Abstract
ObjectivesUsing magnetic resonance imaging (MRI) as the standard of reference, we aimed to evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) in assessing disk injuries in patients aged more than 50 years with vertebral fractures.MethodsThis prospective study was approved by the local ethics committee (EA1/372/14), and all patients gave written informed consent. Patients with suspected fractures underwent spinal DECTs and MRIs. Three readers scored DECT collagen maps for the presence or absence of disk injuries and also scored MR images according to the Sander classification (0–3). Only disks at risk (target disks) were included in the analysis. Sensitivity and specificity were calculated. Fleiss’s κ was used to evaluate interrater agreement. Attenuation, in Hounsfield units, was compared between affected and unaffected disks in DECT.ResultsAnalyzing 295 disks in 67 patients, DECT was both sensitive (0.85) and specific (0.75). Sensitivity varied with the severity of disk damage, as assessed using the Sander scale (grade 1, 0.80; 2, 0.85; and 3, 0.98). Fleiss’s κ was 0.41 for MRI and 0.51 for DECT. In the DECT collagen maps, attenuation was lower in injured disks compared to that in normal disks (80.3 ± 35.2 vs. 97.9 ± 41.0, p < 0.001).ConclusionsCompared to conventional CT, DECT collagen maps can yield more diagnostic information, allowing identification of disk injuries in elderly patients with vertebral fractures.Key Points• Dual-energy computed tomography allows vertebral disk injuries to be detected in elderly patients with vertebral fractures.• Dual-energy computed tomography yields more diagnostic information about vertebral disks compared to conventional CT.• Dual-energy computed tomography can be used as an alternative imaging modality for patients unwilling or unable to undergo MRI.
Highlights
Treatment of thoracolumbar spinal fractures, whether conservative or surgical, remains controversial
This is the first study analyzing the diagnostic accuracy of dual-energy computed tomography (DECT) for detecting disk abnormalities after vertebral fractures
Results show that DECT is suitable for detecting disk injuries in a cohort of patients with vertebral fractures
Summary
Treatment of thoracolumbar spinal fractures, whether conservative or surgical, remains controversial. AOSpine combined it with the older Magerl classification system, forming the AOSpine Thoracolumbar Spine Injury Classification System [2, 3]. These classification systems are gaining popularity worldwide, and they assist surgeons in deciding when surgery is indicated and if it is the best approach. When fracture patterns indicate potential disk injury, preoperative imaging could be a decisive factor. Given that patients with traumatic spinal injuries are relatively young, long-term survival and restored function of the vertebral disk are crucial [5]. Compared to MRI, CT is supposed to be cheaper, faster, and less discomfortable and has fewer contraindications
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