1
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Tuzzato G, Spinnato P, Vara G, Ostetto F, Bianchi G. Spectrum of imaging findings of primary bone lymphoma in pediatric patients. Pediatr Radiol 2024; 54:1809-1817. [PMID: 39134863 DOI: 10.1007/s00247-024-06012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 10/15/2024]
Abstract
Primary bone lymphoma, a rare oncologic entity, may initially present with minimal symptoms. Presenting symptoms range from local pain and mild systemic symptoms to large palpable masses and pathologic fractures. The term "primary bone lymphoma" indicates the finding of bone involvement without other organ sites for at least 6 months. Although some radiological features may raise suspicion about this tumor form, there are no pathognomonic imaging findings, and the diagnosis will likely be delayed for a long time. The most critical radiological feature is soft tissue involvement associated with a preserved cortical layer, much more than expected for an infiltrating lesion. Anyway, very different radiological findings may be displayed in patients with primary bone lymphoma. Although these radiological features of primary bone lymphoma have been discussed in the literature by various authors, there is little data concerning imaging in pediatric patients. This paper aims to depict the possible spectrum of imaging features of primary bone lymphoma in the pediatric age, providing an exemplification pictorial essay extracted from a single institution experience in the year range period 2006-2022.
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Affiliation(s)
- Gianmarco Tuzzato
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli 1, 40136, Bologna, Italy.
| | - Giulio Vara
- Diagnostic and Interventional Radiology, Ospedale Civile "Umberto I", Lugo, Italy
- Cellular Signalling Laboratory, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Federico Ostetto
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Bianchi
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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2
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Eibschutz LS, Matcuk G, Chiu MKJ, Lu MY, Gholamrezanezhad A. Updates on the Applications of Spectral Computed Tomography for Musculoskeletal Imaging. Diagnostics (Basel) 2024; 14:732. [PMID: 38611645 PMCID: PMC11011285 DOI: 10.3390/diagnostics14070732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Spectral CT represents a novel imaging approach that can noninvasively visualize, quantify, and characterize many musculoskeletal pathologies. This modality has revolutionized the field of radiology by capturing CT attenuation data across multiple energy levels and offering superior tissue characterization while potentially minimizing radiation exposure compared to traditional enhanced CT scans. Despite MRI being the preferred imaging method for many musculoskeletal conditions, it is not viable for some patients. Moreover, this technique is time-consuming, costly, and has limited availability in many healthcare settings. Thus, spectral CT has a considerable role in improving the diagnosis, characterization, and treatment of gout, inflammatory arthropathies, degenerative disc disease, osteoporosis, occult fractures, malignancies, ligamentous injuries, and other bone-marrow pathologies. This comprehensive review will delve into the diverse capabilities of dual-energy CT, a subset of spectral CT, in addressing these musculoskeletal conditions and explore potential future avenues for its integration into clinical practice.
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Affiliation(s)
- Liesl S. Eibschutz
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA (M.K.-J.C.); (M.Y.L.)
| | - George Matcuk
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Michael Kuo-Jiun Chiu
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA (M.K.-J.C.); (M.Y.L.)
| | - Max Yang Lu
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA (M.K.-J.C.); (M.Y.L.)
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA (M.K.-J.C.); (M.Y.L.)
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3
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Guerrini S, Bagnacci G, Perrella A, Meglio ND, Sica C, Mazzei MA. Dual Energy CT in Oncology: Benefits for Both Patients and Radiologists From an Emerging Quantitative and Functional Diagnostic Technique. Semin Ultrasound CT MR 2023; 44:205-213. [PMID: 37245885 DOI: 10.1053/j.sult.2023.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Dual-energy CT (DECT) imaging makes it possible to identify the characteristics of materials that cannot be recognized with conventional single-energy CT (SECT). In the postprocessing study phase, virtual monochromatic images and virtual-non-contrast (VNC) images, also permits reduction of dose exposure by eliminating the precontrast acquisition scan. Moreover, in virtual monochromatic images, the iodine contrast increases when the energy level decreases resulting in better visualization of hypervascular lesions and in a better tissue contrast between hypovascular lesions and the surrounding parenchyma; thus, allowing for reduction of required iodinate contrast material, especially important in patients with renal impairment. All these advantages are particularly important in oncology, providing the possibility of overcoming many SECT imaging limits and making CT examinations safer and more feasible in critical patients. This review explores the basis of DECT imaging and its utility in routine oncologic clinical practice, with particular attention to the benefits of this technique for both the patients and the radiologists.
