Diagnostic accuracy and added value of dual-energy subtraction radiography compared to standard conventional radiography using computed tomography as standard of reference

Abstract Objectives To investigate the diagnostic accuracy of collagen-sensitive maps derived from dual-energy computed tomography (DECT) for the detection of lumbar disk pathologies in a feasibility setting. Materials and methods We retrospectively reviewed magnetic resonance imaging (MRI), computed tomography (CT), and DECT datasets acquired in patients who underwent periradicular therapy of the lumbar spine from June to December 2019. Three readers scored DECT collagen maps, conventional CT, and MRI for presence, type, and extent of disk pathology. Contingency table analyses were performed to determine diagnostic accuracy using MRI as standard of reference. Interrater agreement within and between imaging modalities was evaluated by computing intraclass correlation coefficients (ICCs) and Cohen’s kappa. Correlation between sum scores of anteroposterior disk displacement was determined by calculation of a paired t test. Results In 21 disks in 13 patients, DECT had a sensitivity of 0.87 (0.60–0.98) and specificity of 1.00 (0.54–1.00) for the detection of disk pathology. Intermodality agreement for anteroposterior disk displacement was excellent for DECT (ICC 0.963 [0.909–0.985]) and superior to CT (ICC 0.876 [0.691–0.95]). For anteroposterior disk displacement, DECT also showed greater within-modality interrater agreement (ICC 0.820 [0.666–0.916]) compared with CT (ICC 0.624 [0.39–0.808]). Conclusion Our data suggest that collagen-sensitive imaging has an added benefit, allowing more accurate evaluation of the extent of disk displacement with higher interrater reliability. Thus, DECT could provide useful diagnostic information in patients undergoing CT for other indications or with contraindications to MRI.

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Single-source dual-energy computed tomography for the assessment of bone marrow oedema in vertebral compression fractures: a prospective diagnostic accuracy study

European Radiology ◽

10.1007/s00330-018-5568-y ◽

2018 ◽

Vol 29 (1) ◽

pp. 31-39 ◽

Cited By ~ 6

Author(s):

Torsten Diekhoff ◽

Nils Engelhard ◽

Michael Fuchs ◽

Matthias Pumberger ◽

Michael Putzier ◽

...

Keyword(s):

Computed Tomography ◽

Bone Marrow ◽

Diagnostic Accuracy ◽

Dual Energy ◽

Vertebral Compression Fractures ◽

Diagnostic Accuracy Study ◽

Single Source ◽

Dual Energy Computed Tomography ◽

Compression Fractures ◽

Accuracy Study

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Diagnostic Accuracy of Dual-Energy CT in Detection of Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis

Canadian Association of Radiologists Journal ◽

10.1177/0846537120902062 ◽

2020 ◽

pp. 084653712090206 ◽

Cited By ~ 1

Author(s):

Waleed Abdellatif ◽

Mahmoud Ahmed Ebada ◽

Souad Alkanj ◽

Ahmed Negida ◽

Nicolas Murray ◽

...

Keyword(s):

Computed Tomography ◽

Systematic Review ◽

Pulmonary Embolism ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Acute Pulmonary Embolism ◽

Meta Analysis ◽

Dual Energy ◽

Dual Energy Computed Tomography ◽

Sensitivity Specificity

Purpose: In this systematic review and meta-analysis, we aimed to investigate the accuracy of dual-energy computed tomography (DECT) in the detection of acute pulmonary embolism (PE). Methods: We searched Medline (via PubMed), EBSCO, Web of Science, Scopus, and the Cochrane Library for relevant published studies. We selected studies assessing the accuracy of DECT in the detection of PE. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 tool. Meta-analysis was performed to calculate mean estimates of sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR). The summary receiver operating characteristic (sROC) curve was drawn to get the Cochran Q-index and the area under the curve (AUC). Results: Seven studies were included in our systematic review. Of the 182 patients included, 108 patients had PEs. The pooled analysis showed an overall sensitivity and specificity of 88.9% (95% confidence interval [CI]: 81.4%-94.1%) and 94.6% (95% CI: 86.7%-98.5%), respectively. The pooled PLR was 8.186 (95% CI: 3.726-17.986), while the pooled NLR was 0.159 (95% CI: 0.093-0.270). Cochran-Q was 0.8712, and AUC was 0.935 in the sROC curve. Conclusion: Dual-energy computed tomography shows high sensitivity, specificity, and diagnostic accuracy in the detection of acute PE. The high PLR highlights the high clinical importance of DECT as a prevalence-independent, rule-in test. Studies with a larger sample size with standardized reference tests are still needed to increase the statistical power of the study and support these findings.

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Added Value of Dual-Energy Computed Tomography Versus Single-Energy Computed Tomography in Assessing Ferromagnetic Properties of Ballistic Projectiles

Investigative Radiology ◽

10.1097/rli.0000000000000032 ◽

2014 ◽

Vol 49 (6) ◽

pp. 431-437 ◽

Cited By ~ 16

Author(s):

Sebastian Winklhofer ◽

Paul Stolzmann ◽

Andreas Meier ◽

Wolf Schweitzer ◽

Fabian Morsbach ◽

...

