Abstract
ObjectivesTo determine the diagnostic accuracy of dual-energy CT (DECT) virtual noncalcium (VNCa) reconstructions for assessing thoracic disk herniation compared to standard grayscale CT.MethodsIn this retrospective study, 87 patients (1131 intervertebral disks; mean age, 66 years; 47 women) who underwent third-generation dual-source DECT and 3.0-T MRI within 3 weeks between November 2016 and April 2020 were included. Five blinded radiologists analyzed standard DECT and color-coded VNCa images after a time interval of 8 weeks for the presence and degree of thoracic disk herniation and spinal nerve root impingement. Consensus reading of independently evaluated MRI series served as the reference standard, assessed by two separate experienced readers. Additionally, image ratings were carried out by using 5-point Likert scales.ResultsMRI revealed a total of 133 herniated thoracic disks. Color-coded VNCa images yielded higher overall sensitivity (624/665 [94%; 95% CI, 0.89–0.96] vs 485/665 [73%; 95% CI, 0.67–0.80]), specificity (4775/4990 [96%; 95% CI, 0.90–0.98] vs 4066/4990 [82%; 95% CI, 0.79–0.84]), and accuracy (5399/5655 [96%; 95% CI, 0.93–0.98] vs 4551/5655 [81%; 95% CI, 0.74–0.86]) for the assessment of thoracic disk herniation compared to standard CT (all p < .001). Interrater agreement was excellent for VNCa and fair for standard CT (ϰ = 0.82 vs 0.37; p < .001). In addition, VNCa imaging achieved higher scores regarding diagnostic confidence, image quality, and noise compared to standard CT (all p < .001).ConclusionsColor-coded VNCa imaging yielded substantially higher diagnostic accuracy and confidence for assessing thoracic disk herniation compared to standard CT.Key Points• Color-coded VNCa reconstructions derived from third-generation dual-source dual-energy CT yielded significantly higher diagnostic accuracy for the assessment of thoracic disk herniation and spinal nerve root impingement compared to standard grayscale CT.• VNCa imaging provided higher diagnostic confidence and image quality at lower noise levels compared to standard grayscale CT.• Color-coded VNCa images may potentially serve as a viable imaging alternative to MRI under circumstances where MRI is unavailable or contraindicated.
Highlights
Disk herniation represents a frequent disease, affecting people aged 30 to 50 with an incidence of about 5 to 20 cases per 1000 adults annually [1]
MRI revealed a total of 133 thoracic herniated disks (12% of all thoracic intervertebral disks; median per patient, 2; range, 1–3) and 25 instances of spinal nerve root impingement
This study demonstrated first that color-coded virtual noncalcium (VNCa) reconstructions derived from third-generation dual-source dual-energy CT (DECT) improve the depiction of thoracic disk herniation and spinal nerve root impingement with higher diagnostic accuracy compared to standard grayscale CT
Summary
Disk herniation represents a frequent disease, affecting people aged 30 to 50 with an incidence of about 5 to 20 cases per 1000 adults annually [1]. Thoracic disk herniations can result in miscellaneous clinical symptoms including severe myelopathy [4]. MRI represents the current standard of reference for visualization of disk herniation because of its ability to provide high contrast between cerebrospinal fluid and intervertebral disks [6, 7]. Compared to MRI, standard grayscale CT offers several advantages including faster examination times and less contraindications but provides only low sensitivity and specificity for assessing herniated disks due to low contrast [9, 10]
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