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Roemer FW, Wirth W, Demehri S, Kijowski R, Jarraya M, Hayashi D, Eckstein F, Guermazi A. Imaging Biomarkers of Osteoarthritis. Semin Musculoskelet Radiol 2024; 28:14-25. [PMID: 38330967 DOI: 10.1055/s-0043-1776432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Currently no disease-modifying osteoarthritis drug has been approved for the treatment of osteoarthritis (OA) that can reverse, hold, or slow the progression of structural damage of OA-affected joints. The reasons for failure are manifold and include the heterogeneity of structural disease of the OA joint at trial inclusion, and the sensitivity of biomarkers used to measure a potential treatment effect.This article discusses the role and potential of different imaging biomarkers in OA research. We review the current role of radiography, as well as advances in quantitative three-dimensional morphological cartilage assessment and semiquantitative whole-organ assessment of OA. Although magnetic resonance imaging has evolved as the leading imaging method in OA research, recent developments in computed tomography are also discussed briefly. Finally, we address the experience from the Foundation for the National Institutes of Health Biomarker Consortium biomarker qualification study and the future role of artificial intelligence.
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Affiliation(s)
- Frank W Roemer
- Department of Radiology, Chobanian & Avedisian Boston University School of Medicine, Boston, Massachusetts
- Department of Radiology, Universitätsklinikum Erlangen & Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Wirth
- Center of Anatomy, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria
- Chondrometrics, GmbH, Freilassing, Germany
| | - Shadpour Demehri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard Kijowski
- Department of Radiology, New York University Grossmann School of Medicine, New York, New York
| | - Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daichi Hayashi
- Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Felix Eckstein
- Center of Anatomy, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria
- Chondrometrics, GmbH, Freilassing, Germany
| | - Ali Guermazi
- Department of Radiology, Chobanian & Avedisian Boston University School of Medicine, Boston, Massachusetts
- Department of Radiology, Boston VA Healthcare System, West Roxbury, Massachusetts
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Li Z, Chen X, Fang H, Li C, Shi L, Fan X, Xu X, Gao F, Sun W, Qing J. Diagnostic accuracy of dual-energy CT for bone marrow edema in patients with acute knee injury: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:826. [PMID: 37919746 PMCID: PMC10621111 DOI: 10.1186/s13018-023-04151-3] [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: 11/23/2021] [Accepted: 11/21/2022] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Knee injuries are prevalent, and early diagnosis is crucial for guiding clinical therapy. MRI is the diagnostic gold standard for bone marrow edema (BME) in patients with acute knee injuries, yet there are still limitations. Dual-energy CT, a possible viable replacement, is being explored (DECT). METHODS We systematically retrieved studies from EMBASE, Scopus, PUBMED, and the Cochrane Library and collected gray literatures. In accordance with the PRISMA-DTA standards, a systematic review was conducted between the study's initiation and July 31, 2021, utilizing an MRI reference standard and at least 10 adult patients with acute knee injuries to evaluate the diagnostic effectiveness of DECT for diagnosing BME. Two reviewers collected the study's details independently. For the meta-analysis, a bivariate mixed-effects regression model was utilized, and subgroup analysis was employed to determine the sources of variability. RESULTS The research included nine studies that examined 290 individuals between the ages of 23 and 53 with acute knee injuries who had DECT and MRI. Overall, the sensitivity, specificity, and AUC of the BME were 85% (95% confidence interval [CI]: 77-90%), 96% (95% CI: 93-97%), and 0.97 (95% CI: 0.95-0.98), respectively. To account for the assumed diversity of research, there were no statistically significant differences between the comparison groups in terms of specificity and sensitivity. CONCLUSION DECT is a viable alternative to MRI for individuals with acute knee injuries when MRI is inappropriate or unavailable.
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Affiliation(s)
- Zhizhuo Li
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Xuelong Chen
- Department of Orthopedics, Peking University China-Japan Friendship School of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Hui Fang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Chengxin Li
- Department of Orthopedics, Peking University China-Japan Friendship School of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Lijun Shi
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Xiaoyu Fan
- Department of Orthopedics, Peking University China-Japan Friendship School of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Xin Xu
- Department of Orthopedics, Peking University China-Japan Friendship School of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Fuqiang Gao
- Beijing Key Laboratory of Immune Inflammatory Disease, China-Japan Friendship Hospital, Peking Union Medical College, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Wei Sun
- Beijing Key Laboratory of Immune Inflammatory Disease, China-Japan Friendship Hospital, Peking Union Medical College, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Jiang Qing
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
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Foti G, Booz C, Buculo GM, Oliboni E, Longo C, Avanzi P, Campacci A, Zorzi C. Dual-Energy CT Arthrography: Advanced Muscolo-Skelatal Applications in Clinical Practice. Tomography 2023; 9:1471-1484. [PMID: 37624110 PMCID: PMC10458814 DOI: 10.3390/tomography9040117] [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] [Received: 07/06/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
This paper provides a comprehensive overview of the potential applications of dual-energy CT (DECT) in improving image quality and the diagnostic capabilities of CT arthrography (CTA) in clinical practice. The paper covers the use of virtual non-contrast (VNC) images, in which the injected contrast medium is subtracted from the articular cavity in order to better analyze 2D and 3D images of the bone. Moreover, virtual monoenergetic imaging (VMI) applications and their potential use for the reduction of metal artifacts and improving image contrast are reviewed. The role of virtual non-calcium (VNCa) in detecting bone marrow edema surrounding the imaged joint will be discussed. Furthermore, the role of iodine maps in enhancing the contrast between soft tissues, optimizing the visualization of contrast material, and distinguishing contrast material from calcifications is described. Finally, a case series including different joints is provided to underline the additional advantages of high-spatial-resolution dual-energy CT reconstructed images.
