Abstract
ObjectivesTo investigate the diagnostic accuracy of collagen-sensitive maps derived from dual-energy computed tomography (DECT) for the detection of lumbar disk pathologies in a feasibility setting.Materials and methodsWe retrospectively reviewed magnetic resonance imaging (MRI), computed tomography (CT), and DECT datasets acquired in patients who underwent periradicular therapy of the lumbar spine from June to December 2019. Three readers scored DECT collagen maps, conventional CT, and MRI for presence, type, and extent of disk pathology. Contingency table analyses were performed to determine diagnostic accuracy using MRI as standard of reference. Interrater agreement within and between imaging modalities was evaluated by computing intraclass correlation coefficients (ICCs) and Cohen’s kappa. Correlation between sum scores of anteroposterior disk displacement was determined by calculation of a paired t test.ResultsIn 21 disks in 13 patients, DECT had a sensitivity of 0.87 (0.60–0.98) and specificity of 1.00 (0.54–1.00) for the detection of disk pathology. Intermodality agreement for anteroposterior disk displacement was excellent for DECT (ICC 0.963 [0.909–0.985]) and superior to CT (ICC 0.876 [0.691–0.95]). For anteroposterior disk displacement, DECT also showed greater within-modality interrater agreement (ICC 0.820 [0.666–0.916]) compared with CT (ICC 0.624 [0.39–0.808]).ConclusionOur data suggest that collagen-sensitive imaging has an added benefit, allowing more accurate evaluation of the extent of disk displacement with higher interrater reliability. Thus, DECT could provide useful diagnostic information in patients undergoing CT for other indications or with contraindications to MRI.
Highlights
Affecting 3–5% of the population, lumbar radiculopathy is one of the most common symptoms caused by degenerative spinal disease [1]
We retrospectively included patients who presented to our orthopedic clinic with lumbar radiculopathy and an underlying disk pathology on magnetic resonance imaging (MRI) who underwent DECTguided lumbar spine injection in our department of radiology from June 2019 to December 2019
A total of 25 patients who underwent Dual-energy computed tomography (DECT)-guided lumbar spine injections were identified, and 13 patients were included in our retrospective analysis (7 women and 6 men; mean age, 57.9 ± 18.7 years)
Summary
Affecting 3–5% of the population, lumbar radiculopathy is one of the most common symptoms caused by degenerative spinal disease [1]. Patients present with pain or sensory loss in a dermatomal pattern, possibly in conjunction with motor function loss in a myotomal pattern. Radiculopathy is diagnosed by an extensive physical examination and magnetic resonance imaging (MRI), the current diagnostic standard [2]. Dual-energy computed tomography (DECT) is a fairly new CT technique but is already included in guidelines for imaging in gout [3]. It has been introduced for the detection of bone marrow edema in the spine, e.g., in patients
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