Comprehensive comparison of dual-energy computed tomography and magnetic resonance imaging for the assessment of bone marrow edema and fracture lines in acute vertebral fractures

  • Objectives: To 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. Methods: Eighty-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. Results: For 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. Conclusions: DECT 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.
Author:Marco Cavallaro, Tommaso D’AngeloORCiD, Moritz Hans Ernst AlbrechtORCiDGND, Ibrahim YelORCiDGND, Simon S. MartinORCiDGND, Julian WichmannORCiDGND, Lukas Fabian LengaORCiDGND, Silvio MazziottiORCiD, Alfredo Blandino, Giorgio Ascenti, Marcello Longo, Thomas J. VoglORCiDGND, Christian BoozORCiDGND
Parent Title (English):European radiology
Place of publication:Berlin ; Heidelberg
Document Type:Article
Date of Publication (online):2021/07/02
Date of first Publication:2021/07/02
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2022/05/10
Tag:Magnetic resonance imaging; Multidetector computed tomography; Radiology; Retrospective study; Spinal fractures
Page Number:11
First Page:561
Last Page:571
Open Access funding enabled and organized by Projekt DEAL.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0