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Affiliation(s)
- Giovanni Foti
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37042 Negrar, Verona, Italy; (E.O.); (C.L.)
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, Division of Experimental Imaging, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany;
| | | | - Eugenio Oliboni
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37042 Negrar, Verona, Italy; (E.O.); (C.L.)
| | - Chiara Longo
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37042 Negrar, Verona, Italy; (E.O.); (C.L.)
| | - Paolo Avanzi
- Department of Orthopedic Surgery, IRCCS Sacro Cuore Hospital, 37042 Negrar, Verona, Italy; (P.A.); (A.C.)
| | - Antonio Campacci
- Department of Orthopedic Surgery, IRCCS Sacro Cuore Hospital, 37042 Negrar, Verona, Italy; (P.A.); (A.C.)
| | - Claudio Zorzi
- Department of Orthopedic Surgery, IRCCS Sacro Cuore Hospital, 37042 Negrar, Verona, Italy; (P.A.); (A.C.)
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Abstract
PURPOSE OF REVIEW Imaging plays a pivotal role for diagnosis, follow-up and stratification of osteoarthritis patients in clinical trials and research. We aim to present an overview of currently available and emerging imaging techniques for osteoarthritis assessment and provide insight into relevant benefits and pitfalls of the different modalities. RECENT FINDINGS Although radiography is considered sufficient for a structural diagnosis of osteoarthritis and is commonly used to define eligibility of patients for participation in clinical trials, it has inherent limitations based on the projectional nature of the technique and inherent challenges regarding reproducibility in longitudinal assessment. MRI has changed our understanding of the disease from 'wear and tear' of cartilage to a whole organ disorder. MRI assessment of structural changes of osteoarthritis includes semi-quantitative, quantitative and compositional evaluation. Ultrasound is helpful in evaluating the degree of synovitis and has value in the assessment particularly of the patella-femoral joint. Recent development of computed tomography technology including weight-bearing systems has led to broader application of this technology in a research context. SUMMARY Advances in MRI technology have resulted in a significant improvement in understanding osteoarthritis as a multitissue disease.
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Affiliation(s)
- Majid Chalian
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Frank W Roemer
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine
- Department of Radiology, VA Boston Healthcare System, Boston, Massachusetts, USA
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Ren Q, Tang D, Xiong Z, Zhao H, Zhang S. Traumatic bone marrow lesions in dual-energy computed tomography. Insights Imaging 2022; 13:174. [PMID: 36308637 PMCID: PMC9617981 DOI: 10.1186/s13244-022-01312-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/11/2022] [Indexed: 11/26/2022] Open
Abstract
Traumatic bone marrow lesions (TBMLs) are considered to represent a range of concealed bone injuries, including haemorrhage, infarction, and localised oedema caused by trabecular microfracture occurring in the cancellous bone. If TBMLs are not managed timeously, they potentially cause a series of complications that can lead to irreversible morbidity and prolonged recovery time. This article reviews interesting image findings of bone marrow lesions in dual-energy computed tomography (DECT). In addition to combining the benefits of traditional CT imaging, DECT also reveals and identifies various structures using diverse attenuation characteristics of different radiographic spectra. Therefore, DECT has the capacity to detect TBMLs, which have traditionally been diagnosed using MRI. Through evaluating DECT virtual non-calcium maps, the detection of TBMLs is rendered easier and more efficient in some acute accidents.
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Affiliation(s)
- Qiuping Ren
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu West Road, Tianhe District, Guangzhou, 510627, Guangdong, People's Republic of China
| | - Deqiu Tang
- Department of Radiology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Chuanshan Road No. 69, Hengyang, Hunan, People's Republic of China
| | - Zhiyuan Xiong
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu West Road, Tianhe District, Guangzhou, 510627, Guangdong, People's Republic of China
| | - Heng Zhao
- Department of Radiology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Chuanshan Road No. 69, Hengyang, Hunan, People's Republic of China.
| | - Shuixing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu West Road, Tianhe District, Guangzhou, 510627, Guangdong, People's Republic of China.
