Dual-energy CT-generated bone marrow oedema maps improve timely visualisation and recognition of acute lower extremity fractures

Abstract Objectives Scaphoid injuries occult on plain radiography often require further imaging for definitive diagnosis. We investigate the utility of dual-energy computed tomography (DECT) for the detection of acute bone marrow oedema and fracture of scaphoid compared to MRI. Materials and methods Twenty patients who presented acutely (without prior injury) to the emergency department with clinically suspected occult scaphoid fracture and had MRI of the wrist were prospectively recruited to have DECT (GE Revolution CT). Material decomposition images of the water-calcium base pair were generated and assessed in conjunction with the monochromatic images to permit correlation of marrow signal changes with any cortical disruption for fracture confirmation. The assessment was performed by two musculoskeletal radiologists blinded from MRI results. The statistical difference of MRI and reviewers’ detection of acute bone oedema (1 = present, 0 = absent) was performed using the Friedman test (SPSS v.16). Results MRI showed acute scaphoid fracture and/or bone marrow oedema in 14/20 patients of which 6 also had cortical disruption. On DECT, reviewer A identified oedema in 13 and cortical disruption in 10 patients while reviewer B identified oedema in 10 and cortical disruption in seven of the 14 MRI positive patients. No statistically significant difference in oedema detection on MRI and reviewers of DECT (p value 0.61) but DECT was more sensitive at detecting cortical disruption. Conclusion DECT has the capability to detect acute scaphoid oedema in addition to cortical fractures. However, compared to MRI, DECT has lower contrast resolution and less sensitive in the detection of mild oedema. Key Points • Dual-energy CT is able to detect acute traumatic scaphoid marrow oedema. • Dual-energy CT has greater detection rate of scaphoid fractures than MRI. • Dual-energy CT is an alternative to MRI for occult scaphoid injury.

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

Tomography ◽

10.3390/tomography7030037 ◽

2021 ◽

Vol 7 (3) ◽

pp. 424-433

Author(s):

Giovanni Foti ◽

Gerardo Serra ◽

Venanzio Iacono ◽

Claudio Zorzi

Keyword(s):

Bone Marrow ◽

False Negative ◽

Dual Energy ◽

Bone Marrow Oedema ◽

Dual Energy Ct ◽

Imaging Findings ◽

Bone Sclerosis ◽

Negative Findings ◽

Coded Images ◽

Anatomical Area

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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Response to: ‘Use of dual-energy CT to detect and depict bone marrow oedema in rheumatoid arthritis: is it ready to substitute MRI?’ by Wu et al

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2018-213960 ◽

2018 ◽

Vol 78 (9) ◽

pp. e90-e90

Author(s):

Lennart Jans ◽

Isabelle De Kock ◽

Nele Herregods ◽

Koenraad L Verstraete ◽

Filip E Van den Bosch ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Bone Marrow ◽

Dual Energy ◽

Bone Marrow Oedema ◽

Dual Energy Ct

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Diagnostic performance of dual-energy CT for the detection of bone marrow oedema: a systematic review and meta-analysis

European Radiology ◽

10.1007/s00330-018-5411-5 ◽

2018 ◽

Vol 28 (10) ◽

pp. 4182-4194 ◽

Cited By ~ 28

Author(s):

Chong Hyun Suh ◽

Seong Jong Yun ◽

Wook Jin ◽

Sun Hwa Lee ◽

So Young Park ◽

...

Keyword(s):

Systematic Review ◽

Bone Marrow ◽

Diagnostic Performance ◽

Meta Analysis ◽

Dual Energy ◽

Bone Marrow Oedema ◽

Dual Energy Ct

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

Tomography ◽

10.3390/tomography7030034 ◽

2021 ◽

Vol 7 (3) ◽

pp. 387-396

Author(s):

Giovanni Foti ◽

Gerardo Serra ◽

Venanzio Iacono ◽

Stefania Marocco ◽

Giulia Bertoli ◽

...

Keyword(s):

Computed Tomography ◽

Bone Marrow ◽

Avascular Necrosis ◽

Traumatic Stress ◽

Imaging Technique ◽

Dual Energy ◽

Bone Marrow Oedema ◽

Dual Energy Ct ◽

Osteochondral Lesions

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.

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