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Affiliation(s)
- Susanna Guerrini
- Unit of Diagnostic Imaging, Department of Medical Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
| | - Giulio Bagnacci
- Diagnostic Imaging Unit, Department of Diagnostic Imaging, Azienda USL-Toscana Sud-Est, Poggibonsi, Valdelsa, Italy
| | - Armando Perrella
- Diagnostic Imaging Unit, Department of Diagnostic Imaging, Azienda USL-Toscana Sud-Est, Grosseto, Italy
| | - Nunzia Di Meglio
- Unit of Diagnostic Imaging, Department of Medical Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Cristian Sica
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Medical Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Medical Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
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4
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Utility of dual energy computed tomography in the evaluation of infiltrative skeletal lesions and metastasis: a literature review. Skeletal Radiol 2022; 51:1731-1741. [PMID: 35294599 DOI: 10.1007/s00256-022-04032-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 02/02/2023]
Abstract
Computed tomography (CT) is routinely used to diagnose and evaluate metastatic lesions in oncology. CT alone suffers from lack of sensitivity, especially for skeletal lesions in the bone marrow and lesions that have similar attenuation profiles to surrounding bone. Magnetic resonance imaging and nuclear medicine imaging remain the gold standard in evaluating skeletal lesions. However, compared to CT, these modalities are not as widely available or suitable for all patients. Dual energy computed tomography (DECT) exploits variations in linear attenuation coefficient of materials at different photon energy levels to reconstruct images based on material composition. DECT in musculoskeletal imaging is used in the imaging of crystal arthropathy and detecting subtle fractures, but it is not broadly utilized in evaluating infiltrative skeletal lesions. Malignant skeletal lesions have different tissue and molecular compositions compared to normal bone. DECT may exploit these physical differences to delineate infiltrative skeletal lesions from surrounding bone better than conventional monoenergetic CT. Studies so far have examined the utility of DECT in evaluating skeletal metastases, multiple myeloma lesions, pathologic fractures, and performing image-guided biopsies with promising results. These studies were mostly retrospective analyses and case reports containing small samples sizes. As DECT becomes more widely used clinically and more scientific studies evaluating the performance of DECT are published, DECT may eventually become an important modality in the work-up of infiltrative skeletal lesions. It may even challenge MRI and nuclear medicine because of relatively faster scanning times and ease of access.
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Cheraya G, Sharma S, Chhabra A. Dual energy CT in musculoskeletal applications beyond crystal imaging: bone marrow maps and metal artifact reduction. Skeletal Radiol 2022; 51:1521-1534. [PMID: 35112139 DOI: 10.1007/s00256-021-03979-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 02/02/2023]
Abstract
Dual energy CT (DECT) is becoming increasingly popular and valuable in the domain of musculoskeletal imaging. Gout maps and crystal detection have been predominant indications for about a decade. Other important indications of bone marrow maps and metal artifact reduction are also frequent with added advantages of detection and characterization of bone marrow lesions similar to MR imaging and diagnosis of hardware related complications, respectively. This article discusses technical considerations and physics of DECT imaging and its role in musculoskeletal indications apart from crystal imaging with respective case examples and review of the related literature. DECT pitfalls in these domains are also highlighted and the reader can gain knowledge of above concepts for prudent use of DECT in their musculoskeletal and general practices.