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Roemer FW, Guermazi A, Demehri S, Wirth W, Kijowski R. Imaging in Osteoarthritis. Osteoarthritis Cartilage 2022; 30:913-934. [PMID: 34560261 DOI: 10.1016/j.joca.2021.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is the most frequent form of arthritis with major implications on both individual and public health care levels. The field of joint imaging, and particularly magnetic resonance imaging (MRI), has evolved rapidly due to the application of technical advances to the field of clinical research. This narrative review will provide an introduction to the different aspects of OA imaging aimed at an audience of scientists, clinicians, students, industry employees, and others who are interested in OA but who do not necessarily focus on OA. The current role of radiography and recent advances in measuring joint space width will be discussed. The status of cartilage morphology assessment and evaluation of cartilage biochemical composition will be presented. Advances in quantitative three-dimensional morphologic cartilage assessment and semi-quantitative whole-organ assessment of OA will be reviewed. Although MRI has evolved as the most important imaging method used in OA research, other modalities such as ultrasound, computed tomography, and metabolic imaging play a complementary role and will also be discussed.
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Affiliation(s)
- F W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA, 02118, USA; Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, Erlangen, 91054, Germany.
| | - A Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA, 02118, USA; Department of Radiology, VA Boston Healthcare System, 1400 VFW Pkwy, Suite 1B105, West Roxbury, MA, 02132, USA
| | - S Demehri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolf Street, Park 311, Baltimore, MD, 21287, USA
| | - W Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg, Salzburg, Austria, Nüremberg, Germany; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria; Chondrometrics, GmbH, Freilassing, Germany
| | - R Kijowski
- Department of Radiology, New York University Grossmann School of Medicine, 550 1st Avenue, 3nd Floor, New York, NY, 10016, USA
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Diagnostic accuracy of dual-energy computed tomography (DECT) to detect non-traumatic bone marrow edema: a systematic review and meta-analysis. Eur J Radiol 2022; 153:110359. [DOI: 10.1016/j.ejrad.2022.110359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/13/2022] [Accepted: 05/04/2022] [Indexed: 11/21/2022]
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Diagnostic Performance for Detecting Bone Marrow Edema of the Hip on Dual-Energy CT: Deep Learning Model vs. Musculoskeletal Physicians and Radiologists. Eur J Radiol 2022; 152:110337. [DOI: 10.1016/j.ejrad.2022.110337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/30/2022] [Accepted: 04/21/2022] [Indexed: 02/03/2023]
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Low YL, Finkelstein E. Cost-Effective Analysis of Dual-Energy Computed Tomography for the Diagnosis of Occult Hip Fractures Among Older Adults. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1754-1762. [PMID: 34838273 DOI: 10.1016/j.jval.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Early and accurate diagnosis of hip fractures minimizes morbidity and mortality. Although current guidelines favor magnetic resonance imaging (MRI) for the diagnosis of occult hip fractures, a new technology called dual-energy computed tomography (DECT) seems an effective alternative. This article investigates a potentially cost-effective strategy for the diagnosis of occult hip fractures in older adults in Singapore. METHODS A decision tree model was developed to compare costs from a payer's perspective and outcomes in terms of quality-adjusted life-years (QALYs) of different imaging strategies for diagnosing occult hip fracture, comparing MRI with DECT supplementing single-energy computed tomography (SECT) and SECT alone. Model inputs were obtained from local sources where available. Sensitivity analyses are performed to test the robustness of the results. RESULTS The MRI strategy was dominated by the DECT strategy, whereas DECT supplementing SECT provided 0.30 more QALYs at an incremental cost of SGD106.41 with an incremental cost-effectiveness ratio of SGD352.52 per QALY relative to SECT alone. DECT seemed a cost-effective strategy at a willingness-to-pay threshold of SGD50 000 per QALY. CONCLUSION DECT supplementing SECT is a cost-effective imaging strategy to diagnose occult hip fractures among older adults in Singapore and should be included in clinical pathways to expedite timely treatment and considered for reimbursement schemes.
