 90.5% and 85.7%, respectively. And the sensitivity for detecting BME (grade 1–2) were 94.3% and 94.3%, with the specificity 96.7% and 93.3%, the PPV 98.8% and 97.6%, the NPV 85.3% and 84.8%, respectively. The consistency test between the two observers showed that Kappa value was 0.650 (P < 0.001). The VNCa images had higher CT value in the positive regions than in the negative regions (P < 0.05). Statistically significant differences in the CT value were identified in different regions with the three-scale grading system (thoracic levels: F = 136.690, P < 0.001; lumbar levels: F = 92.689, P < 0.001). Conclusions: Acute traumatic BME in the vertebrae can be detected on VNCa images in both qualitative and quantitative analyses. DECT VNCa images are expected to serve as an additional method for the evaluation of BME.

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