Dual-energy CT in the diagnosis of occult acute scaphoid injury: a direct comparison with MRI.

Published on Dec 19, 2020in European Radiology4.101
· DOI :10.1007/S00330-020-07604-Z
Cheng Xie (John Radcliffe Hospital), Cheng Xie3
Estimated H-index: 3
(John Radcliffe Hospital)
+ 2 AuthorsRajat Chowdhury1
Estimated H-index: 1
(NOC: Nuffield Orthopaedic Centre)
Scaphoid injuries occult on plain radiography often require further imaging for definitive diagnosis. We investigate the utility of dual-energy computed tomography (DECT) for the detection of acute bone marrow oedema and fracture of scaphoid compared to MRI. Twenty patients who presented acutely (without prior injury) to the emergency department with clinically suspected occult scaphoid fracture and had MRI of the wrist were prospectively recruited to have DECT (GE Revolution CT). Material decomposition images of the water-calcium base pair were generated and assessed in conjunction with the monochromatic images to permit correlation of marrow signal changes with any cortical disruption for fracture confirmation. The assessment was performed by two musculoskeletal radiologists blinded from MRI results. The statistical difference of MRI and reviewers’ detection of acute bone oedema (1 = present, 0 = absent) was performed using the Friedman test (SPSS v.16). MRI showed acute scaphoid fracture and/or bone marrow oedema in 14/20 patients of which 6 also had cortical disruption. On DECT, reviewer A identified oedema in 13 and cortical disruption in 10 patients while reviewer B identified oedema in 10 and cortical disruption in seven of the 14 MRI positive patients. No statistically significant difference in oedema detection on MRI and reviewers of DECT (p value 0.61) but DECT was more sensitive at detecting cortical disruption. DECT has the capability to detect acute scaphoid oedema in addition to cortical fractures. However, compared to MRI, DECT has lower contrast resolution and less sensitive in the detection of mild oedema. • Dual-energy CT is able to detect acute traumatic scaphoid marrow oedema. • Dual-energy CT has greater detection rate of scaphoid fractures than MRI. • Dual-energy CT is an alternative to MRI for occult scaphoid injury.
#1Christian BoozH-Index: 13
#2Jochen NöskeH-Index: 3
Last. Ibrahim YelH-Index: 7
view all 11 authors...
Abstract Purpose To investigate the diagnostic accuracy of dual-energy computed tomography (CT) virtual non-calcium (VNCa) reconstructions for the depiction of traumatic bone marrow edema of the calcaneus. Method Data from 62 patients (33 women, 29 men; mean age: 41 years, range: 19-84 years) with acute tarsal trauma who had undergone third-generation dual-source dual-energy CT and 3-T magnetic resonance imaging (MRI) within seven days between January 2017 and July 2018 were retrospectively anal...
7 CitationsSource
#1Victor NeuhausH-Index: 7
#2Simon LennartzH-Index: 11
Last. Jan BorggrefeH-Index: 23
view all 11 authors...
Abstract Purpose To evaluate calcium suppressed images (CaSupp) in dual-layer detector computed tomography (DLCT) for the detection of bone marrow edema (BME) in vertebral fractures. Materials and methods The retrospective study was approved by the institutional review board. 34 patients with synchronous DLCT and MRI, who were diagnosed with one or more acute vertebral fractures, were included. MRI were systematically analyzed as reference standard. Two blinded and independent readers evaluated ...
11 CitationsSource
#1Ismail Tawakol Ali (Vancouver General Hospital)H-Index: 5
#2William D. Wong (UBC: University of British Columbia)H-Index: 2
Last. Savvas Nicolaou (Vancouver General Hospital)H-Index: 38
view all 7 authors...
OBJECTIVE. The purpose of this study is to determine the utility of dual-energy CT (DECT) for assessing carpal fractures and to obtain an attenuation value cutoff (in Hounsfield units) to identify bone marrow edema due to an acute carpal fracture. MATERIALS AND METHODS. In this retrospective study, 24 patients who presented with wrist fractures from September 3, 2014, through March 9, 2015, underwent imaging with DECT (80 and 140 kVp). Using the three-material decomposition algorithm specific fo...
15 CitationsSource
We aimed to determine whether bone marrow edema (BME) in acute traumatic scaphoid fracture could be demonstrated with dual-energy CT (DECT) using MRI as the gold standard. In recent years, virtual non-calcium (VNCa) images have been used to demonstrate BME in trauma cases, for example, in vertebral compression fractures, hip trauma to detect occult fractures and knee fractures. We present three cases of acute scaphoid trauma. Two patients had subtle or invisible fractures on x-ray and convention...
13 CitationsSource
#1Trenton Kellock (UBC: University of British Columbia)H-Index: 3
#2Savvas Nicolaou (UBC: University of British Columbia)H-Index: 38
Last. Patrick D. McLaughlin (UBC: University of British Columbia)H-Index: 20
view all 8 authors...