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Affiliation(s)
- Ying Liang Low
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Dual-Energy CT in Traumatic Bone Lesions: Myth or Reality? J Belg Soc Radiol 2021. [DOI: 10.5334/jbsr.2652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fervers P, Celik E, Bratke G, Maintz D, Baues C, Ruffing S, Pollman-Schweckhorst P, Kottlors J, Lennartz S, Große Hokamp N. Radiotherapy Response Assessment of Multiple Myeloma: A Dual-Energy CT Approach With Virtual Non-Calcium Images. Front Oncol 2021; 11:734819. [PMID: 34646776 PMCID: PMC8504158 DOI: 10.3389/fonc.2021.734819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
Background Life expectancy of patients with multiple myeloma (MM) has increased over the past decades, underlining the importance of local tumor control and avoidance of dose-dependent side effects of palliative radiotherapy (RT). Virtual noncalcium (VNCa) imaging from dual-energy computed tomography (DECT) has been suggested to estimate cellularity and metabolic activity of lytic bone lesions (LBLs) in MM. Objective To explore the feasibility of RT response monitoring with DECT-derived VNCa attenuation measurements in MM. Methods Thirty-three patients with 85 LBLs that had been irradiated and 85 paired non-irradiated LBLs from the same patients were included in this retrospective study. Irradiated and non-irradiated LBLs were measured by circular regions of interest (ROIs) on conventional and VNCa images in a total of 216 follow-up measurements (48 before and 168 after RT). Follow-ups were rated as therapy response, stable disease, or local progression according to the MD Anderson criteria. Receiver operating characteristic (ROC) analysis was performed to discriminate irradiated vs. non-irradiated and locally progressive vs. stable/responsive LBLs using absolute attenuation post-irradiation and percentage attenuation change for patients with pre-irradiation DECT, if available. Results Attenuation of LBLs decreased after RT depending on the time that had passed after irradiation [absolute thresholds for identification of irradiated LBLs 30.5–70.0 HU [best area under the curve [AUC] 0.75 (0.59–0.91)] and -77.0 to -22.5 HU [best AUC 0.85 (0.65–1.00)]/-50% and -117% to -167% proportional change of attenuation on conventional and VNCa images, respectively]. VNCa CT was significantly superior for identification of RT effects in LBLs with higher calcium content [best VNCa AUC 0.96 (0.91–1.00), best conventional CT AUC 0.64 (0.45–0.83)]. Thresholds for early identification of local irradiation failure were >20.5 HU on conventional CT [AUC 0.78 (0.68–0.88)] and >-27 HU on VNCa CT [AUC 0.83 (0.70–0.96)]. Conclusion Therapy response of LBLs after RT can be monitored by VNCa imaging based on regular myeloma scans, which yields potential for optimizing the lesion-specific radiation dose for local tumor control. Decreasing attenuation indicates RT response, while above threshold attenuation of LBLs precedes local irradiation failure.
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Affiliation(s)
- Philipp Fervers
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Erkan Celik
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Grischa Bratke
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Christian Baues
- Department of Radiotherapy and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - Simon Ruffing
- Department of Radiotherapy and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | | | - Jonathan Kottlors
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Simon Lennartz
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
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Foti G, Serra G, Iacono V, Zorzi C. Identification of Traumatic Bone Marrow Oedema: The Pearls and Pitfalls of Dual-Energy CT (DECT). ACTA ACUST UNITED AC 2021; 7:424-433. [PMID: 34564299 PMCID: PMC8482263 DOI: 10.3390/tomography7030037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 12/04/2022]
Abstract
Dual-energy computed tomography (DECT) has been reported to successfully identify bone marrow oedema (BME) in various traumatic settings. DECT has multiple strengths, including the availability of both a 3D view of the anatomical area studied and of high-resolution dual energy specific maps super-imposed onto conventional grayscale morphological images. Windowing can be used to enhance the visualization of BME by increasing the level of the super-imposed images. Conversely, by decreasing the level of the super-imposition of color-coded images, it is possible to progressively enhance the visualization of fine anatomical details, which is useful for diagnosing associated imaging findings. Importantly, bone sclerosis may represent an important pitfall for DECT, potentially generating both false positive and false negative findings by locally altering CT numbers. The aim of this paper was to evaluate the strengths and limitations of DECT in accurately detecting traumatic BME, by considering practical approaches to imaging at several anatomical sites.
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Affiliation(s)
- Giovanni Foti
- Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Italy
- Correspondence: ; Tel.: +39-0456013874
| | - Gerardo Serra
- Department of Anesthesia and Analgesic Therapy, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Italy;
| | - Venanzio Iacono
- Department of Orthopaedic Surgery, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Italy; (V.I.); (C.Z.)
| | - Claudio Zorzi
- Department of Orthopaedic Surgery, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Italy; (V.I.); (C.Z.)
