Dual-Energy-CT für muskuloskelettale Bildgebung

Zusammenfassung

Die Dual-Energy-Computertomografie (DECT) hat sich in den letzten Jahren als wertvolles Werkzeug in der rheumatologischen Bildgebung etabliert. Neben der Detektion von Harnsäurekristallen bei Gicht erlaubt sie durch virtuelle Kalziumsubtraktion auch die Darstellung von Knochenmarködemen, nach Kontrastmittelgabe die Detektion aktiver Weichteilentzündung. Gerade bei komplexen Differenzialdiagnosen oder Patienten mit MRT-Kontraindikationen bietet DECT einen erheblichen Zusatznutzen. Der Beitrag beleuchtet technische Hintergründe, Limitationen und klinische Einsatzmöglichkeiten in der muskuloskelettalen Diagnostik, insbesondere bei Gicht und rheumatoider Arthritis. Auch neue Entwicklungen wie photonenzählende CT-Detektoren und multiparametrische Auswertungen werden vorgestellt.

Schlüsselwörter

Dual-Energy-CT - Gicht - rheumatoide Arthritis - Knochenmarködem - Kristallarthropathie

Publication History

Article published online:
06 October 2025

• Literatur

• 1 McCollough CH, Leng S, Yu L. et al. Dual-and multi-energy CT: principles, technical approaches, and clinical applications. Radiology 2015; 276: 637-653
• 2 Grajo JR, Patino M, Prochowski A. et al. Dual energy CT in practice: basic principles and applications. Applied Radiology 2016; 45: 6
• 3 Garcia LIR, Azorin JFP, Almansa JF. A new method to measure electron density and effective atomic number using dual-energy CT images. Phys Med Biol 2015; 61: 265
• 4 Patino M, Prochowski A, Agrawal MD. et al. Material separation using dual-energy CT: current and emerging applications. Radiographics : a review publication of the Radiological Society of North America, Inc. 2016; 36: 1087-1105
• 5 Kiefer T, Diekhoff T, Hermann S. et al. Single source dual-energy computed tomography in the diagnosis of gout: Diagnostic reliability in comparison to digital radiography and conventional computed tomography of the feet. Eur J Radiol 2016; 85: 1829-1834 http://dx.doi.org/10.1016/j.ejrad.2016.08.004
• 6 Kaza RK, Platt JF, Cohan RH. et al. Dual-energy CT with single-and dual-source scanners: current applications in evaluating the genitourinary tract. Radiographics : a review publication of the Radiological Society of North America, Inc. 2012; 32: 353-369
• 7 Edmund J, Rønjom MF, van Overeem Felter M. et al. Split-filter dual energy computed tomography radiotherapy: From calibration to image guidance. Phys Imaging Radiat Oncol 2023; 28: 100495
• 8 Kordbacheh H, Baliyan V, Singh P. et al. Rapid kVp switching dual-energy CT in the assessment of urolithiasis in patients with large body habitus: preliminary observations on image quality and stone characterization. Abdominal Radiol 2019; 44: 1019-1026
• 9 Diekhoff T, Scheel M, Kress W. et al. Dual-energy computed tomography of the neck—optimizing tube current settings and radiation dose using a 3D-printed patient phantom. Quant Imaging Med Surg 2021; 11: 1144
• 10 Diekhoff T, Kotlyarov M, Mews J. et al. Iterative reconstruction may improve diagnosis of gout: an ex vivo (bio) phantom dual-energy computed tomography study. Investigative Radiol 2018; 53: 6 -–12
• 11 Schmolke SA, Diekhoff T, Mews J. et al. Deep learning reconstruction enhances tophus detection in a dual-energy CT phantom study. Sci Reports 2025; 15: 1-10
• 12 Rassouli N, Etesami M, Dhanantwari A. et al. Detector-based spectral CT with a novel dual-layer technology: principles and applications. Insights Imaging 2017; 8: 589-598
• 13 Tortora M, Gemini L, D’Iglio I. et al. Spectral photon-counting computed tomography: a review on technical principles and clinical applications. J Imaging 2022; 8: 112
• 14 Diekhoff T, Hermann KGA, Lambert RG. Future of low-dose computed tomography and dual-energy computed tomography in axial spondyloarthritis. Currt Rheumatol Reports 2022; 24: 198-205
• 15 Meinel FG, Bischoff B, Zhang Q. et al. Metal artifact reduction by dual-energy computed tomography using energetic extrapolation: a systematically optimized protocol. Investigative Radiol 2012; 47: 406-414
• 16 Diekhoff T, Kiefer T, Stroux A. et al. Detection and characterization of crystal suspensions using single-source dual-energy computed tomography: a phantom model of crystal arthropathies. Investigative Radiol 2015; 50: 255-260
• 17 Christiansen SN, Müller FC, Østergaard M. et al. Dual-energy CT in gout patients: Do all colour-coded lesions actually represent monosodium urate crystals?. Arthritis Res Ther 2020; 22: 212