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Affiliation(s)
| | - Salil Sharma
- Mary Imogene Bassett Hospital, Cooperstown, NY, USA
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Hagen F, Fritz J, Mair A, Horger M, Bongers MN. Dual-Energy Computed Tomography-Based Quantitative Bone Marrow Imaging in Non-Hematooncological Subjects: Associations with Age, Gender and Other Variables. J Clin Med 2022; 11:jcm11144094. [PMID: 35887858 PMCID: PMC9317680 DOI: 10.3390/jcm11144094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Our aim is to assess the utility and associations of quantitative bone marrow attenuation (BMA) values measured on clinical dual-energy computed tomography (DECT) exams in non-hematooncologic subjects with skeletal regions, patient age, gender, and other clinical variables. Methods: Our local ethics committee approved this retrospective image data analysis. Between July 2019 and July 2021, 332 eligible patients (mean age, 64 ± 18 years; female, 135) were identified. Inclusion criteria were the availability of a standardized abdominopelvic DECT data set acquired on the same scanner with identical protocol. Eleven regions-of-interest were placed in the T11-L5 vertebral bodies, dorsal iliac crests, and femur necks. Patient age, gender, weight, clinical, habitual variables, inflammation markers, and anemia were documented in all cases. Results: Multi-regression analyses (all, p < 0.05) identified age as the strongest predictor of lumbar BMA (standardized coefficient: β = −0.74), followed by CRP (β = 0.11), LDH (β = 0.11), and gender (β = −0.10). In the lower thoracic spine, age was the strongest predictor (β = −0.58) of BMA, followed by gender (β = −0.09) and LDH (β = 0.12). In femoral bones, age was negatively predictive of BMA (β = −0.12), whereas LDH and anemia were positively predictive (β = 0.16 both). Heart insufficiency significantly decreased (β = 0.12, p = 0.034) a BMA value gradient from higher to lower HU values along the vertebrae T11 and L5, whereas age significantly increased this gradient (β = −0.2, p ≤ 0.001). Conclusions: DECT-based BMA measurements can be obtained from clinical CT exams. BMA values are negatively associated with patient age and influenced by gender, anemia, and inflammatory markers.
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Affiliation(s)
- Florian Hagen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany; (A.M.); (M.H.); (M.N.B.)
- Correspondence: ; Tel.: +49-7071-2968622
| | - Jan Fritz
- Grossman School of Medicine, NYU Langone Health, 550 First Avenue, New York, NY 10016, USA;
| | - Antonia Mair
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany; (A.M.); (M.H.); (M.N.B.)
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany; (A.M.); (M.H.); (M.N.B.)
| | - Malte N. Bongers
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany; (A.M.); (M.H.); (M.N.B.)
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Kuah T, Vellayappan BA, Makmur A, Nair S, Song J, Tan JH, Kumar N, Quek ST, Hallinan JTPD. State-of-the-Art Imaging Techniques in Metastatic Spinal Cord Compression. Cancers (Basel) 2022; 14:3289. [PMID: 35805059 PMCID: PMC9265325 DOI: 10.3390/cancers14133289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 12/23/2022] Open
Abstract
Metastatic Spinal Cord Compression (MSCC) is a debilitating complication in oncology patients. This narrative review discusses the strengths and limitations of various imaging modalities in diagnosing MSCC, the role of imaging in stereotactic body radiotherapy (SBRT) for MSCC treatment, and recent advances in deep learning (DL) tools for MSCC diagnosis. PubMed and Google Scholar databases were searched using targeted keywords. Studies were reviewed in consensus among the co-authors for their suitability before inclusion. MRI is the gold standard of imaging to diagnose MSCC with reported sensitivity and specificity of 93% and 97% respectively. CT Myelogram appears to have comparable sensitivity and specificity to contrast-enhanced MRI. Conventional CT has a lower diagnostic accuracy than MRI in MSCC diagnosis, but is helpful in emergent situations with limited access to MRI. Metal artifact reduction techniques for MRI and CT are continually being researched for patients with spinal implants. Imaging is crucial for SBRT treatment planning and three-dimensional positional verification of the treatment isocentre prior to SBRT delivery. Structural and functional MRI may be helpful in post-treatment surveillance. DL tools may improve detection of vertebral metastasis and reduce time to MSCC diagnosis. This enables earlier institution of definitive therapy for better outcomes.
