Moritz Kaup, Presenter: Nothing to Disclose

Julian Lukas Wichmann MD, Abstract Co-Author: Nothing to Disclose

Jan-Erik Scholtz MD, Abstract Co-Author: Nothing to Disclose

Martin Beeres MD, Abstract Co-Author: Nothing to Disclose

Josef Matthias Kerl MD, Abstract Co-Author: Research Consultant, Siemens AG Speakers Bureau, Siemens AG

Thomas Lehnert MD, Abstract Co-Author: Nothing to Disclose

Moritz Albrecht MD, Abstract Co-Author: Nothing to Disclose

Renate Maria Hammerstingl MD, Abstract Co-Author: Nothing to Disclose

Wolfgang Kromen, Abstract Co-Author: Nothing to Disclose

Thomas Josef Vogl MD, PhD, Abstract Co-Author: Nothing to Disclose

Ralf W. Bauer MD, Abstract Co-Author: Research Consultant, Siemens AG Speakers Bureau, Siemens AG

To evaluate whether virtual non-calcium (VNC) dual-energy computed tomography (DECT) can improve the detection rate of acute thoracolumbar vertebral compression fractures in osteoporotic patients on CT in correlation with magnetic resonance imaging (MRI).

In this prospective IRB-approved study, 31 patients with known osteoporosis and suspected acute vertebral compression fractures underwent second-generation DECT (80/140 kV) and MRI. Standard grayscale CT (M_0.4; bone kernel) and corresponding VNC-DECT reconstructions were calculated. Five blinded radiologists (1-7 years of experience in skeletal radiology) first evaluated the grayscale CT scans to detect vertebral compression fractures (acute and old). After each case, VNC fusion maps were evaluated to detect bone marrow edema indicative of acute fractures. Findings were compared with MRI as gold standard. Sensitivity, specificity, predictive values, intra- and interobserver agreements were calculated.

Compared with grayscale CT images, supplemental VNC-DECT showed a significantly higher (P<0.001) global sensitivity (95.1% vs. 70.1%), negative predictive value (NPV, 91.8% vs. 65.5%), and accuracy (90.2% vs. 77.7%). Specificity (83.0% vs. 89.6%) and positive predictive value (PPV, 89.4% vs. 91.4%) decreased due to increased false positive findings (23 vs.11). Differences regarding the detection of bone marrow edema between VNC-DECT and MRI were non-significant (P=0.417). Further analysis with the Youden-index confirmed a higher diagnostic performance for CT + VNC-DECT (0.780) compared to grayscale CT scans only (0.597; P<0.001). Global interobserver agreement regarding the evaluation of VNC-DECT series was substantial (intraclass correlation coefficient [ICC]: 0.655; 95% confidence intervals [CI]: 0.488, 0.779) while global intraobserver agreement between both CT image series was fair (ICC: 0.267; 95% CI: 0.080, 0.414).

VNC-DECT can accurately depict bone marrow edema in acute thoracolumbar vertebral compression fractures in osteoporotic patients with good correlation to MRI and significantly improves the detection rate of such fractures compared with grayscale CT scans.

DECT can significantly improve the detection rate of acute vertebral compression fractures on CT imaging and may be especially beneficial for patients with contraindications for MRI.

Kaup, M, Wichmann, J, Scholtz, J, Beeres, M, Kerl, J, Lehnert, T, Albrecht, M, Hammerstingl, R, Kromen, W, Vogl, T, Bauer, R, Detection of Bone Marrow Edema for Diagnosis of Osteoporotic Thoracolumbar Vertebral Compression Fractures Using Dual-Energy CT in Correlation with MRI.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007068.html