A Comparison of Dual-Energy CT with MRI in the Detection of Traumatic Bone Marrow Edema in Distal Extremity Bones

Abstract

Objective: Our objective was to evaluate the performance of dual-energy computed tomography (DECT) in detecting post-traumatic bone marrow edema (BME) in distal extremities.Materials and Methods: We prospectively studied 31 consecutive patients (25 males) who presented within the first four weeks following distal extremity traumas (wrist, n=19; ankle, n=14) (protocol number: 2017/74). All patients underwent DECT and magnetic resonance imaging (MRI) within three days of presentation. Two independent radiologists analyzed DECT images for fractures and BME qualitatively. Computed tomography (CT) numbers on Virtual non-calcium (VNCa) images were obtained in both edematous and non-edematous areas for quantitative consensus assessment. We used MRI as a reference standard. Results: MRI identified BME in 56/71 bones (78.9%). The rates of BME detection on CT compared to MRI at the patient level were found to be statistically significantly lower, ex-cept for individuals over 40 years of age, women, those with 7-30 days between trauma and admission, and those with CT-detected fractures (p<0.05). The rates of BME detection on CT at the bone level, compared to MRI, were found to be statistically significantly lower (p<0.01), except for women and those with fractures detected on CT. The interobserver agreement for the qualitative analysis of BME was fair (kappa=0.407 and p<0.001). DECT's diagnostic accuracy rates in predicting BME were significantly higher in patients with fractures (p=0.028). CT numbers in edematous areas were significantly higher than in non-edematous areas (p<0.001).Conclusion: DECT may serve as an alternative for detecting post-traumatic BME in distal extremity bones. However, in our heterogeneous bone sample group, it exhibited low sensitivity and a low negative predictive value.