Detection of Bone Marrow Edema in the Head and Neck With Dual-Energy CT: Ready for Clinical Use?

Timmer, Veronique C. M. L.; Kroonenburgh, Annemarieke M J L van; Henneman, Wouter J.P.; Vaassen, Lauretta A. A.; Roele, Elise D.; Keßler, Peter; Postma, Alida A.

doi:10.2214/ajr.19.21881

Cited by 10 publications

(5 citation statements)

References 32 publications

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“…Numerous applications of DECT have been described in head and neck imaging. 10,[13][14][15][16][17][18][19][20][21] Previously published studies of dual-energy parathyroid CT have primarily focused on the potential for radiation dose reduction using virtual noncontrast images to eliminate the standard noncontrast phase 22,23 and on describing quantitative dual-energy characteristics of parathyroid adenomas, thyroid parenchyma, and lymph nodes on postcontrast phases. 24,25 The authors are aware of 1 previous study that evaluated dual-energy noncontrast parathyroid CT images obtained on a dual-source system using 90-keV, 150-keV, and mixed images (dual-energy composition factor, 0.8), but 40-keV VMI were not specifically evaluated in this previous investigation.…”

Section: Discussionmentioning

confidence: 99%

Dual-Energy Parathyroid 4D-CT: Improved Discrimination of Parathyroid Lesions from Thyroid Tissue Using Noncontrast 40-keV Virtual Monoenergetic Images

Bunch

Pavlina

Lipford

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:In parathyroid CT, a noncontrast phase aids discrimination of parathyroid lesions (not iodinecontaining) from thyroid tissue (iodine-containing). When thyroid iodine is pathologically diminished, this differentiation is difficult with standard CT. Because the attenuation of an element is maximal near its K-edge (iodine ¼ 33.2 keV), we hypothesized that dual-energy CT 40-keV virtual monoenergetic images will accentuate thyroid iodine relative to standard images, improving the differentiation of thyroid from parathyroid lesions. Our purpose was to test this hypothesis through quantitative assessment of Hounsfield unit attenuation and contrast-to-noise on dual-energy CT standard (70-keV) and 40-keV noncontrast images. MATERIALS AND METHODS:For this retrospective study including 20 dual-energy parathyroid CTs, we used an ROI-based analysis to assess the attenuation of thyroid tissue, parathyroid lesions, and sternocleidomastoid muscle as well as corresponding contrast-to-noise on standard and 40-keV noncontrast images. Wilcoxon signed rank tests were performed to compare differences between 70 and 40 keV.RESULTS: Absolute and percentage increases in attenuation at 40 keV were significantly greater for thyroid gland than for parathyroid lesions and sternocleidomastoid muscle (P , .001 for all). Significant increases in the contrast-to-noise of thyroid relative to parathyroid lesions (median increase, 0.8; P , .001) and relative to sternocleidomastoid muscle (median increase, 1.3; P , .001) were observed at 40 keV relative to 70 keV.CONCLUSIONS: Forty-kiloelectron volt virtual monoenergetic images facilitate discrimination of parathyroid lesions from thyroid tissue by significantly increasing thyroid attenuation and associated contrast-to-noise. These findings are particularly relevant for parathyroid lesions that exhibit isoattenuation to the thyroid on parathyroid CT arterial and venous phases and could, therefore, be missed without the noncontrast phase.ABBREVIATIONS: CNR ¼ contrast-to-noise ratio; DECT ¼ dual-energy CT; IQR ¼ interquartile range; VMI ¼ virtual monoenergetic images P arathyroid 4D-CT is a powerful tool for localizing abnormal parathyroid tissue in the setting of primary hyperparathyroidism. 1 Localization of a single adenoma facilitates minimally invasive parathyroidectomy and its associated benefits, 2,3 whereas localization of multigland disease aids bilateral neck exploration. The optimal number of CT phases is undetermined, but the most commonly used protocol involves 3 CT acquisitions of the neck and upper chest, including noncontrast, arterial, and venous phases. 4 Parathyroid lesions, exophytic thyroid nodules, and lymph nodes may appear morphologically identical on CT. 5 Although the

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Section: Discussionmentioning

confidence: 99%

Dual-Energy Parathyroid 4D-CT: Improved Discrimination of Parathyroid Lesions from Thyroid Tissue Using Noncontrast 40-keV Virtual Monoenergetic Images

