title: Vertebral Compression Fractures: Third-Generation Dual-Energy CT for Detection of Bone Marrow Edema at Visual and Quantitative Analyses.
abstract: Purpose To assess the diagnostic performance of a third-generation dual-energy computed tomographic (CT) virtual noncalcium (VNCa) technique for detection of traumatic bone marrow edema in patients with vertebral compression fractures. Materials and Methods This prospective study was approved by the institutional review board. Informed consent was obtained from all participants. Twenty-two consecutive patients with 37 morphologic vertebral fractures were studied between October 2015 and May 2016. All patients underwent dual-energy CT (90 kV and 150 kV with a tin filter) and 3-T magnetic resonance (MR) imaging. Two independent readers visually evaluated all vertebral bodies (n = 163) for the presence of abnormal bone marrow attenuation on VNCa images by using color-coded maps and performed a quantitative analysis of CT numbers on VNCa images. MR images served as the reference standard. CT numbers were subjected to receiver operating characteristic analysis to calculate cutoff values. Results In the visual analysis, VNCa images had an overall sensitivity of 64.0%, specificity of 99.3%, accuracy of 93.9%, positive predictive value of 94.1%, and negative predictive value of 93.8%. The interobserver agreement was excellent (κ = 0.85). CT numbers obtained from VNCa images were significantly different in vertebral bodies with and without edema (P < .001). Receiver operating characteristic analysis revealed an area under the curve of 0.922. A cutoff value of -47 provided sensitivity of 92.0%, specificity of 82.6%, accuracy of 84.0%, positive predictive value of 48.9%, and negative predictive value of 98.3% for the differentiation of edematous vertebral bodies. Conclusion Visual and quantitative analyses of dual-energy VNCa images showed excellent diagnostic performance for assessing traumatic bone marrow edema in vertebral compression fractures.©RSNA, 2017 Online supplemental material is available for this article.
authors.affiliation: From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.).
authors.forename: Bernhard
authors.identifier: 0000-0002-9909-1592
authors.initials: B
authors.lastname: Petritsch
authors.affiliation: From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.).
authors.forename: Aleksander
authors.initials: A
authors.lastname: Kosmala
authors.affiliation: From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.).
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Weng
authors.affiliation: From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.).
authors.forename: Bernhard
authors.initials: B
authors.lastname: Krauss
authors.affiliation: From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.).
authors.forename: Anke
authors.initials: A
authors.lastname: Heidemeier
authors.affiliation: From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.).
authors.forename: Richard
authors.initials: R
authors.lastname: Wagner
authors.affiliation: From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.).
authors.forename: Timo M
authors.initials: TM
authors.lastname: Heintel
authors.affiliation: From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.).
authors.forename: Tobias
authors.initials: T
authors.lastname: Gassenmaier
authors.affiliation: From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.).
authors.forename: Thorsten A
authors.initials: TA
authors.lastname: Bley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000473:pathology*; D004487:Edema / Q000473:pathology*; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D016103:Spinal Fractures / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*