Detection of bone marrow edema possible through DECT: European Radiology

Dual-energy computed tomography (DECT) virtual noncalcium (VNCa) technique can help in accurate detection of bone marrow edema (BME) in patients with vertebral compression fractures, and VNCa images can be acquired on a single-source system, finds a new study.

The study published in the journal European Radiology, further finds that the image quality of VNCa images is adequate but trained readers are required for image interpretation.

Torsten Diekhoff, Department of Radiology, Free University of Berlin, Berlin, Germany, and colleagues conducted the study to evaluate the diagnostic accuracy of single-source DECT for the detection of BME in patients with vertebral compression fractures.

Read Also: Dual-energy CT as good as MRI for diagnosing wrist fractures

For the study, the researchers prospectively enrolled patients over 50 years of age with radiographically suspected vertebral compression fracture of the thoracic or lumbar spine. The patients underwent DECT with a sequential acquisition of 80 and 135 kVp datasets on a 320-row detector CT scanner and 1.5-Tesla magnetic resonance imaging (MRI) including T1-weighted and short-tau inversion recovery (STIR) sequences.

VNCa images were reconstructed using a three-material decomposition algorithm. Vertebrae with height loss in CT were scored for the presence of BME in both MRI and DECT and used to determine signal- and contrast-to-noise ratios (SNR and CNR). Contingency analysis using MRI as a standard of reference and Fleiss's kappa were calculated. IRB approval was obtained.

The analysis consisted of total 192 vertebral compression fractures in 70 patients (23 men, 47 women; mean age 70.7 years (SD 9.8)).

Key Findings:

• DECT showed a reader-dependent sensitivity of 72% and specificity of 70% for BME.


• Fleiss's kappa was .40 for DECT and .58 for MRI.


• T1-weighted images had significantly better SNR and CNR compared to STIR, CT, and VNCa (p < .0001); however, there was no difference between STIR and VNCa.

"VNCa images depict BME with adequate sensitivity and specificity and can be acquired on a single-source system. Image quality is adequate but trained readers are needed for image interpretation, concluded the authors.

Important Takeaways from the Study:

• Dual-energy CT in a single-source technique can help to detect bone marrow edema in patients with vertebral compression fractures.


• However, given the inferior inter-rater reliability and limited specificity compared to MRI, experienced readers are needed for image interpretation.


• Dual-energy CT of the spine has limited sensitivity for the detection of bone marrow edema in vertebra with previous surgical intervention.