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Affiliation(s)
- Tricia Kuah
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore 119074, Singapore;
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Shalini Nair
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
| | - Junda Song
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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Zandee EY, Wu J, Deshmukh S. Troubleshooting Challenging Musculoskeletal Tumor Biopsies: Tricks of the Trade. Semin Roentgenol 2022; 57:275-290. [DOI: 10.1053/j.ro.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/11/2022]
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Fervers P, Fervers F, Kottlors J, Lohneis P, Pollman-Schweckhorst P, Zaytoun H, Rinneburger M, Maintz D, Große Hokamp N. Feasibility of artificial intelligence–supported assessment of bone marrow infiltration using dual-energy computed tomography in patients with evidence of monoclonal protein — a retrospective observational study. Eur Radiol 2021; 32:2901-2911. [PMID: 34921619 PMCID: PMC9038860 DOI: 10.1007/s00330-021-08419-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/30/2021] [Accepted: 10/17/2021] [Indexed: 12/20/2022]
Abstract
Abstract
Objectives
To demonstrate the feasibility of an automated, non-invasive approach to estimate bone marrow (BM) infiltration of multiple myeloma (MM) by dual-energy computed tomography (DECT) after virtual non-calcium (VNCa) post-processing.
Methods
Individuals with MM and monoclonal gammopathy of unknown significance (MGUS) with concurrent DECT and BM biopsy between May 2018 and July 2020 were included in this retrospective observational study. Two pathologists and three radiologists reported BM infiltration and presence of osteolytic bone lesions, respectively. Bone mineral density (BMD) was quantified CT-based by a CE-certified software. Automated spine segmentation was implemented by a pre-trained convolutional neural network. The non-fatty portion of BM was defined as voxels > 0 HU in VNCa. For statistical assessment, multivariate regression and receiver operating characteristic (ROC) were conducted.
Results
Thirty-five patients (mean age 65 ± 12 years; 18 female) were evaluated. The non-fatty portion of BM significantly predicted BM infiltration after adjusting for the covariable BMD (p = 0.007, r = 0.46). A non-fatty portion of BM > 0.93% could anticipate osteolytic lesions and the clinical diagnosis of MM with an area under the ROC curve of 0.70 [0.49–0.90] and 0.71 [0.54–0.89], respectively. Our approach identified MM-patients without osteolytic lesions on conventional CT with a sensitivity and specificity of 0.63 and 0.71, respectively.
Conclusions
Automated, AI-supported attenuation assessment of the spine in DECT VNCa is feasible to predict BM infiltration in MM. Further, the proposed method might allow for pre-selecting patients with higher pre-test probability of osteolytic bone lesions and support the clinical diagnosis of MM without pathognomonic lesions on conventional CT.
Key Points
• The retrospective study provides an automated approach for quantification of the non-fatty portion of bone marrow, based on AI-supported spine segmentation and virtual non-calcium dual-energy CT data.
• An increasing non-fatty portion of bone marrow is associated with a higher infiltration determined by invasive biopsy after adjusting for bone mineral density as a control variable (p = 0.007, r = 0.46).
• The non-fatty portion of bone marrow might support the clinical diagnosis of multiple myeloma when conventional CT images are negative (sensitivity 0.63, specificity 0.71).
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Okamoto S, Ishii H, Hiraki T. Bone Subtraction Iodine Imaging for CT-Guided Bone Biopsy. Cardiovasc Intervent Radiol 2021; 45:255-258. [PMID: 34708267 DOI: 10.1007/s00270-021-02995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Soichiro Okamoto
- Department of Radiology, Okayama Red Cross Hospital, 2-1-1 Aoe, Kita-ku, Okayama, 700-8607, Japan.
