Dual-Energy CT of Material Decomposition Analysis for Detection with Bone Marrow Edema in Patients with Vertebral Compression Fractures

Rationale and objectives: This study investigated detecting bone marrow edema (BME) in patients with vertebral compression fractures. We compared dual-energy material density analysis images to magnetic resonance imaging (MRI), which is considered the gold standard.

Materials and methods: In this retrospective study, 260 vertebral bodies from 30 patients (11 males, 19 females, mean age of 81) were assessed by MRI and dual-energy material density analysis. Diagnostic accuracy was assessed using the receiver operating characteristic (ROC) curve. Fifty-two of the 260 vertebral bodies were considered to have BME based on the dual-energy material density analysis images; 50 were deemed to have BME by MRI.

Results: ROC analysis of the dual-energy material density analysis values revealed an area under the ROC curve of 0.95 for radiologist 1, 0.97 for radiologist 2, and 0.96 for radiologist 3. A mean cutoff value of 1032.6 mg/cm³ provided an overall sensitivity of 93.0% (95% confidence intervals [CI]: 86.0%-99.9%), specificity of 98.0% (95% CI: 95.5%-99.0%), accuracy of 97.0% (95% CI: 95.2%-99.0%), positive predictive value of 95.0% (95% CI: 81.0%-97.5%), and negative predictive value of 98.0% (95% CI: 93.0%-99.9%).

Conclusion: BME in patients with vertebral compression fractures can be detected using dual-energy material density analysis images.