• 18 Hamm CA, Hampe O, Mews J. et al. Quantitative dual-energy CT as a nondestructive tool to identify indicators for fossilized bone in vertebrate paleontology. Sci Reports 2022; 12: 16407
• 19 Diekhoff T, Hermann KG, Pumberger M. et al. Dual-energy CT virtual non-calcium technique for detection of bone marrow edema in patients with vertebral fractures: A prospective feasibility study on a single- source volume CT scanner. Eur J Radiol 2017; 87: 59-65
• 20 Ulas ST, Ziegeler K, Richter S-T. et al. Contrast-enhanced CT techniques and MRI perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study. Eur Radiol 2022; 32: 6376-6383
• 21 Pumberger M, Fuchs M, Engelhard N. et al. Disk injury in patients with vertebral fractures-a prospective diagnostic accuracy study using dual-energy computed tomography. Eur Radiol 2019; 29: 4495-4502
• 22 Kotlyarov M, Hermann KGA, Mews J. et al. Development and validation of a quantitative method for estimation of the urate burden in patients with gouty arthritis using dual-energy computed tomography. Eur Radiol 2020; 30: 404-412
• 23 Bongartz T, Glazebrook KN, Kavros SJ. et al. Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study. Ann Rheum Dis 2015; 74: 1072-1077
• 24 Mallinson PI, Coupal T, Reisinger C. et al. Artifacts in dual-energy CT gout protocol: a review of 50 suspected cases with an artifact identification guide. Am J Roentgenol 2014; 203: W103-W109
• 25 Kotlyarov M, Mews J, Ulas ST. et al. Influence of contrast medium on tophus detection using dual-energy CT: phantom study and clinical illustration. Eur Radiol Experiment 2023; 7: 43
• 26 Gibney B, Murray N. Dual-energy CT of spinal tophaceous gout. Radiology 2020; 296: 276-276
• 27 Toprover M, Mechlin M, Fields T. et al. Monosodium urate deposition in the lumbosacral spine of patients with gout compared with non-gout controls: A dual-energy CT study. Semin Arthritis Rheum 2022; 56: 152064
• 28 Ziegeler K, Hermann S, Hermann KGA. et al. Dual-energy CT in the differentiation of crystal depositions of the wrist: does it have added value?. Skeletal Radiol 2020; 49: 707-713
• 29 Ramon A, Bohm-Sigrand A, Pottecher P. et al. Role of dual-energy CT in the diagnosis and follow-up of gout: systematic analysis of the literature. Clin Rheumatol 2018; 37: 587-595
• 30 Chowalloor PV, Siew TK, Keen HI. Imaging in gout: A review of the recent developments. Ther Adv Musculoskelet Dise 2014; 6: 131-143
• 31 Diekhoff T, Scheel M, Hermann S. et al. Osteitis: a retrospective feasibility study comparing single-source dual-energy CT to MRI in selected patients with suspected acute gout. Skeletal Radiol 2017; 46: 185-190
• 32 Jans L, De Kock I, Herregods N. et al. Dual-energy CT: a new imaging modality for bone marrow oedema in rheumatoid arthritis. Ann Rheum Dis 2018; 77 (6)
• 33 Fukuda T, Umezawa Y, Asahina A. et al. Dual energy CT iodine map for delineating inflammation of inflammatory arthritis. Eur Radiol 2017; 27: 5034-5040
• 34 Diekhoff T, Ulas ST, Poddubnyy D. et al. Ultra-low-dose CT detects synovitis in patients with suspected rheumatoid arthritis. Ann Rheum Dis 2019; 78: 31-35
• 35 Ziegeler K, Diekhoff T, Hermann S. et al. Low-dose computed tomography as diagnostic tool in calcium pyrophosphate deposition disease arthropathy: focus on ligamentous calcifications of the wrist. Clin Experiment Rheumatol 2019; 37: 826-833
• 36 Ward IM, Scott JN, Mansfield LT. et al. Dual-energy computed tomography demonstrating destructive calcium pyrophosphate deposition disease of the distal radioulnar joint mimicking tophaceous gout. J Clin Radiol 2015; 21: 314-317
• 37 Diekhoff T, Engelhard N, Fuchs M. et al. Single-source dual-energy computed tomography for the assessment of bone marrow oedema in vertebral compression fractures: a prospective diagnostic accuracy study. Eur Radiol 2019; 29: 31-39
• 38 Vereecke E, Diekhoff T, Eshed I. et al. ESR Essentials: Imaging of sacroiliitis-practice recommendations by ESSR. Eur Radiol 2024; 34 (Suppl. 2)
• 39 Deppe D, Ziegeler K, Hermann KGA. et al. Dual-Energy-CT for osteitis and fat lesions in axial spondyloarthritis: How feasible is low-dose scanning?. Diagnostics 2023; 13: 776
• 40 Ulas ST, Mews J, Ohrndorf S. et al. Clinical impact of multiparametric contrast-enhanced dual-energy computed tomography in arthritis imaging–a prospective single-center study.. Arthritis Rheumatol 2025; Online ahead of print