Dual-energy CT in vertebral compression fractures: performance of visual and quantitative analysis for bone marrow edema demonstration with comparison to MRI.
OBJECTIVE
To prospectively evaluate the performance of virtual non-calcium (VNC) dual-energy CT (DECT) images for the demonstration of trauma-related abnormal marrow attenuation in collapsed and non-collapsed vertebral compression fractures (VCF) with MRI as a reference standard.


METHODS
Twenty patients presenting with non-tumoral VCF were consecutively and prospectively included in this IRB-approved study, and underwent MRI and DECT of the spine. MR examination served as a reference standard. Two independent readers visually evaluated all vertebrae for abnormal marrow attenuation ("CT edema") on VNC DECT images; specificity, sensitivity, predictive values, intra and inter-observer agreements were calculated. A last reader performed a quantitative evaluation of CT numbers; cut-off values were calculated using ROC analysis.


RESULTS
In the visual analysis, VNC DECT images had an overall sensitivity of 84%, specificity of 97%, and accuracy of 95%, intra- and inter-observer agreements ranged from k = 0.74 to k = 0.90. CT numbers were significantly different between vertebrae with edema on MR and those without (p < 0.0001). Cut-off values provided sensitivity of 85% (77%) and specificity of 82% (74%) for "CT edema" on thoracic (lumbar) vertebrae.


CONCLUSIONS
VNC DECT images allowed an accurate demonstration of trauma-related abnormal attenuation in VCF, revealing the acute nature of the fracture, on both visual and quantitative evaluation.
Department of Radiology, University Hospital of Strasbourg, 10 Avenue Molière, 67098, Strasbourg, France, guillaume.bierry@chru-strasbourg.fr.
Guillaume
G
Bierry
Aïna
A
Venkatasamy
Stéphane
S
Kremer
Jean-Claude
JC
Dosch
Jean-Louis
JL
Dietemann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001855:Bone Marrow Diseases / Q000175:diagnosis* / Q000209:etiology; D004487:Edema / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D050815:Fractures, Compression / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods*