1
|
Mahmoudi S, Gruenewald LD, Koch V, Bernatz S, Martin SS, Engelskirchen L, Radic I, Bucolo G, D'Angelo T, Gotta J, Mader C, Dos Santos DP, Scholtz JE, Gruber-Rouh T, Eichler K, Vogl TJ, Booz C, Yel I. Potential of Dual-Energy CT-Based Collagen Maps for the Assessment of Disk Degeneration in the Lumbar Spine. Acad Radiol 2024:S1076-6332(24)00127-2. [PMID: 38519304 DOI: 10.1016/j.acra.2024.02.036] [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: 01/26/2024] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 03/24/2024]
Abstract
RATIONALE AND OBJECTIVES Lumbar disk degeneration is a common condition contributing significantly to back pain. The objective of the study was to evaluate the potential of dual-energy CT (DECT)-derived collagen maps for the assessment of lumbar disk degeneration. PATIENTS AND METHODS We conducted a retrospective analysis of 127 patients who underwent dual-source DECT and MRI of the lumbar spine between 07/2019 and 10/2022. The level of lumbar disk degeneration was categorized by three radiologists as follows: no/mild (Pfirrmann 1&2), moderate (Pfirrmann 3&4), and severe (Pfirrmann 5). Recall (sensitivity) and accuracy of DECT collagen maps were calculated. Intraclass correlation coefficient (ICC) was used to evaluate inter-reader reliability. Subjective evaluations were performed using 5-point Likert scales for diagnostic confidence and image quality. RESULTS We evaluated a total of 762 intervertebral disks from 127 patients (median age, 69.7 (range, 23.0-93.7), female, 56). MRI identified 230 non/mildly degenerated disks (30.2%), 484 moderately degenerated disks (63.5%), and 48 severely degenerated disks (6.3%). DECT collagen maps yielded an overall accuracy of 85.5% (1955/2286). Recall (sensitivity) was 79.3% (547/690) for the detection of no/mild lumbar disk degeneration, 88.7% (1288/1452) for the detection of moderate disk degeneration, and 83.3% (120/144) for the detection of severe disk degeneration (ICC=0.9). Subjective evaluations of DECT collagen maps showed high diagnostic confidence (median 4) and good image quality (median 4). CONCLUSION The use of DECT collagen maps to distinguish different stages of lumbar disk degeneration may have clinical significance in the early diagnosis of disk-related pathologies in patients with contraindications for MRI or in cases of unavailability of MRI.
Collapse
Affiliation(s)
- Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany; Dr. Senckenberg Institute for Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Lara Engelskirchen
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Ivana Radic
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Giuseppe Bucolo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Jennifer Gotta
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Christoph Mader
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Daniel Pinto Dos Santos
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany; Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
2
|
Meer E, Patel M, Chan D, Sheikh AM, Nicolaou S. Dual-Energy Computed Tomography and Beyond: Musculoskeletal System. Radiol Clin North Am 2023; 61:1097-1110. [PMID: 37758359 DOI: 10.1016/j.rcl.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Traditional monoenergetic computed tomography (CT) scans in musculoskeletal imaging provide excellent detail of bones but are limited in the evaluation of soft tissues. Dual-energy CT (DECT) overcomes many of the traditional limitations of CT and offers anatomical details previously seen only on MR imaging. In addition, DECT has benefits in the evaluation and characterization of arthropathies, bone marrow edema, and collagen applications in the evaluation of tendons, ligaments, and vertebral discs. There is current ongoing research in the application of DECT in arthrography and bone mineral density calculation.