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Dual-Energy Computed Tomography Virtual Noncalcium Technique in Diagnosing Osteoporosis: Correlation With Quantitative Computed Tomography. J Comput Assist Tomogr 2021; 45:452-457. [PMID: 34297514 PMCID: PMC8132909 DOI: 10.1097/rct.0000000000001168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The aim of this study was to evaluate dual-energy computed tomography (CT) virtual noncalcium (VNCa) technique as a means of quantifying osteoporosis. Methods Dual-energy CT scans were obtained prospectively, targeting lumbar regions of 55 patients with chronic low back pain. A standard quantitative CT (QCT) phantom was positioned at the waist during each procedure, using proprietary software (QCT Pro; Mindways, Tex) to measure bone mineral density (BMD) in each vertebral body. Vendor dual-energy analytic software was altered with a specially modified configuration file to produce a “Virtual Non Calcium” or “VNCa” output, as such output variables were remapped to produce the following calcium values rather than iodine, yielding the following QCT parameters: CT value of calcium (originally “contrast media” [CM]), CT value of mixed energy imaging (regular CT value [rCT]), calcium density (originally “contrast agent density” [CaD]), and fat fraction (FF). Pearson test served to assess correlations between BMD and these parameters. Multiple linear regression analysis was applied to construct an equation for generating regressive BMD (rBMD) values. In gauging diagnostic accuracies, the criterion-standard BMD cutoff point (<80 mg/cm3) was adopted for QCT, whereas the rBMD threshold was defined by receiver operating characteristic curve. Results Contrast media, rCT, CaD, and FF values (reflecting CT value of calcium, regular CT value, calcium density, and fat fraction, respectively) significantly correlated with BMD (r values: 0.885, 0.947, 0.877, and 0.492, respectively; all P < 0.01). Contrast media, CaD, and FF showed independent associations with BMD; the regressive equation was formulated as follows: rBMD = 54.82 − 0.19 × CM + 20.03 × CaD − 1.24 × FF. The area under the curve of rBMD in diagnosing osteoporosis was 0.966 ± 0.009 (P < 0.01). At an rBMD threshold of less than 81.94 mg/cm3, sensitivity and specificity were 90.0% and 92.0%, respectively. Conclusions Dual-energy CT VNCa technique may constitute a valid alternative method for quantifying the mineral content and marrow fat composition of bone in diagnostic assessments of osteoporosis.
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Bäcker HC, Wu CH, Perka C, Panics G. Dual-Energy Computed Tomography in Spine Fractures: A Systematic Review and Meta-Analysis. Int J Spine Surg 2021; 15:525-535. [PMID: 33963025 DOI: 10.14444/8074] [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] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to perform a systematic literature review and meta-analysis to evaluate the sensitivity, specificity, and accuracy of dual-energy computed tomography (DE-CT) of bone marrow edema and disc edema in spine injuries.In vertebral injuries, prompt diagnosis is essential to avoid any delays in treatment. Conventional radiography may only reveal indirect signs of fractures, such as when it is displaced. Therefore, to detect the presence of bone marrow or disc edemas, adjunctive tools are required, such as magnetic resonance imaging (MRI) or DE-CT. METHODS Search terms included ((DECT) OR (DE-CT) OR (dual-energy CT) OR "Dual energy CT" OR (dual-energy computed tomography) OR (dual energy computed tomography)) AND ((spine) OR (vertebral)), and the PubMed, EMBASE, and MEDLINE databases and the Cochrane Library and Google were used. We found 1233 articles on our preliminary search, but only 13 articles met all criteria. Data were extracted to calculate the pooled sensitivity, specificity, and diagnostic odds ratio for analysis using R software. RESULTS Within the 13 studies, 515 patients, 3335 vertebrae, and 926 acute fractures (27.8%) defined by MRI were included. The largest cohort included 76 patients with 774 vertebrae. In 12 publications, MRI was reported for comparison. For DE-CT, the overall sensitivity was 86.2% with a specificity of 91.2% and accuracy of 89.3%. Furthermore, 5 studies reported the accuracy of CT with an overall sensitivity of 81.3%, specificity of 80.7%, and accuracy with 80.9%. Significant differences were found for specificity (P < .001) and accuracy (P = .023). However, significant interobserver differences were reported. CONCLUSIONS DE-CT seems to be a promising diagnostic tool to detect bone marrow and disc edemas, which can potentially replace the current gold standard, the MRI. LEVEL OF EVIDENCE 2. CLINICAL RELEVANCE This study shows that DE-CT seems to be a promising diagnostic tool with an accuracy of 89.3%.
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Affiliation(s)
- Henrik C Bäcker
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Berlin, Germany
| | - Chia H Wu
- Department of Orthopedics & Sports Medicine, Baylor College of Medicine Medical Center, Houston, Texas, USA
| | - Carsten Perka
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Berlin, Germany
| | - Gergely Panics
- Department of Orthopaedic Surgery and Traumatology, Uszoki Hospital, Budapest, Hungary
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Diagnostic accuracy of dual-energy CT for detecting bone marrow edema in patients with acute knee injuries: a systematic review and meta-analysis. Skeletal Radiol 2021; 50:871-879. [PMID: 33090251 DOI: 10.1007/s00256-020-03646-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This systematic review and meta-analysis evaluated the diagnostic accuracy of dual-energy CT (DECT) for detecting bone marrow edema (BME) in adult patients with acute knee injuries. METHODS A systematic review of MEDLINE, EMBASE, Scopus, the Cochrane Library, and gray literature was performed from inception to January 31, 2020, using PRISMA-DTA guidelines. The review included studies assessing the diagnostic accuracy of DECT for detecting BME in at least 10 adult patients with acute knee injuries and with an MRI reference standard. Study details were independently extracted by two reviewers. Meta-analysis was performed using a bivariate mixed-effects regression model with subgroup analysis performed to evaluate for sources of variability. Risk of bias (ROB) was evaluated using the QUADAS-2 tool. RESULTS Eight studies evaluating 267 patients between the ages of 25-54 with acute knee injuries undergoing DECT and MRI were included in analysis. Summary sensitivity, specificity, and AUROC values for BME were 84% (95% confidence interval (CI) 74-91%), 96% (95% CI 93-98%), and 0.97 (95% CI 0.95-0.98), respectively. Bone-based characterization was found to have lower specificity than region-based characterization (83% (57-95%) versus 97 (96-98%), p < 0.05), but no difference in sensitivity. No other statistical differences were identified amongst study subgroups to account for presumed variability amongst studies. Most studies were rated low risk for bias and applicability concerns. CONCLUSION DECT is specific and accurate for detecting BME in adult patients with acute knee injuries and can be used as an alternative to MRI, particularly when MRI is contraindicated or unavailable.