| | - Hiroaki Ishii
- Department of Radiology, Okayama Red Cross Hospital, 2-1-1 Aoe, Kita-ku, Okayama, 700-8607, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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D'Angelo T, Albrecht MH, Caudo D, Mazziotti S, Vogl TJ, Wichmann JL, Martin S, Yel I, Ascenti G, Koch V, Cicero G, Blandino A, Booz C. Virtual non-calcium dual-energy CT: clinical applications. Eur Radiol Exp 2021; 5:38. [PMID: 34476640 PMCID: PMC8413416 DOI: 10.1186/s41747-021-00228-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/11/2021] [Indexed: 12/15/2022] Open
Abstract
Dual-energy CT (DECT) has emerged into clinical routine as an imaging technique with unique postprocessing utilities that improve the evaluation of different body areas. The virtual non-calcium (VNCa) reconstruction algorithm has shown beneficial effects on the depiction of bone marrow pathologies such as bone marrow edema. Its main advantage is the ability to substantially increase the image contrast of structures that are usually covered with calcium mineral, such as calcified vessels or bone marrow, and to depict a large number of traumatic, inflammatory, infiltrative, and degenerative disorders affecting either the spine or the appendicular skeleton. Therefore, VNCa imaging represents another step forward for DECT to image conditions and disorders that usually require the use of more expensive and time-consuming techniques such as magnetic resonance imaging, positron emission tomography/CT, or bone scintigraphy. The aim of this review article is to explain the technical background of VNCa imaging, showcase its applicability in the different body regions, and provide an updated outlook on the clinical impact of this technique, which goes beyond the sole improvement in image quality.
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Affiliation(s)
- Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Moritz H Albrecht
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Danilo Caudo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Julian L Wichmann
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Simon Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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12
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Musa Aguiar P, Zarantonello P, Aparisi Gómez MP. Differentiation Between Osteoporotic And Neoplastic Vertebral Fractures: State Of The Art And Future Perspectives. Curr Med Imaging 2021; 18:187-207. [PMID: 33845727 DOI: 10.2174/1573405617666210412142758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/22/2022]
Abstract
Vertebral fractures are a common condition, occurring in the context of osteoporosis and malignancy. These entities affect a group of patients in the same age range; clinical features may be indistinct and symptoms non-existing, and thus present challenges to diagnosis. In this article, we review the use and accuracy of different imaging modalities available to characterize vertebral fracture etiology, from well-established classical techniques, to the role of new and advanced imaging techniques, and the prospective use of artificial intelligence. We also address the role of imaging on treatment. In the context of osteoporosis, the importance of opportunistic diagnosis is highlighted. In the near future, the use of automated computer-aided diagnostic algorithms applied to different imaging techniques may be really useful to aid on diagnosis.
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Affiliation(s)
- Paula Musa Aguiar
- Serdil, Clinica de Radiologia e Diagnóstico por Imagem; R. São Luís, 96 - Santana, Porto Alegre - RS, 90620-170. Brazil
| | - Paola Zarantonello
- Department of paediatric orthopedics and traumatology, IRCCS Istituto Ortopedico Rizzoli; Via G. C. Pupilli 1, 40136 Bologna. Italy
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13
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Review article: the current status of CT-guided needle biopsy of the spine. Skeletal Radiol 2021; 50:281-299. [PMID: 32815040 DOI: 10.1007/s00256-020-03584-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
CT-guided percutaneous needle biopsy of the spine is a well-described technique for determining the nature of indeterminate vertebral lesions or establishing a diagnosis of spinal infection, the high diagnostic accuracy and the safety of the procedure having been extensively documented. The purpose of the current article is to review the literature to date on CT-guided spinal biopsy. Specifically, indications for spinal biopsy, techniques for optimising yield, detail of the approaches for various spinal levels which is dependent upon both the region within the spinal column and lesion location within the vertebra (body vs. neural arch), determinants of biopsy outcome and complications are covered. It is hoped that the review will be of particular benefit to junior radiologists who are required to perform this procedure.