Collapse
Affiliation(s)
- Emtenen Meer
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada; King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Mitulkumar Patel
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Chan
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Adnan M Sheikh
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
3
|
Abdellatif W, Nugent JP, Alballa F, Murray N, Jalal S, Ali IT, Nicolaou S. Dual Energy Computed Tomography Collagen Material Decomposition for Detection of Lumbar Spine Disc Extrusion and Sequestration: A Comparative Study With Greyscale Computed Tomography. Can Assoc Radiol J 2023; 74:110-118. [PMID: 35948996 DOI: 10.1177/08465371221118886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose: To assess value of dual energy computed tomography (DECT) collagen material decomposition algorithm when combined with standard computed tomography (CT) in detection of lumbar disc extrusion and sequestration. Materials and Methods: Retrospective analysis of all patients with acute low back pain who had a diagnosis of lumbar spine disc extrusion and/or sequestration on Magnetic Resonance Imaging (MRI) (reference standard), and had undergone non-contrast DECT of the lumbar spine within 60 days of the MRI. Age and sex-matched control patients (n = 42) were included. Patients were grouped into standard, grey-scale CT only group and standard CT + DECT tendon images group. Two double-blinded radiologists reviewed both groups for presence of extrusion or sequestration. They also rated their diagnostic confidence on Likert 5-point scale. McNemar Chi-square test was used to compare diagnostic accuracy, unpaired t-test to compare reviewers diagnostic confidence, and Cohen's k (kappa) test for interobserver agreement. Results: The combined group showed higher overall sensitivity (96.6% vs 87.2%), specificity (99% vs 95.4%), and diagnostic accuracy (98.7% vs 94.5%) with a lower false positive rate (1.1% vs 4.6%). McNemar Chi-square test confirmed statistical significance (P = .03 and P = .02 for Reviewers R1 and R2, respectively). The mean diagnostic confidence was also significantly higher on combined group (R1: 3.74 ± 1.1 vs 3.47 ± 1.15 (P < .01) and R2: 3.91 ± 1.15 vs 3.72 ± 1.16 [mean ± SD] (P = .02)). Conclusion: Utilizing MRI as a reference standard, DECT tendon application combined with standard CT increases the sensitivity, specificity, and accuracy of detection of lumbar spine disc extrusion and sequestration, when compared to standard CT alone.
Collapse
Affiliation(s)
- Waleed Abdellatif
- Department of Radiology, 12334UT Southwestern Medical Center, Dallas, TX, USA
| | - James P Nugent
- Department of Radiology, 8167University of British Columbia/Vancouver General Hospital, Vancouver, BC, Canada
| | - Faisal Alballa
- Department of Radiology, 37852King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nicolas Murray
- Department of Radiology, 8167University of British Columbia/Vancouver General Hospital, Vancouver, BC, Canada
| | - Sabeena Jalal
- Department of Radiology, 8167Vancouver General Hospital, Vancouver, BC, Canada
| | - Ismail T Ali
- Department of Radiology, 8167University of British Columbia/Vancouver General Hospital, Vancouver, BC, Canada
| | - Savvas Nicolaou
- Department of Radiology, 8167Vancouver General Hospital, Vancouver, BC, Canada
| |
Collapse
|
4
|
The Impact of Virtual Monoenergetic Imaging on Visualization of the Cervical Spinal Canal. J Comput Assist Tomogr 2023; 47:160-164. [PMID: 36112014 DOI: 10.1097/rct.0000000000001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES Our purpose is to explore the role of dual-energy computed tomography (DECT) and virtual monoenergetic energy levels in reducing shoulder artifact to improve visualization of the cervical spinal canal. MATERIALS AND METHODS A retrospective review of 171 consecutive DECT scans of the neck (95 male, 65 female; mean age, 60.9 years, ranging from 18 to 88 years; with 11 excluded because of nondiagnostic image quality) during an 8-month period was performed with postprocessing of monoenergetic images at 50, 70, 100, and 140 keV. Subjective comparisons and objective image noise between the monoenergetic images and standard computed tomography (CT) were analyzed by 1-way analysis of variance to determine the optimal DECT energy level with the highest image quality. RESULTS Subjectively, 100-keV DECT best visualizes the spinal canal relative to standard CT, 50 and 70 keV ( P < 0.01), and was superior to 140 keV for reader 1 ( P < 0.01). Objectively, 100 keV demonstrated less noise relative to 50 keV (72.02; P < 0.01). There was no difference in noise between 100 keV and 70 keV, or between 100 keV and standard CT, which also demonstrated lower noise relative to 50-, 70-, and 140-keV levels (91.53, P < 0.01; 29.84, P < 0.01; and 22.66, P < 0.03). CONCLUSION Dual-energy CT at 100 keV may be the preferred DECT monoenergetic level for soft tissue assessment. Increasing energy level is associated with reduction in shoulder artifact, with no difference in noise between 100 keV and standard CT, although 100-keV images may be subjectively better.
Collapse
|
5
|
Abstract
This article provides a focused overview of emerging technology in musculoskeletal MRI and CT. These technological advances have primarily focused on decreasing examination times, obtaining higher quality images, providing more convenient and economical imaging alternatives, and improving patient safety through lower radiation doses. New MRI acceleration methods using deep learning and novel reconstruction algorithms can reduce scanning times while maintaining high image quality. New synthetic techniques are now available that provide multiple tissue contrasts from a limited amount of MRI and CT data. Modern low-field-strength MRI scanners can provide a more convenient and economical imaging alternative in clinical practice, while clinical 7.0-T scanners have the potential to maximize image quality. Three-dimensional MRI curved planar reformation and cinematic rendering can provide improved methods for image representation. Photon-counting detector CT can provide lower radiation doses, higher spatial resolution, greater tissue contrast, and reduced noise in comparison with currently used energy-integrating detector CT scanners. Technological advances have also been made in challenging areas of musculoskeletal imaging, including MR neurography, imaging around metal, and dual-energy CT. While the preliminary results of these emerging technologies have been encouraging, whether they result in higher diagnostic performance requires further investigation.
Collapse
Affiliation(s)
- Richard Kijowski
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 3rd Floor, New York, NY 10016
| | - Jan Fritz
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 3rd Floor, New York, NY 10016
| |
Collapse
|
6
|
Ditges AK, Diekhoff T, Engelhard N, Muellner M, Pumberger M, Schömig F. Neuroforamen stenosis remains a challenge in conventional computed tomography and new dual-energy techniques. Sci Rep 2022; 12:6678. [PMID: 35461368 PMCID: PMC9035174 DOI: 10.1038/s41598-022-10673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/04/2022] [Indexed: 12/01/2022] Open
Abstract
Lumbar foraminal stenosis may be caused by osseous and soft tissue structures. Thus, both computed tomography (CT) and magnetic resonance imaging (MRI) play a role in the diagnostic algorithm. Recently, dual-energy CT (DECT) has been introduced for the detection of spinal disorders. Our study’s aim was to investigate the diagnostic accuracy of collagen-sensitive maps derived from DECT in detecting lumbar foraminal stenosis compared with standard CT and MRI. We retrospectively reviewed CT, DECT, and MRI datasets in patients with vertebral fractures between January 2015 and February 2017. Images were scored for presence and type of lumbar neuroforaminal stenosis. Contingency tables were calculated to determine diagnostic accuracy and interrater agreement was evaluated. 612 neuroforamina in 51 patients were included. Intraclass correlation coefficients for interrater reliability in detecting foraminal stenoses were 0.778 (95%-CI 0.643–0.851) for DECT, 0.769 (95%-CI 0.650–0.839) for CT, and 0.820 (95%-CI 0.673–0.888) for MRI. Both DECT and conventional CT showed good diagnostic accuracy in detecting lumbar foraminal stenosis but low sensitivities in detecting discoid stenosis. Thus, even though previous studies suggest that DECT has high diagnostic accuracy in assessing lumbar disc pathologies, we show that DECT does not provide additional information for detecting discoid stenosis compared with conventional CT.
Collapse
Affiliation(s)
- Ann-Kathrin Ditges
- Department of Radiology, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Nils Engelhard
- Department of Radiology, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| |
Collapse
|
7
|
Future of Low-Dose Computed Tomography and Dual-Energy Computed Tomography in Axial Spondyloarthritis. Curr Rheumatol Rep 2022; 24:198-205. [PMID: 35397047 PMCID: PMC9184454 DOI: 10.1007/s11926-022-01075-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/08/2022]
Abstract
Purpose of Review Recent technical advances in computed tomography (CT) such as low-dose CT and dual-energy techniques open new applications for this imaging modality in clinical practice and for research purposes. This article will discuss the latest innovations and give a perspective on future developments. Recent Findings Low-dose CT has increasingly been used for assessing structural changes at the sacroiliac joints and the spine. It has developed into a method with similar or even lower radiation exposure than radiography while outperforming radiography for lesion detection. Despite being incompatible with low-dose scanning, some studies have shown that dual-energy CT can provide additional information that is otherwise only assessable with magnetic resonance imaging (MRI). However, it is unclear whether this additional information is reliable enough and if it would justify the additional radiation exposure, i.e. whether the performance of dual-energy CT is close enough to MRI to replace it in clinical practice. Summary While the role of dual-energy CT in patients with axial spondyloarthritis remains to be established, low-dose CT has developed to an appropriate modality that should replace radiography in many circumstances and might supplement MRI.