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Foti G, Guerriero M, Faccioli N, Fighera A, Romano L, Zorzi C, Carbognin G. Identification of bone marrow edema around the ankle joint in non-traumatic patients: Diagnostic accuracy of dual-energy computed tomography. Clin Imaging 2020; 69:341-348. [PMID: 33059186 DOI: 10.1016/j.clinimag.2020.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/02/2020] [Accepted: 09/22/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of DECT in the identification of BME of the ankle in non-traumatic patients. METHODS This prospective institutional review board approved study included 40 consecutive patients (21 males and 19 females, mean age 56.8 years, SD = 11.37) that were examined using DECT and MRI in the period between April 2019 and January 2020. Two radiologists (7 and 16 years of experience) evaluated the presence of BME on DECT mages. Diagnostic accuracy values for diagnosing BME on a per-patient and on a per-partition basis analysis were calculated for DECT images by two readers (R1 and R2, with 16 and 7 years of experience, respectively), using MRI as a gold-standard for diagnosis. Inter-observer agreements were calculated with k-statistics. A p-value of <0.05 was considered as statistically significant. RESULTS MRI depicted BME in 29/40 patients (72.50%) and in 43/240 partitions (17.91%). The consensus reading by R1 and R2 of DECT images allowed us to achieve 89.7% sensitivity (26/29 patients) and 81.8% specificity (9/11 patients). Regarding the partitions-basis analysis, BME was depicted by DECT in 39/43 partitions (90.69% sensitivity), and ruled out in 189/197 partitions (95.93% specificity). Sensitivity and specificity for the most involved partitions (talar dome) were both 95%. The inter-observer agreement for patients' analysis was substantial (k = 0.697), whereas for the partitions' analysis, it ranged from substantial (k = 0.724) to near perfect (k = 0.950). CONCLUSIONS DECT can accurately diagnose BME of the ankle in a cohort of non-traumatic patients.
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Affiliation(s)
- Giovanni Foti
- Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy.
| | - Massimo Guerriero
- Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Niccolò Faccioli
- Department of Radiology, Verona University Hospital, Verona, Italy
| | | | - Luigi Romano
- Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Claudio Zorzi
- Department of Orthopaedic Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Giovanni Carbognin
- Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
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Wilson MP, Lui K, Nobbee D, Murad MH, McInnes MDF, McGrath TA, Katlariwala P, Low G. Diagnostic accuracy of dual-energy CT for the detection of bone marrow edema in the appendicular skeleton: a systematic review and meta-analysis. Eur Radiol 2020; 31:1558-1568. [PMID: 32901304 DOI: 10.1007/s00330-020-07236-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/12/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This meta-analysis evaluated the diagnostic accuracy of dual-energy CT (DECT) for detecting bone marrow edema (BME) in the appendicular skeleton. METHODS A systematic review of MEDLINE, EMBASE, Scopus, the Cochrane Library, and gray literature from inception through January 31, 2020, was performed. Original articles with > 10 patients evaluating the accuracy of DECT for detecting BME in the appendicular skeleton with a reference standard of MRI and/or clinical follow-up were included. Study details were independently extracted by two reviewers. Meta-analysis was performed using a bivariate random-effects model with multivariable meta-regression. Risk of bias (RoB) was evaluated with QUADAS-2. RESULTS Twenty studies evaluating 790 patients for BME in the appendicular skeleton were included in analysis. The summary sensitivity, specificity, and AUC values for BME in the appendicular skeleton were 86% (95% confidence interval [CI] 82-89%), 93% (95% CI 90-95%), and 0.95, respectively. Quantitative analysis had a higher sensitivity than qualitative analysis on meta-regression (p = 0.01), but no difference in specificity (p = 0.28). No other covariates contributed to variability in accuracy (etiology (trauma vs non-trauma); location (upper vs lower extremity); and RoB). Studies demonstrated generally low or unclear RoB and applicability. Eight studies included index tests with high RoB when quantitative assessments used a retrospective cut-off value. CONCLUSIONS DECT demonstrates a higher specificity than sensitivity and AUC > 0.9. In scenarios where MRI availability is limited or contraindicated, DECT could be an alternative to MRI for detecting BME in the appendicular skeleton. However, limitations in sources of variability and RoB warrant continued study. KEY POINTS • Twenty studies evaluating 790 patients for bone marrow edema in the appendicular skeleton with dual-energy CT were included in analysis. • The summary sensitivity, specificity, and AUC values for detecting bone marrow in the appendicular skeleton were 86% (95% confidence interval [CI] 82-89%), 93% (95% CI 90-95%), and 0.95, respectively. • In scenarios where MRI availability is limited or is contraindicated, DECT could be an alternative to MRI for detecting bone marrow edema in the appendicular skeleton.