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Abstract
Metastatic bone disease (MBD) is common—it is detected in up to 65–75% of patients with breast or prostate cancer, in over 35% of patients with lung cancer; and almost all patients with symptomatic multiple myeloma have focal lesions or a diffuse bone marrow infiltration. Metastatic bone disease can cause a variety of symptoms and is often associated with a poorer prognosis, with high social and health-care costs. Population-based cohort studies confirm significantly increased health-care utilization costs in patients presenting with cancer with MBD compared with those without MBD. The prolonged survival of patients with bone metastasis thanks to advances in therapy presents an opportunity for better treatments for this patient cohort. Early and accurate diagnosis of bone metastases is therefore crucial. The patterns and presentation of MBD are quite heterogeneous and necessitate good knowledge of the possibilities and limitations of each imaging modality. Here, we review the state-of-the-art imaging techniques, assess the need for evidence-based and cost-effective patient care pathways, and advocate multidisciplinary management based on collaborations between orthopedic surgeons, pathologists, oncologists, radiotherapists, and radiologists aimed at improving patient outcomes. Radiologists play a key role in this multidisciplinary approach to decision-making through correlating the tumor entity, the tumor biology, the impact on the surrounding tissues and progression, as well as the overall condition of the patient. This approach helps to choose the best patient-tailored imaging plan advocating a “choose wisely” strategy throughout the initial diagnosis, minimally invasive treatment procedures, as well as follow-up care plans.
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15
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Virtual calcium-suppression in dual energy computed tomography predicts metabolic activity of focal MM lesions as determined by fluorodeoxyglucose positron-emission-tomography. Eur J Radiol 2020; 135:109502. [PMID: 33388530 DOI: 10.1016/j.ejrad.2020.109502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/07/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Recent studies showed that dual energy CT (DECT) allows for detection of bone marrow infiltration in multiple myeloma (MM) by obtaining virtual non-calcium (VNCa) images. This feasibility study investigated, if VNCa imaging might discriminate metabolically active, focal lesions in MM against avital lesions in MM patients, considering fluorodeoxyglucose positron-emission-tomography CT (FDG PET/CT) as the standard of reference. METHOD The study included 60 osteolytic lesions in 10 consecutive low-dose whole body CT scans of patients with MM, who underwent both FDG PET/CT and DECT at a tertiary care university hospital. Circular ROI measurements were performed in predefined lesions on the monoenergetic CT (MECT) and VNCa images by three blinded radiologists. Each lesion was rated vital or avital by a blinded specialist of nuclear medicine, based on their FDG metabolism. RESULTS Each of the three readers could separate FDG PET/CT negative and positive MM lesions when analyzing the VNCa images, while MECT did not show a significant difference. Best results were yielded by high calcium suppression with excellent inter-rater reliability (average sensitivity 0.91, specificity 0.88, cutoff -46.9 HU), followed by medium and low calcium suppression. CONCLUSIONS In contrast to MECT imaging, VNCa imaging in DECT appears to be feasible to assess metabolic activity of focal MM lesions as defined by the standard of reference, FDG PET/CT. Considering the higher cost and radiation exposure of FDG PET/CT, DECT VNCa imaging might develop to be the modality of choice to assess metabolic activity of focal MM lesions.
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Dalili D, Isaac A, Bazzocchi A, Åström G, Bergh J, Lalam R, Weber MA, Fritz J, Mansour R. Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation. Semin Musculoskelet Radiol 2020; 24:692-709. [PMID: 33307585 DOI: 10.1055/s-0040-1719103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Musculoskeletal (MSK) image-guided oncologic intervention is an established field within radiology. Numerous studies have described its clinical benefits, safety, cost effectiveness, patient satisfaction, and improved quality of life, thereby establishing image-guided oncologic intervention as a preferred pathway in treating patients presenting with specific benign MSK tumors. But there is a paradigm shift on the horizon because these techniques may also support established pillars (surgery, systemic treatment, radiotherapy) in the treatment of malignant MSK tumors. Unlike benign tumors, where they are used as primary therapy lines with curative intent, such interventions can be selected for malignant tumors as adjuvant treatment in painful or unstable bone or soft tissue lesions or as more palliative therapy strategies. Using examples from our clinical practices, we elaborate on the benefits of applying a multidisciplinary approach (traditionally involving MSK radiologists, oncologists, orthopaedic surgeons, microbiologists, pathologists, physiotherapists, and pain management experts), ideally within a sarcoma treatment center to deliver a patient-specific therapy plan and illustrate methods to assess the benefits of this model of care.In this article, we review the current repertoire of ablation techniques, demonstrate why such procedures offer value-based alternatives to conventional treatments of specific tumors, and reflect on future directions. Additionally, we review the advantages and limitations of each technique and offer guidance to improve outcomes.
