Abstract
ObjectivesTo compare dual-energy CT (DECT) and MRI for assessing presence and extent of traumatic bone marrow edema (BME) and fracture line depiction in acute vertebral fractures.MethodsEighty-eight consecutive patients who underwent dual-source DECT and 3-T MRI of the spine were retrospectively analyzed. Five radiologists assessed all vertebrae for presence and extent of BME and for identification of acute fracture lines on MRI and, after 12 weeks, on DECT series. Additionally, image quality, image noise, and diagnostic confidence for overall diagnosis of acute vertebral fracture were assessed. Quantitative analysis of CT numbers was performed by a sixth radiologist. Two radiologists analyzed MRI and grayscale DECT series to define the reference standard.ResultsFor assessing BME presence and extent, DECT showed high sensitivity (89% and 84%, respectively) and specificity (98% in both), and similarly high diagnostic confidence compared to MRI (2.30 vs. 2.32; range 0–3) for the detection of BME (p = .72). For evaluating acute fracture lines, MRI achieved high specificity (95%), moderate sensitivity (76%), and a significantly lower diagnostic confidence compared to DECT (2.42 vs. 2.62, range 0–3) (p < .001). A cutoff value of − 0.43 HU provided a sensitivity of 89% and a specificity of 90% for diagnosing BME, with an overall AUC of 0.96.ConclusionsDECT and MRI provide high diagnostic confidence and image quality for assessing acute vertebral fractures. While DECT achieved high overall diagnostic accuracy in the analysis of BME presence and extent, MRI provided moderate sensitivity and lower confidence for evaluating fracture lines.Key Points• In the setting of spinal trauma, dual-energy CT (DECT) is highly accurate in the evaluation of acute vertebral fractures and bone marrow edema presence and extent.• MRI provides moderate sensitivity and lower diagnostic confidence for the depiction of acute fracture lines, when compared to DECT, which might result in potentially inaccurate and underestimated severity assessment of injuries in certain cases when no fracture lines are visible on MRI.• DECT may represent a valid imaging alternative to MRI in specific settings of acute spinal trauma and in follow-up examinations, especially in elderly or unstable patients and in cases of subtle or complex orientated fracture lines.
Highlights
In the setting of spinal trauma, radiologic diagnosis of acute vertebral fractures based on exclusive morphologic signs of fracture lines can be challenging, especially in elderly patients presenting with older osteoporotic fractures [1]
Magnetic resonance imaging (MRI) provides moderate sensitivity and lower diagnostic confidence for the depiction of acute fracture lines, when compared to dual-energy Computed tomography (CT) (DECT), which might result in potentially inaccurate and underestimated severity assessment of injuries in certain cases when no fracture lines are visible on MRI
The receiver operating characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.96 and an optimal cutoff value of − 0.43 to identify vertebral bone marrow edema (BME), with an overall sensitivity of 89% and specificity of 90% (Fig. 5)
Summary
In the setting of spinal trauma, radiologic diagnosis of acute vertebral fractures based on exclusive morphologic signs of fracture lines can be challenging, especially in elderly patients presenting with older osteoporotic fractures [1]. In this context, detection of bone marrow edema (BME) as a sign of acute injury can substantially facilitate a more accurate diagnosis [2]. DECT usage has significantly increased in clinical routine and numerous postprocessing algorithms have been developed [9,10,11] In this context, DECT-derived virtual non-calcium (VNCa) images allow for subtraction of calcium signal from trabecular bone, enabling visualization of BME [12, 13]. Several studies demonstrated high diagnostic accuracy of VNCa series exclusively for the assessment of BME compared with MRI [1, 6, 14]
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