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Affiliation(s)
- Mitchell P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada.
| | - Kevin Lui
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Dorian Nobbee
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Mohammad H Murad
- Evidence-Based Practice Center, Mayo Clinic, Room 2-54, 205 3rd Ave SW, Rochester, MN, 55905, USA
| | - Matthew D F McInnes
- Departments of Radiology and Epidemiology, University of Ottawa/The Ottawa Hospital Research Institute, 501 Smyth Road, Box 232, Ottawa, Ontario, K1H-8L6, Canada
| | - Trevor A McGrath
- Department of Radiology, University of Ottawa, 501 Smyth Road, Box 232, Ottawa, Ontario, K1H-8L6, Canada
| | - Prayash Katlariwala
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada
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Engelhard N, Hermann KG, Greese J, Fuchs M, Pumberger M, Putzier M, Diekhoff T. Single-source dual-energy computed tomography for the detection of bone marrow lesions: impact of iterative reconstruction and algorithms. Skeletal Radiol 2020; 49:765-772. [PMID: 31822941 DOI: 10.1007/s00256-019-03330-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/29/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the diagnostic performance of different reconstruction algorithms of single-source dual-energy computed tomography (DECT) for the detection of bone marrow lesions (BML) in patients with vertebral compression fracture using MRI as the standard of reference. MATERIAL AND METHODS Seventeen patients with an age over 50 who underwent single-source DECT of the spine were included. The raw data (RD) were reconstructed using filtered back-projection (FBP) and iterative reconstruction (IR) with three iteration levels (IR1-IR3). Bone marrow images were generated using a three-material decomposition (3MD) and a two-material decomposition (2MD) algorithm and an RD-based approach. Three blinded readers scored the images for image quality and the presence of bone marrow lesions (BML). Only vertebrae with height loss were included. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. The different reconstructions were compared using Dunn's multiple comparison test. RESULTS Thirty-nine vertebrae were included. IR(1-3) showed superior sensitivity (87.5%) compared to FBP (75%) using 3MD but was comparable to RD (83.3%). All 2MD images were inferior (sensitivity < 38%). The image quality score was significantly higher for 3MD-IR(1-3) compared to 3MD-FBP (p < 0.0001) and all 2MD data sets (p < 0.03). This pattern was also supported by the SNR and CNR measurements. RD showed no significant improvement compared to IR. CONCLUSION The image quality of bone marrow images acquired with DECT can be improved by using IR compared with FBP. RD-based reconstruction does not offer significant improvement over image data-based reconstruction. 2MD algorithms are not suitable for BML detection.
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Affiliation(s)
- N Engelhard
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - K G Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - J Greese
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - M Fuchs
- Department for Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - M Pumberger
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - M Putzier
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - T Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany.
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Jang SW, Chung BM, Kim WT, Gil JR. Nondisplaced fractures on hip CT: added value of dual-energy CT virtual non-calcium imaging for detection of bone marrow edema using visual and quantitative analyses. Acta Radiol 2019; 60:1465-1473. [PMID: 30818978 DOI: 10.1177/0284185119831690] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Seong Won Jang
- Department of Radiology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Bo Mi Chung
- Department of Radiology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Wan Tae Kim
- Department of Radiology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Jea Ryung Gil
- Department of Radiology, Veterans Health Service Medical Center, Seoul, Republic of Korea
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Foti G, Catania M, Caia S, Romano L, Beltramello A, Zorzi C, Carbognin G. Identification of bone marrow edema of the ankle: diagnostic accuracy of dual-energy CT in comparison with MRI. Radiol Med 2019; 124:1028-1036. [PMID: 31273545 DOI: 10.1007/s11547-019-01062-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/24/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) to identify bone marrow edema (BME) of the ankle. METHODS This prospective institutional review board approved study included 40 consecutive patients (29 males and 11 females; mean age of 32.3 years) studied with DECT (80 kV and tin filter 150 kV) and MRI within 10 days. DECT data were post-processed for generating non-calcium images of the ankle. Two radiologists evaluated the presence of BME on color-coded maps. Diagnostic accuracy values for diagnosing BME were calculated for DECT maps (qualitative assessment) and for CT numbers (quantitative assessment) by using receiver operator curves and area under the curve (AUC), using MRI as the gold standard. Interobserver and intraobserver agreements were calculated with k-statistics. A p < 0.05 was considered statistically significant. RESULTS DECT depicted BME in 23/25 patients (92.0%). The sensitivity, specificity, PPV and NPV, and accuracy achieved by evaluating the DECT images were 92.0, 86.6, 92.0, 84.6, and 90.0%, for reader 1 and 88.0, 86.6, 91.6, 78.6, and 87.5, for reader 2, respectively. The interobserver and intraobsever agreements were near perfect (k = 0.87 and k = 0.83, respectively). DECT numbers were significantly different between positive (mean - 12.6 ± 29.6 HU) and negative cases (mean - 64.2 ± 34.5 HU) with a p value < 0.001. By using - 20HU cutoff to identify BME (AUC of 0.896.), the sensitivity, specificity, PPV and NPV, and accuracy of the quantitative analysis were 88.0, 92.6, 95.7, 92.6, and 87.5%, respectively. CONCLUSION DECT represents an accurate imaging tool for demonstration of BME of the ankle when compared to MRI.
