Bone Marrow Edema in Vertebral Compression Fractures: Detection with Dual-Energy CT

Wang, Chien-Kuo; Tsai, Jen Ming; Chuang, Ming Tsung; Wang, Min Tsung; Huang, Kuo Yuan; Lin, Ray–Ming

doi:10.1148/radiol.13122577

Cited by 157 publications

(95 citation statements)

References 30 publications

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“…Currently, only a few studies have reported on the use of DSCT to visualize the bone marrow. 1,5,11,23,29 The attenuation values measured on the non-calcium images obtained by DSCT were higher in abnormal bone marrow areas than in normal areas. These increased attenuation values are correlated with the knowledge about the increase in fluid and/or blood components of the bone marrow in trauma patients.…”

Section: Discussionmentioning

confidence: 90%

“…These increased attenuation values are correlated with the knowledge about the increase in fluid and/or blood components of the bone marrow in trauma patients. 5,30,31 However, the attenuation difference between abnormal and normal bone marrow is greater in elderly patients owing to the increased fat component of their vertebrae. 5 The three false-negative findings were in the vertebral bodies with sclerosis.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20][21] For our evaluation of the vertebral bodies, the relative contrast material ratio was set to a value of 1.75, and the range of the filter was set to 3 based on the experience from previous studies. 5,11,22,23 Non-calcium images were displayed in greyscale.…”

Section: Dual-source Ct Protocolmentioning

confidence: 99%

“…3,4 Among these procedures, MRI is the modality of choice to obtain information about both vertebral fractures and bone marrow oedema. [5][6][7][8] However, MRI is not routinely used in all patients with vertebral trauma owing to reduced availability, contraindications and/or metal artefacts. Compared with MRI, CT is more available, requires less time and has better spatial resolution.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Although bones can be removed on singleenergy CT images, the surrounding trabecular structures complicate the visualization of vertebral oedema. 5,[11][12][13][14] With the advancements in dual-energy CT technology, material decomposition and the elimination of misregistration artefacts are possible. 15 Materials, particularly those with high atomic weight numbers (e.g.…”

Section: Introductionmentioning

confidence: 99%

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The feasibility of dual-energy CT in differentiation of vertebral compression fractures

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Yuceler

Kantarcı

et al. 2016

BJR

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Objective: To prospectively evaluate the ability of dual-energy CT (DECT), compared with MRI, to identify vertebral compression fractures in acute trauma patients. Methods: This institutional review board-approved study included 23 consecutive patients with 32 vertebral fractures who underwent both DECT and MRI of the spine between February 2014 and September 2014. A total of 209 vertebrae were evaluated for the presence of abnormal bone marrow attenuation on DECT and signal on MRI by five experienced radiologists. The specificity, sensitivity, predictive values and intraobserver and interobserver agreements were calculated. Results: MRI revealed a total of 47 vertebrae (22.4% of all vertebrae) and DECT revealed 44 vertebrae (21.0% of all vertebrae) with oedema. Using MRI as the reference standard, DECT had sensitivity, specificity, positive-predictive value, negative-predictive value and accuracy of 89.3, 98.7, 95.4, 96.9 and 96.6%, respectively. With respect to establishing the presence of oedema, the interobserver agreement was almost perfect (k 5 0.82), and the intraobserver agreement was substantial (k 5 0.80). Conclusion: Compared with MRI, DECT can provide an accurate demonstration of acute vertebral fractures and can be used as an alternative imaging modality for the assessment of vertebral fractures in patients with contraindications for MRI. Advances in knowledge: Distinguishing of acute and chronic vertebral compression fracture is important for treatment choices. DECT is very fast compared with MRI and is an alternative imaging modality for the assessment of vertebral fractures in patients with contraindications for MRI.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Dual-source Ct Protocolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The feasibility of dual-energy CT in differentiation of vertebral compression fractures

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Kantarcı

et al. 2016

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Principles and applications of multienergy CT: Report of AAPM Task Group 291