Collapse
|
8
|
Pohlan J, Stelbrink C, Tuttle N, Kubicka F, Kwon HJ, Jahnke P, Goehler F, Kershaw O, Gruber AD, Pumberger M, Diekhoff T. Visualizing patterns of intervertebral disc damage with dual-energy computed tomography: assessment of diagnostic accuracy in an ex vivo spine biophantom. Acta Radiol 2021; 63:1118-1125. [PMID: 34219471 PMCID: PMC9272519 DOI: 10.1177/02841851211025863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Julian Pohlan
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Carsten Stelbrink
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Niklas Tuttle
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Felix Kubicka
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Ho Jung Kwon
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Paul Jahnke
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Friedemann Goehler
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Olivia Kershaw
- Department of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Achim D Gruber
- Department of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Matthias Pumberger
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
9
|
Age-dependent microstructural changes of the intervertebral disc: a validation of proteoglycan-sensitive spectral CT. Eur Radiol 2021; 31:9390-9398. [PMID: 33993329 PMCID: PMC8589800 DOI: 10.1007/s00330-021-08028-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/23/2021] [Accepted: 04/29/2021] [Indexed: 11/27/2022]
Abstract
Objective To analyze the two major components of the intervertebral disc (IVD) in an ex vivo phantom, as well as age-related changes in patients. Methods Collagen and chondroitin sulfate were imaged at different concentrations in agar solution. Age-related changes in disc density were retrospectively analyzed in normal-appearing discs in dual-energy computed tomography (DECT) images from a patient cohort with various spinal pathologies (n = 136). All computed tomography (CT) scans were acquired using single-source DECT at 80 and 135 kVp with automatic exposure calculation. In 136 patients, the attenuation of normal-appearing discs on collagen/chondroitin maps (cMaps) correlated with the patients’ age with Pearson’s r using standardized regions of interest in the anterior anulus fibrosus (AAF) and nucleus pulposus (NP). Results DECT collagen mapping revealed concentration-dependent Hounsfield units (HU) of IVD components. For collagen, we found Pearson’s r = 0.9610 (95% CI 0.6789–0.9959), p = 0.0023 at 120 kVe, and r = 0.8824 (95% CI 0.2495–0.9871), p = 0.0199 in cMap. For chondroitin sulfate, Pearson’s r was 0.9583 (95% CI 0.6603–0.9956), p = 0.0026 at 120 kVp, and r = 0.9646 (95% CI 0.7044–0.9963), p = 0.0019 in cMap. Analysis of normal-appearing IVDs revealed an inverse correlation of density with age in the AAF: Pearson’s r = − 0.2294 at 135 kVp (95% CI − 0.4012 to − 0.04203; p=0.0141) and r = − 0.09341 in cMap (95% CI − 0.2777 to 0.09754; p = 0.0003). In the NP, age and density did not correlate significantly at 135 kVp (p = 0.9228) and in cMap (p = 0.3229). Conclusions DECT-based collagen mapping allows microstructural analysis of the two main intervertebral disc components—collagen and chondroitin sulfate. IVD density declines with age, presumably due to a reduction in collagen and chondroitin sulfate content. Age-related alterations of disc microstructure appear most pronounced in the AAF. Key Points • DECT-based collagen mapping allows precise analysis of the two main intervertebral disc components—collagen and chondroitin sulfate. • Intervertebral disc (IVD) density declines with age, presumably due to a reduction in collagen and chondroitin sulfate content. • Age-related alterations of disc microstructure are most pronounced in the anterior anulus fibrosus (AAF). Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08028-z.
Collapse
|