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Affiliation(s)
- Giovanni Foti
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37024, Negrar, VR, Italy.
| | - Matteo Catania
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37024, Negrar, VR, Italy
| | - Simone Caia
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37024, Negrar, VR, Italy
| | - Luigi Romano
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37024, Negrar, VR, Italy
| | - Alberto Beltramello
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37024, Negrar, VR, Italy
| | - Claudio Zorzi
- Department of Orthopedic Surgery, IRCCS Sacro Cuore Hospital, Negrar, Italy
| | - Giovanni Carbognin
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37024, Negrar, VR, Italy
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Cheung KK, Dhawan RT, Wilson LF, Peirce NS, Rajeswaran G. Pars interarticularis injury in elite athletes – The role of imaging in diagnosis and management. Eur J Radiol 2018; 108:28-42. [DOI: 10.1016/j.ejrad.2018.08.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 08/31/2018] [Indexed: 02/01/2023]
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Suh CH, Yun SJ, Jin W, Lee SH, Park SY, Ryu CW. Diagnostic performance of dual-energy CT for the detection of bone marrow oedema: a systematic review and meta-analysis. Eur Radiol 2018; 28:4182-4194. [PMID: 29679212 DOI: 10.1007/s00330-018-5411-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to assess the sensitivity and specificity of dual-energy CT (DECT) for the detection of bone marrow oedema (BME). METHODS An electronic search of the PubMed and EMBASE databases was conducted. Bivariate modelling and hierarchical summary receiver-operating characteristic modelling were performed to evaluate the overall diagnostic performance of DECT for BME. Subgroup analysis was performed according to the assessment type (qualitative vs. quantitative) and anatomical location (spine vs. appendicular skeleton). Meta-regression analyses were performed according to the subject, study, and DECT characteristics. RESULTS Twelve eligible studies (1901 lesions, 450 patients) were included. DECT exhibited a pooled sensitivity of 0.85 [95% confidence interval (CI): 0.78-0.90] and a pooled specificity of 0.97 (95% CI: 0.92-0.98) for BME detection. In addition, the diagnostic performance of qualitative assessment (sensitivity, 0.85; specificity, 0.97) was higher than that of quantitative assessment (sensitivity, 0.84; specificity, 0.88) of DECT findings. The diagnostic performance of DECT for the spine (sensitivity, 0.84; specificity, 0.98) and appendicular skeleton (sensitivity, 0.84; specificity, 0.93) were excellent. According to meta-regression analysis, the use of a tin filter, ≥ 2 image planes, and a slice thickness < 1 mm tended to exhibit higher sensitivity and hyperacute stage BME (< 24 h) tended to exhibit lower sensitivity. CONCLUSIONS These findings indicate that DECT has excellent sensitivity and specificity for BME detection. Qualitative assessment of DECT findings obtained using a tin filter, ≥ 2 image planes, and a 0.5-1-mm slice thickness in the acute stage BME (≥24 h) is recommended for more sensitive diagnosis. KEY POINTS • Overall, DECT is useful for the detection of BME (sensitivity, 85%; specificity-97%). • Qualitative assessment (sensitivity-85%; specificity-97%) is more accurate than quantitative assessment (sensitivity-84%; specificity-88%). • DECT showed excellent diagnostic performance for both the spine/appendicular skeleton (sensitivity-84%/84%; specificity-98%/93%).
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Affiliation(s)
- Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea.
- Department of Radiology, Kyung Hee University, Seoul, Republic of Korea.
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
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Clinical applications of a computed tomography color “marrow mapping” algorithm to increase conspicuity of nondisplaced trabecular fractures. Emerg Radiol 2018; 26:59-66. [DOI: 10.1007/s10140-018-1631-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 08/01/2018] [Indexed: 01/14/2023]
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Single-source dual-energy computed tomography for the assessment of bone marrow oedema in vertebral compression fractures: a prospective diagnostic accuracy study. Eur Radiol 2018; 29:31-39. [DOI: 10.1007/s00330-018-5568-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/16/2018] [Accepted: 05/28/2018] [Indexed: 12/20/2022]
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