Bunch

Pavlina

Lipford

et al. 2021

AJNR Am J Neuroradiol

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“…BME is a prodrome of bone destruction and a prediction marker for worsening of symptoms 9,10 . It is also one of the first signs of inexplicable pain or teeth mobility 28 . Recently, DECT has not become available in clinical practice to detect BME caused by various diseases [1][2][3][4][5] .…”

Section: Discussionmentioning

confidence: 99%

“…It is being used to visualize subtle bone involvement in oncology, osteomyelitis, and osteonecrosis of the head and neck region 8 . The sensitivity and specificity of DECT for the detection of BME with VNCa DECT reconstructions were investigated in numerous studies and were found to be relatively high at 82-96% and 83-98%, respectively [28][29][30] . Therefore, DECT is a reliable diagnostic tool for the detection of BME.…”

Section: Discussionmentioning

confidence: 99%

Detection of bone marrow edema in differential diagnoses of odontogenic cysts using dual-energy computed tomography

Hasegawa

Arimoto

Saito

et al. 2022

Oral Maxillofac Surg

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Purpose: In this study, we prospectively investigated the relationship between bone marrow edema (BME) and odontogenic cysts and explored the possibility of using dual-energy computed tomography (DECT) as an auxiliary tool for the diagnosis of odontogenic cysts. Methods:This cross-sectional study included 73 patients who underwent the DECT scan and surgery for odontogenic cysts or odontogenic tumors. The virtual noncalcium (VNCa) computed tomography (CT) values and CT values were measured at several sites. The predictor variable was diagnosis, and the other variables included age, sex, and sites. The primary outcome was VNCa CT value. Variables were tested using the chi-square test or Kruskal-Wallis test. The VNCa CT and CT values were tested using the Scheffe test for multiple comparisons. All variables were analyzed as independent variables affecting the VNCa CT values around the lesion in the multiple regression analysis.Result: There were 35 men and 38 women. The mean patient age was 50.0 ± 19.5 years (range: 8-86). The VNCa CT values (-6.2 ± 34.3) around the lesion in patients with RCs were significantly higher than those in patients with dentigerous cysts (-44.4 ± 28.6) and odontogenic keratocysts (-67.3 ± 19.5). In multiple regression analysis, the VNCa CT values around the lesion showed a significant positive correlation with histological results (regression coefficient: -0.605, P < 0.001). Conclusion:The presence of BME is associated with radicular cysts, and DECT can be used as an auxiliary tool for radicular cyst diagnosis.

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“…Recent data from studies with new-generation dual-energy CT systems suggest an improved detection of tumour invasion into cartilage, cortical bone, and bone marrow [ 64 , 65 ].…”

Section: Quantitative Diagnosismentioning

confidence: 99%

Qualitative and Quantitative Diagnosis in Head and Neck Cancer

et al. 2021

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The diagnosis is the art of determining the nature of a disease, and an accurate diagnosis is the true cornerstone on which rational treatment should be built. Within the workflow in the management of head and neck tumours, there are different types of diagnosis. The purpose of this work is to point out the differences and the aims of the different types of diagnoses and to highlight their importance in the management of patients with head and neck tumours. Qualitative diagnosis is performed by a pathologist and is essential in determining the management and can provide guidance on prognosis. The evolution of immunohistochemistry and molecular biology techniques has made it possible to obtain more precise diagnoses and to identify prognostic markers and precision factors. Quantitative diagnosis is made by the radiologist and consists of identifying a mass lesion and the estimation of the tumour volume and extent using imaging techniques, such as CT, MRI, and PET. The distinction between the two types of diagnosis is clear, as the methodology is different. The accurate establishment of both diagnoses plays an essential role in treatment planning. Getting the right diagnosis is a key aspect of health care, and it provides an explanation of a patient’s health problem and informs subsequent decision. Deep learning and radiomics approaches hold promise for improving diagnosis.

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Detection of Bone Marrow Edema in the Head and Neck With Dual-Energy CT: Ready for Clinical Use?

Cited by 10 publications

References 32 publications

Dual-Energy Parathyroid 4D-CT: Improved Discrimination of Parathyroid Lesions from Thyroid Tissue Using Noncontrast 40-keV Virtual Monoenergetic Images

Dual-Energy Parathyroid 4D-CT: Improved Discrimination of Parathyroid Lesions from Thyroid Tissue Using Noncontrast 40-keV Virtual Monoenergetic Images

Detection of bone marrow edema in differential diagnoses of odontogenic cysts using dual-energy computed tomography

Qualitative and Quantitative Diagnosis in Head and Neck Cancer

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