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Affiliation(s)
- Danoob Dalili
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Jonas Bergh
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital Stockholm, Sweden
| | - Radhesh Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York
| | - Ramy Mansour
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Isaac A, Lecouvet F, Dalili D, Fayad L, Pasoglou V, Papakonstantinou O, Ahlawat S, Messiou C, Weber MA, Padhani AR. Detection and Characterization of Musculoskeletal Cancer Using Whole-Body Magnetic Resonance Imaging. Semin Musculoskelet Radiol 2020; 24:726-750. [PMID: 33307587 DOI: 10.1055/s-0040-1719018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Whole-body magnetic resonance imaging (WB-MRI) is gradually being integrated into clinical pathways for the detection, characterization, and staging of malignant tumors including those arising in the musculoskeletal (MSK) system. Although further developments and research are needed, it is now recognized that WB-MRI enables reliable, sensitive, and specific detection and quantification of disease burden, with clinical applications for a variety of disease types and a particular application for skeletal involvement. Advances in imaging techniques now allow the reliable incorporation of WB-MRI into clinical pathways, and guidelines recommending its use are emerging. This review assesses the benefits, clinical applications, limitations, and future capabilities of WB-MRI in the context of other next-generation imaging modalities, as a qualitative and quantitative tool for the detection and characterization of skeletal and soft tissue MSK malignancies.
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Affiliation(s)
- Amanda Isaac
- School of Biomedical Engineering & Imaging Sciences, Kings College London, United Kingdom.,Guy's & St Thomas' Hospitals, London, United Kingdom
| | - Frederic Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Danoob Dalili
- School of Biomedical Engineering & Imaging Sciences, Kings College London, United Kingdom.,Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Laura Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science, John's Hopkins School of Medicine, Baltimore, Maryland
| | - Vasiliki Pasoglou
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Olympia Papakonstantinou
- 2nd Department of Radiology, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology and Radiological Science, John's Hopkins School of Medicine, Baltimore, Maryland
| | - Christina Messiou
- The Royal Marsden Hospital, London, United Kingdom.,The Institute of Cancer Research, London, United Kingdom
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Anwar R Padhani
- The Institute of Cancer Research, London, United Kingdom.,Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom
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Rajiah P, Parakh A, Kay F, Baruah D, Kambadakone AR, Leng S. Update on Multienergy CT: Physics, Principles, and Applications. Radiographics 2020; 40:1284-1308. [DOI: 10.1148/rg.2020200038] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Prabhakar Rajiah
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (P.R., S.L.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P., A.R.K.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (F.K.); and Department of Radiology, Medical University of South Carolina, Charleston, SC (D.B.)
| | - Anushri Parakh
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (P.R., S.L.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P., A.R.K.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (F.K.); and Department of Radiology, Medical University of South Carolina, Charleston, SC (D.B.)
| | - Fernando Kay
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (P.R., S.L.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P., A.R.K.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (F.K.); and Department of Radiology, Medical University of South Carolina, Charleston, SC (D.B.)
| | - Dhiraj Baruah
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (P.R., S.L.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P., A.R.K.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (F.K.); and Department of Radiology, Medical University of South Carolina, Charleston, SC (D.B.)
| | - Avinash R. Kambadakone
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (P.R., S.L.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P., A.R.K.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (F.K.); and Department of Radiology, Medical University of South Carolina, Charleston, SC (D.B.)
| | - Shuai Leng
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (P.R., S.L.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P., A.R.K.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (F.K.); and Department of Radiology, Medical University of South Carolina, Charleston, SC (D.B.)
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Abstract
OBJECTIVE. The purpose of this article is to provide a step-by-step guide for bone imaging-guided percutaneous core needle biopsy, including the armamentarium available and the most recent advances. CONCLUSION. Bone imaging-guided percutaneous core needle biopsies are well-established, minimally invasive, cost-effective interventions for histologic characterization of bone lesions with an excellent safety profile and diagnostic outcomes; they play a crucial role in management of patients. Radiologists involved in the care of patients with bone lesions must be familiar with the various steps involved in such procedures and their role in patient management.