McCollough

Boedeker

Cody³

et al. 2020

Medical Physics

161

195

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In x-ray computed tomography (CT), materials with different elemental compositions can have identical CT number values, depending on the mass density of each material and the energy of the detected x-ray beam. Differentiating and classifying different tissue types and contrast agents can thus be extremely challenging. In multienergy CT, one or more additional attenuation measurements are obtained at a second, third or more energy. This allows the differentiation of at least two materials. Commercial dual-energy CT systems (only two energy measurements) are now available either using sequential acquisitions of low-and high-tube potential scans, fast tube-potential switching, beam filtration combined with spiral scanning, dual-source, or dual-layer detector approaches. The use of energy-resolving, photon-counting detectors is now being evaluated on research systems. Irrespective of the technological approach to data acquisition, all commercial multienergy CT systems circa 2020 provide dual-energy data. Material decomposition algorithms are then used to identify specific materials according to their effective atomic number and/or to quantitate mass density. These algorithms are applied to either projection or image data. Since 2006, a number of clinical applications have been developed for commercial release, including those that automatically (a) remove the calcium signal from bony anatomy and/or calcified plaque; (b) create iodine concentration maps from contrast-enhanced CT data and/or quantify absolute iodine concentration; (c) create virtual noncontrast-enhanced images from contrast-enhanced scans; (d) identify perfused blood volume in lung parenchyma or the myocardium; and (e) characterize materials according to their elemental compositions, which can allow in vivo differentiation between uric-acid and non-uric-acid urinary stones or uric acid (gout) or non-uric-acid (calcium pyrophosphate) deposits in articulating joints and surrounding tissues. In this report, the underlying physical principles of multienergy CT are reviewed and each of the current technical approaches are described. In addition, current and evolving clinical applications are introduced. Finally, the impact of multienergy CT technology on patient radiation dose is summarized.

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Deep learning‐based virtual noncalcium imaging in multiple myeloma using dual‐energy CT

et al. 2022

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Background: Dual-energy CT with virtual noncalcium (VNCa) images allows the evaluation of focal intramedullary bone marrow involvement in patients with multiple myeloma. However, current commercial VNCa techniques suffer from excessive image noise and artifacts due to material decomposition used in synthesizing VNCa images. Objectives: In this work, we aim to improve VNCa image quality for the assessment of focal multiple myeloma, using an Artificial intelligence based Generalizable Algorithm for mulTi-Energy CT (AGATE) method. Materials and methods: AGATE method used a custom dual-task convolutional neural network (CNN) that concurrently carries out material classification and quantification. The material classification task provided an auxiliary regularization to the material quantification task. CNN parameters were optimized using custom loss functions that involved cross-entropy, physics-informed constraints, structural redundancy in spectral and material images, and texture information in spectral images. For training data, CT phantoms (diameters 30 to 45 cm) with tissue-mimicking inserts were scanned on a third generation dual-source CT system. Scans were performed at routine dose and half of the routine dose. Small image patches (i.e., 40 × 40 pixels) of tissue-mimicking inserts with known basis material densities were extracted for training samples. Numerically simulated insert materials with various shapes increased diversity of training samples. Generalizability of AGATE was evaluated using CT images from phantoms and patients. In phantoms, material decomposition accuracy was estimated using mean-absolute-percent-error (MAPE), using physical inserts that were not used during the training. Noise power spectrum (NPS) and modulation transfer function (MTF) were compared across phantom sizes and radiation dose levels. Five patients with multiple myeloma underwent dual-energy CT, with VNCa images generated using a commercial method and AGATE. Two fellowship-trained musculoskeletal radiologists reviewed the VNCa images (commercial and AGATE) side-by-side using a dual-monitor display, blinded to VNCa type, rating the image quality for focal multiple myeloma lesion visualization using a 5-level Likert comparison scale (−2 = worse visualization and diagnostic confidence, −1 = worse visualization but equivalent diagnostic confidence, 0 = equivalent visualization and diagnostic confidence, 1 = improved visualization but equivalent diagnostic confidence, 2 = improved visualization and diagnostic confidence). A post hoc assignment of comparison ratings was performed to rank AGATE images in comparison to commercial ones.

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Bone Marrow Edema in Vertebral Compression Fractures: Detection with Dual-Energy CT

Cited by 157 publications

References 30 publications

The feasibility of dual-energy CT in differentiation of vertebral compression fractures

The feasibility of dual-energy CT in differentiation of vertebral compression fractures

Principles and applications of multienergy CT: Report of AAPM Task Group 291

Deep learning‐based virtual noncalcium imaging in multiple myeloma using dual‐energy CT

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