Keyword(s):

Computed Tomography ◽

Dual Energy ◽

Added Value ◽

Ferromagnetic Properties ◽

Dual Energy Computed Tomography ◽

Ballistic Projectiles

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Diagnostic Accuracy of Cone-beam Computed Tomography and Conventional Radiography on Apical Periodontitis: A Systematic Review and Meta-analysis

Journal of Endodontics ◽

10.1016/j.joen.2015.12.015 ◽

2016 ◽

Vol 42 (3) ◽

pp. 356-364 ◽

Cited By ~ 45

Author(s):

Kamile Leonardi Dutra ◽

Letícia Haas ◽

André Luís Porporatti ◽

Carlos Flores-Mir ◽

Juliana Nascimento Santos ◽

...

Keyword(s):

Computed Tomography ◽

Systematic Review ◽

Diagnostic Accuracy ◽

Cone Beam Computed Tomography ◽

Meta Analysis ◽

Conventional Radiography ◽

Apical Periodontitis ◽

Cone Beam

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Disk injury in patients with vertebral fractures—a prospective diagnostic accuracy study using dual-energy computed tomography

European Radiology ◽

10.1007/s00330-018-5963-4 ◽

2019 ◽

Vol 29 (8) ◽

pp. 4495-4502 ◽

Cited By ~ 5

Author(s):

Matthias Pumberger ◽

Michael Fuchs ◽

Nils Engelhard ◽

Kay Geert Hermann ◽

Michael Putzier ◽

...

Keyword(s):

Computed Tomography ◽

Diagnostic Accuracy ◽

Vertebral Fractures ◽

Dual Energy ◽

Diagnostic Accuracy Study ◽

Dual Energy Computed Tomography ◽

Accuracy Study

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Acute vertebral fracture after spinal fusion: a case report illustrating the added value of single-source dual-energy computed tomography to magnetic resonance imaging in a patient with spinal Instrumentation

Skeletal Radiology ◽

10.1007/s00256-016-2419-2 ◽

2016 ◽

Vol 45 (9) ◽

pp. 1303-1306 ◽

Cited By ~ 3

Author(s):

M. Fuchs ◽

M. Putzier ◽

M. Pumberger ◽

K. G. Hermann ◽

T. Diekhoff

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Case Report ◽

Vertebral Fracture ◽

Magnetic Resonance ◽

Spinal Instrumentation ◽

Dual Energy ◽

Added Value ◽

Single Source ◽

Resonance Imaging

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Visualizing patterns of intervertebral disc damage with dual-energy computed tomography: assessment of diagnostic accuracy in an ex vivo spine biophantom

Acta Radiologica ◽

10.1177/02841851211025863 ◽

2021 ◽

pp. 028418512110258

Author(s):

Julian Pohlan ◽

Carsten Stelbrink ◽

Niklas Tuttle ◽

Felix Kubicka ◽

Ho Jung Kwon ◽

...

Keyword(s):

Computed Tomography ◽

Intervertebral Disc ◽

Diagnostic Accuracy ◽

Ex Vivo ◽

Dual Energy ◽

Detection Accuracy ◽

Single Source ◽

Ct Scanner ◽

Dual Energy Computed Tomography ◽

Diagnostic Potential

Background Previously, dual-energy computed tomography (DECT) has been established for imaging spinal fractures as an alternative modality to magnetic resonance imaging (MRI). Purpose To analyze the diagnostic accuracy of DECT in visualizing intervertebral disc (IVD) damage. Material and Methods The lumbar spine of a Great Dane dog was used as an ex vivo biophantom. DECT was performed as sequential volume technique on a single-source CT scanner. IVDs were imaged before and after an injection of sodium chloride solution and after anterior discectomy in single-source sequential volume DECT technique using 80 and 135 kVp. Chondroitin/Collagen maps (cMaps) were reconstructed at 1 mm and compared with standard CT. Standardized regions of interest (ROI) were placed in the anterior anulus fibrosus, nucleus pulposus, and other sites. Three blinded readers classified all images as intact disc, nucleus lesion, or anulus lesion. Additionally, clinical examples from patients with IVD lesions were retrospectively identified from the radiological database. Results Interrater reliability was almost perfect with a Fleiss kappa of 0.833 (95% confidence interval [CI] 0.83–0.835) for DECT, compared with 0.780 (95% CI 0.778–0.782) for standard CT. For overall detection accuracy of IVD, DECT achieved 91.0% sensitivity (95% CI 83.6–95.8) and 92.0% specificity (95% CI 80.8–97.8). Standard CT showed 91.0% sensitivity (95% CI 83.6–95.8) and 78.0% specificity (95% CI 64.0–88.5). Conclusion DECT reliably identified IVD damage in an ex vivo biophantom. Clinical examples of patients with different lesions illustrate the accurate depiction of IVD microstructure. These data emphasize the diagnostic potential of DECT cMaps.

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