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20
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Björkman AS, Koskinen SK, Lindblom M, Persson A. Diagnostic accuracy of dual-energy CT for detection of bone marrow lesions in the subacutely injured knee with MRI as reference method. Acta Radiol 2020; 61:749-759. [PMID: 31581782 DOI: 10.1177/0284185119877343] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dual-energy computer tomography (DECT) can detect post-traumatic bone marrow lesions. Prospective studies of the knee with large numbers of participants and intra-observer agreement assessment are limited. PURPOSE To investigate the diagnostic accuracy of DECT in detecting bone marrow lesions as well as estimating the bone marrow lesion volume in patients with suspected anterior cruciate ligament trauma with magnetic resonance imaging (MRI) as reference standard. MATERIAL AND METHODS Forty-eight consecutive patients with suspected anterior cruciate ligament injury were imaged bilaterally with DECT within a mean of 25 days (range 4-55 days) following injury and MRI within seven days of DECT. Two readers analyzed DECT virtual non-calcium-blinded images. Consensus MRI was reference standard. Intra- and inter-observer agreement were determined using weighted kappa statistics. Sensitivity, specificity, and negative and positive predictive values were calculated. Bone marrow lesion volumes were measured; for comparison, intra-class correlation coefficient was used. RESULTS The 48 patients (26 men, 22 women; mean age 23 years, age range 15-37 years) were imaged bilaterally yielding 52 knees with bone marrow lesions, of which 44 were in the femur and 41 were in the tibia. Intra- and inter-observer agreement to detect bone marrow lesions was moderate and fair to moderate (κ 0.54-0.66, 95% confidence interval [CI] 0.39-0.80 and 0.37-0.41, 95% CI 0.20-0.57) and overall sensitivity and specificity were 70.1% and 69.1%, respectively. Positive and negative predictive values were 72.9% and 66.1%, respectively. Bone marrow lesion volumes showed excellent intra- and inter-observer agreement (0.83-0.91, 95% CI 0.74-0.94 and 0.76-0.78, 95% CI 0.57-0.87). CONCLUSION The diagnostic performance of DECT to detect bone marrow lesions in the subacutely injured knee was moderate with intra- and inter-observer agreement ranging from moderate to substantial and fair to moderate. Bone marrow lesion volume correlation was excellent.
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Affiliation(s)
- Ann-Sofi Björkman
- Department of Radiology in Linköping, Center for Diagnostics, Region Östergötland, Sweden
| | - Seppo K Koskinen
- Department of Clinical Science, Intervention, and Technology, Division for Radiology, Karolinska Institute, Stockholm, Sweden
| | - Maria Lindblom
- Department of Radiology in Linköping, Center for Diagnostics, Region Östergötland, Sweden
| | - Anders Persson
- Department of Radiology in Linköping, Center for Diagnostics, Region Östergötland, Sweden
- Department of Clinical Science, Intervention, and Technology, Division for Radiology, Karolinska Institute, Stockholm, Sweden
- Division of Radiological Sciences, Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, CMIV, Faculty of Health Sciences, Linköping University, Sweden
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21
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Clinical utility of virtual noncalcium dual-energy CT in imaging of the pelvis and hip. Skeletal Radiol 2019; 48:1833-1842. [PMID: 31147733 DOI: 10.1007/s00256-019-03243-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/22/2019] [Accepted: 05/12/2019] [Indexed: 02/02/2023]
Abstract
Dual-energy virtual noncalcium images are increasingly used to identify marrow edema which accompanies bony pelvic injuries and marrow pathology obscured by cancellous bone. We present a clinical perspective of our experience using virtual noncalcium images in the work up of pelvic osseous pathology.
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22
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Dual-Energy CT in Musculoskeletal Imaging: What Is the Role Beyond Gout? AJR Am J Roentgenol 2019; 213:493-505. [DOI: 10.2214/ajr.19.21095] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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