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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2020; 30(01): 59-63
DOI: 10.4103/ijri.IJRI_59_19
Musculoskeletal Imaging

Diagnostic accuracy of dual energy CT in the assessment of traumatic bone marrow edema of lower limb and its correlation with MRI

Harsh Yadav
Department of Radiodiagnosis, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
,
Sachin Khanduri
Department of Radiodiagnosis, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
,
Poonam Yadav
Department of Radiodiagnosis, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
,
Sushma Pandey
Department of Radiodiagnosis, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
,
Vivek Kumar Yadav
Department of Radiodiagnosis, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
,
Shahla Khan
Department of Radiodiagnosis, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
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Abstract

Background: Bone marrow edema is assumed to be caused as a result of trabecular microfractures that are detected by MRI. As MRI is not widely available in countries like India, this study aims to encourage the use of DECT in detection of bone edema as evidence with comparable efficiency to MRI. Aim: To assess the diagnostic accuracy of dual-energy CT in detecting bone marrow edema in patients of trauma of lower limb and correlate it with MRI. Setting and Design: It is a cross-sectional study. Materials and Methods: The study included 40 patients of age 15–70 years irrespective of sex. All the patients of lower extremity trauma underwent DECT and MRI evaluation after clinical evaluation. All the images were postprocessed on a work station and were further evaluated by a radiologist. Results: Mean attenuation at fractured site observed by Dual energy CT was found to be significantly higher as compared to that at adjacent site (170.75 ± 33.99 vs. 19.73 ± 22.50 HU). The sensitivity and specificity of dual energy CT as compared to MRI in detecting bone marrow edema were 94.1% and 91.3%, respectively. Of the 40 cases enrolled in the study, agreement of MRI and Dual energy CT was observed in 37 (92.5%). Conclusion: Dual energy CT can be an effective alternative to MRI in the detection of bone marrow edema in patients of lower limb trauma. Dual energy CT can also be used in patients in whom MRI is contraindicated.

Keywords

Bone marrow edema - DECT - lower limb - trauma - MRI


Publication History

Received: 07 March 2019

Accepted: 28 January 2020

Article published online:
19 July 2021

© 2020. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Eustace S, Keogh C, Blake M, Ward RJ, Oder PD, Dimasi M. MR imaging of bone oedema: Mechanisms and interpretation. Clin Radiol 2001; 56: 4-12
    CrossrefPubMedSearch in Google Scholar
  • 2 Hofmann S, Kramer J, Vakil-Adli A, Aigner N, Breitenseher M. Painful bone marrow edema of the knee: Differential diagnosis and therapeutic concepts. OrthopClin N Am 2004; 35 (03) 321-33
    CrossrefPubMedSearch in Google Scholar
  • 3 Boks SS, Vroegindeweij D, Koes BW, Hunink MG, Bierma-Zeinstra SM. Follow-up of occult bone lesions detected at MR imaging: Systematic review. Radiology 2006; 238: 853-62
    CrossrefPubMedSearch in Google Scholar
  • 4 Vincken PW, Ter Braak BP, van Erkel AR, Coerkamp EG, Mallens WM, Bloem JL. Clinical consequences of bone bruise around the knee. Eur Radiol 2006; 16: 97-107
    CrossrefPubMedSearch in Google Scholar
  • 5 Pache G, Krauss B, Strohm P, Saueressig U, Blanke P, Bulla S. et al. Dual-energy CT virtual noncalcium technique: Detecting posttraumatic bone marrow lesions--feasibility study. Radiology 2010; 256: 617-24
    CrossrefPubMedSearch in Google Scholar
  • 6 Sanders TG, Medynski MA, Feller JF, Lawhorn KW. Bone contusion patterns of the knee at MR imaging: Footprint of the mechanism of injury. Radiographics 2000; 20: S135-51
    CrossrefPubMedSearch in Google Scholar
  • 7 Guggenberger R, Gnannt R, Hodler J, Krauss B, Wanner GA, Csuka E. et al. Diagnostic performance of dual-energy CT for the detection of traumatic bone marrow lesions in the ankle: Comparison with MR imaging. Radiology 2012; 264: 164-73
    CrossrefPubMedSearch in Google Scholar
  • 8 Seo SH, Sohn YJ, Lee CH, Park SH, Kim HW, Juhng SK. Dual-energy CT for detection of traumatic bone bruises in the knee joint. J Korean Soc Radiol 2013; 69: 487-94
    CrossrefSearch in Google Scholar
  • 9 Wang CK, Tsai JM, Chuang MT, Wang MT, Huang KY, Lin RM. Bone marrow edema in vertebral compression fractures: Detection with dual-energy CT. Radiology 2013; 269: 525-33
    CrossrefPubMedSearch in Google Scholar
  • 10 Ai S, Qu M, Glazebrook KN, Liu Y, Rhee PC, Leng S. et al. Use of dual-energy CT and virtual non-calcium techniques to evaluate post-traumatic bone bruises in knees in the subacute setting. Skeletal Radiol 2014; 43: 1289-95
    CrossrefPubMedSearch in Google Scholar
  • 11 Reddy T, McLaughlin PD, Mallinson PI, Reagan AC, Munk PL, Nicolaou S. et al. Detection of occult, undisplaced hip fractures with a dual-energy CT algorithm targeted to detection of bone marrow edema. Emerg Radiol 2015; 22: 25-9
    CrossrefPubMedSearch in Google Scholar
  • 12 Kaup M, Wichmann JL, Scholtz JE, Beeres M, Kromen W, Albrecht MH. et al. Dual-energy CT-based display of bone marrow edema in osteoporotic vertebral compression fractures: Impact on diagnostic accuracy of radiologists with varying levels of experience in correlation to MR imaging. Radiology 2016; 280: 510-9
    CrossrefPubMedSearch in Google Scholar
  • 13 Karaca L, Yuceler Z, Kantarci M, Çakır M, Sade R, Calıkoglu C. et al. The feasibility of dual-energy CT in differentiation of vertebral compression fractures. Br J Radiol 2016; 89: 20150300
    CrossrefPubMedSearch in Google Scholar
  • 14 Dareez NM, Dahlslett KH, Engesland E, Lindland ES. Scaphoid fracture: Bone marrow edema detected with dual-energy CT virtual non-calcium images and confirmed with MRI. Skeletal Radiol 2017; 46: 1753-6
    CrossrefPubMedSearch in Google Scholar
  • 15 Petritsch B, Kosmala A, Weng AM, Krauss B, Heidemeier A, Wagner R. et al. Vertebral compression fractures: Third-generation dual-energy CT for detection of bone marrow edema at visual and quantitative analyses. Radiology 2017; 284: 161-8
    CrossrefPubMedSearch in Google Scholar
  • 16 Kellock TT, Nicolaou S, Kim SSY, Al-Busaidi S, Louis LJ, O’Connell TW. et al. Detection of bone marrow edema in nondisplaced hip fractures: Utility of a virtual unenhanced dual-energy CT application. Radiology 2017; 284: 798-805
    CrossrefPubMedSearch in Google Scholar
  • 17 Ali IT, Wong WD, Liang T, Khosa F, Mian M, Jalal S. et al. Clinical utility of dual-energy CT analysis of bone marrow edema in acute wrist fractures. Am J Roentgenol 2018; 210: 842-7
    CrossrefPubMedSearch in Google Scholar