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Color-coded virtual non-calcium dual-energy CT for the depiction of bone marrow edema in patients with acute knee trauma: a multireader diagnostic accuracy study

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To evaluate the diagnostic accuracy of dual-energy computed tomography (CT) virtual non-calcium (VNCa) reconstructions for the depiction of traumatic knee bone marrow edema.

Methods

Fifty-seven patients (mean age, 50 years; range, 20–82 years) with acute knee trauma further divided into 30 women and 27 men, who had undergone third-generation dual-source dual-energy CT and 3-T magnetic resonance imaging (MRI) within 7 days between January 2017 and May 2018, were retrospectively analyzed. Six radiologists, blinded to clinical and MRI information, independently analyzed conventional grayscale dual-energy CT series for fractures; after 8 weeks, readers evaluated color-coded VNCa reconstructions for the presence of bone marrow edema in six femoral and six tibial regions. Quantitative analysis of CT numbers on VNCa reconstructions was performed by a seventh radiologist. Two additional radiologists, blinded to clinical and CT information, analyzed MRI series in consensus to define the reference standard. Sensitivity, specificity, and the area under the curve (AUC) were the primary metrics of diagnostic accuracy.

Results

MRI revealed 197 areas with bone marrow edema (91/342 femoral, 106/342 tibial). In the qualitative analysis, VNCa showed high overall sensitivity (1108/1182 [94%]) and specificity (2789/2922 [95%]) for depicting bone marrow edema. The AUC was 0.96 (femur) and 0.97 (tibia). A cutoff value of − 51 Hounsfield units (HU) provided high sensitivity (102/106 [96%]) and specificity (229/236 [97%]) for differentiating tibial bone marrow edema.

Conclusions

In both quantitative and qualitative analyses, dual-energy CT VNCa reconstructions yielded excellent diagnostic accuracy for depicting traumatic knee bone marrow edema compared with MRI.

Key Points

• Dual-energy CT (DECT) virtual non-calcium (VNCa) reconstructions are highly accurate in depicting bone marrow edema of the femur and tibia.

• Diagnostic confidence, image noise, and image quality were rated as equivalent in VNCa reconstructions and MRI (magnetic resonance imaging) series.

• VNCa images may serve as an alternative imaging approach to MRI.

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Abbreviations

AUC:

Area under the curve

CT:

Computed tomography

HU:

Hounsfield unit

MRI:

Magnetic resonance imaging

MSK:

Musculoskeletal

NPV:

Negative predictive value

PD:

Proton density

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

ROI:

Region of interest

VNCa:

Virtual non-calcium

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Acknowledgments

This work won the RSNA Trainee Research Prize 2018 at the RSNA 2018 meeting.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Christian Booz, Jochen Nöske, Lukas Lenga, Simon S. Martin, Ibrahim Yel, Moritz H. Albrecht & Julian L. Wichmann

  2. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany

    Katrin Eichler, Tatjana Gruber-Rouh & Thomas J. Vogl

  3. Interdisciplinary Center for Neuroscience, Goethe-University of Frankfurt, Frankfurt am Main, Germany

    Nicole Huizinga

  4. Smart Reporting GmbH, Munich, Germany

    Julian L. Wichmann

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  1. Christian Booz
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Corresponding author

Correspondence to Julian L. Wichmann.

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Guarantor

The scientific guarantor of this publication is Prof. Dr. Thomas J. Vogl (Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt).

Conflict of interest

The authors of this manuscript declare relationships with the following companies: J.L.W. received speakers’ fees from GE Healthcare and Siemens Healthineers and is an employee of Smart Reporting GmbH. C.B. received speakers’ fees from Siemens Healthineers. M.H.A. received speakers’ fees from Siemens Healthineers and Bracco. All other authors report no potential conflicts of interest.

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No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Booz, C., Nöske, J., Lenga, L. et al. Color-coded virtual non-calcium dual-energy CT for the depiction of bone marrow edema in patients with acute knee trauma: a multireader diagnostic accuracy study. Eur Radiol 30, 141–150 (2020). https://doi.org/10.1007/s00330-019-06304-7

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