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

ObjectivesTo evaluate the diagnostic accuracy of single-source dual-energy computed tomography (DECT) for the detection of bone marrow oedema (BME) in patients with vertebral compression fractures.MethodsPatients over 50 years of age with radiographically suspected vertebral compression fracture of the thoracic or lumbar spine were prospectively enrolled. All patients underwent DECT with sequential acquisition of 80 and 135 kVp datasets on a 320-row detector CT scanner and 1.5-Tesla magnetic resonance imaging (MRI) including T1-weighted and short-tau inversion recovery (STIR) sequences. Virtual non-calcium (VNCa) images were reconstructed using a three-material decomposition algorithm. Vertebrae with height loss in CT were scored for the presence of BME in both MRI and DECT and used to determine signal- and contrast-to-noise ratios (SNR and CNR). Contingency analysis using MRI as standard of reference and Fleiss's kappa were calculated. IRB approval was obtained.ResultsIn total 192 vertebral compression fractures in 70 patients (23 men, 47 women; mean age 70.7 years (SD 9.8)) were included in our analysis. DECT showed a reader-dependent sensitivity of 72% and specificity of 70% for BME. Fleiss's kappa was .40 for DECT and .58 for MRI. T1-weighted images had significantly better SNR and CNR compared to STIR, CT, and VNCa (p < .0001); however, there was no difference between STIR and VNCa.ConclusionsVNCa images depict BME with adequate sensitivity and specificity and can be acquired on a single-source system. Image quality is adequate but trained readers are needed for image interpretation.Key Points center dot Dual-energy CT in a single-source technique can help to detect bone marrow oedema in patients with vertebral compression fractures.center dot However, given the inferior inter-rater reliability and limited specificity compared to MRI, experienced readers are needed for image interpretation.center dot Dual-energy CT of the spine has limited sensitivity for the detection of bone marrow oedema in vertebra with previous surgical intervention.