The results of this study illustrate that, when virtual noncalcium images are used in conjunction with CT bone reconstructions, sensitivity (95% and 100% [21 and 22 of 22 patients, respectively]) and specificity (99% and 100% [95 and 96 of 96 patients, respectively]) is high and diagnostic confidence in the exclusion of an acute hip fracture is improved over that with CT bone reconstruction alone.
38 CitationsSource
#1Bernhard PetritschH-Index: 2
#1Bernhard PetritschH-Index: 10
Last. Thorsten A. BleyH-Index: 39
view all 9 authors...
Visual and quantitative analyses of dual-energy virtual noncalcium images had excellent diagnostic performance in the depiction of traumatic bone marrow edema in patients with vertebral compression fractures.
53 CitationsSource
#1M. BiondiH-Index: 5
#2E. VanziH-Index: 3
Last. Luca Volterrani (UNISI: University of Siena)H-Index: 21
view all 14 authors...
Introduction Many studies aimed at validating the application of Dual Energy Computed Tomography (DECT) in clinical practice where conventional CT is not exhaustive. An example is given by bone marrow oedema detection, in which DECT based on water/calcium (W/Ca) decomposition was applied. In this paper a new DECT approach, based on water/cortical bone (W/CB) decomposition, was investigated. Materials and methods Eight patients suffering from marrow oedema were scanned with MRI and DECT. Two-mate...
16 CitationsSource
#1Wouter H. MalleeH-Index: 11
#2Junfeng WangH-Index: 12
Last. Job N. Doornberg (AMC: Academic Medical Center)H-Index: 2
view all 7 authors...
Background In clinically suspected scaphoid fractures, early diagnosis reduces the risk of non-union and minimises loss in productivity resulting from unnecessary cast immobilisation. Since initial radiographs do not exclude the possibility of a fracture, additional imaging is needed. Computed tomography (CT), magnetic resonance imaging (MRI) and bone scintigraphy (BS) are widely used to establish a definitive diagnosis, but there is uncertainty about the most appropriate method. Objectives The ...
31 CitationsSource
#1T. Reddy (Vancouver General Hospital)H-Index: 1
#2Patrick D. McLaughlin (Vancouver General Hospital)H-Index: 20
Last. Hugue Ouellette (Vancouver General Hospital)H-Index: 23
view all 7 authors...
The purpose of this study is to describe our initial clinical experience with dual-energy computed tomography (DECT) virtual non-calcium (VNC) images for the detection of bone marrow (BM) edema in patients with suspected hip fracture following trauma. Twenty-five patients presented to the emergency department at a level 1 trauma center between January 1, 2011 and January 1, 2013 with clinical suspicion of hip fracture and normal radiographs were included. All CT scans were performed on a dual-so...
40 CitationsSource
#1Songtao Ai (Mayo Clinic)H-Index: 3
#2Mingliang Qu (Mayo Clinic)H-Index: 11
Last. Cynthia H. McCollough (Mayo Clinic)H-Index: 76
view all 7 authors...
Objective The purpose of this study was to determine the ability of dual-energy computed tomography (DECT) and virtual non-calcium (VNCa) imaging to detect magnetic resonance imaging (MRI)-demonstrated bone bruises several weeks after unilateral knee injury.
35 CitationsSource
Cited By1
#1A. Narayanan (UTSW: University of Texas Southwestern Medical Center)
#2N. Dettori (UTSW: University of Texas Southwestern Medical Center)
Last. Avneesh Chhabra (UTSW: University of Texas Southwestern Medical Center)H-Index: 36
view all 0 authors...
AIM null To assesses whether utilising bone marrow oedema (BMO) maps improved fracture read times and reader confidence in a large series of acute lower extremity trauma dual-energy computed tomography (DECT) studies. null null null MATERIALS AND METHODS null One hundred and six DECT studies, including 60 fracture cases and 46 non-fracture cases, were evaluated retrospectively in this cross-sectional study. Three-dimensional (3D) BMO maps were generated for each study and coded to display skelet...
#1Felix Christoph Müller (Siemens)H-Index: 2
#1Felix C. Müller (Siemens)H-Index: 2
Last. Mikael Boesen (Frederiksberg Hospital)H-Index: 25
view all 9 authors...
Abstract Purpose Purpose of this study was to investigate Dual-energy CT (DECT) derived virtual non-calcium (VNCa) values for absolute quantification of the bone marrow composition in the wrist. Materials and Methods We prospectively included consecutive adult participants and examined their wrists with DECT. Ranges of VNCa and calcium values were measured in the carpal bones, radius and ulna using a semi-automatic method. Bones with bone marrow edema, assessed by two blinded radiologists, were ...