Thomas Beyer, Erik Volmer, Patrick Gahr, Marc-André Weber
{"title":"双能CT检测创伤性椎体骨髓水肿的诊断准确性:与MRI在一级创伤中心的前瞻性比较研究。","authors":"Thomas Beyer, Erik Volmer, Patrick Gahr, Marc-André Weber","doi":"10.1007/s00234-025-03763-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Traumatic vertebral fractures present a significant diagnostic challenge in emergency settings. Magnetic resonance imaging (MRI) excels in detecting bone marrow edema but faces practical limitations in acute trauma care. This prospective study evaluates the diagnostic accuracy of Dual-Energy Computed Tomography (DECT) in detecting traumatic vertebral bone marrow edema within a Level I trauma center environment.</p><p><strong>Methods: </strong>Between May 2020 and July 2023, 291 DECT examinations were performed on adult patients presenting with suspected or confirmed spinal injury. From these, 233 (80.1%) met quality criteria for analysis. A subgroup of 47 patients underwent additional MRI as reference standard, with 44 (93.6%) providing diagnostically evaluable images. Two board-certified radiologists independently assessed vertebral bone marrow edema presence in blinded, randomized evaluations using both modalities. Diagnostic parameters, examination times, radiation exposure, and cost-efficiency were analyzed.</p><p><strong>Results: </strong>DECT demonstrated an overall sensitivity of 82.9% and specificity of 96.6% for detecting vertebral bone marrow edema compared to MRI. The thoracolumbar junction showed highest sensitivity (91.7% for L3). DECT examination time was 7.2 minutes (including post-processing) versus 12 minutes for MRI, meaning MRI required 66.7% more time than DECT. DECT radiation exposure showed a mean dose-length product increase of only 3% compared to conventional CT. Body mass index showed no significant influence on DECT interpretability (p=0.196) or diagnostic accuracy except in isolated segments (L3, T11). Cost-benefit analysis revealed potential savings of 49.1% (€104.40) per spinal segment with DECT-based diagnostic pathways.</p><p><strong>Conclusion: </strong>DECT offers high diagnostic accuracy for detecting traumatic vertebral bone marrow edema with substantial time and cost advantages compared to MRI. The technique demonstrates particular value in acute trauma settings, while acknowledging limitations from artifacts (19.9% of cases) primarily caused by medical devices. These findings support implementing DECT as an efficient alternative to MRI in spinal trauma diagnostics.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diagnostic accuracy of Dual-Energy CT in detecting traumatic vertebral bone marrow edema: a prospective comparative study with MRI in the context of a level I trauma center.\",\"authors\":\"Thomas Beyer, Erik Volmer, Patrick Gahr, Marc-André Weber\",\"doi\":\"10.1007/s00234-025-03763-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Traumatic vertebral fractures present a significant diagnostic challenge in emergency settings. Magnetic resonance imaging (MRI) excels in detecting bone marrow edema but faces practical limitations in acute trauma care. This prospective study evaluates the diagnostic accuracy of Dual-Energy Computed Tomography (DECT) in detecting traumatic vertebral bone marrow edema within a Level I trauma center environment.</p><p><strong>Methods: </strong>Between May 2020 and July 2023, 291 DECT examinations were performed on adult patients presenting with suspected or confirmed spinal injury. From these, 233 (80.1%) met quality criteria for analysis. A subgroup of 47 patients underwent additional MRI as reference standard, with 44 (93.6%) providing diagnostically evaluable images. Two board-certified radiologists independently assessed vertebral bone marrow edema presence in blinded, randomized evaluations using both modalities. Diagnostic parameters, examination times, radiation exposure, and cost-efficiency were analyzed.</p><p><strong>Results: </strong>DECT demonstrated an overall sensitivity of 82.9% and specificity of 96.6% for detecting vertebral bone marrow edema compared to MRI. The thoracolumbar junction showed highest sensitivity (91.7% for L3). DECT examination time was 7.2 minutes (including post-processing) versus 12 minutes for MRI, meaning MRI required 66.7% more time than DECT. DECT radiation exposure showed a mean dose-length product increase of only 3% compared to conventional CT. Body mass index showed no significant influence on DECT interpretability (p=0.196) or diagnostic accuracy except in isolated segments (L3, T11). Cost-benefit analysis revealed potential savings of 49.1% (€104.40) per spinal segment with DECT-based diagnostic pathways.</p><p><strong>Conclusion: </strong>DECT offers high diagnostic accuracy for detecting traumatic vertebral bone marrow edema with substantial time and cost advantages compared to MRI. The technique demonstrates particular value in acute trauma settings, while acknowledging limitations from artifacts (19.9% of cases) primarily caused by medical devices. 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Diagnostic accuracy of Dual-Energy CT in detecting traumatic vertebral bone marrow edema: a prospective comparative study with MRI in the context of a level I trauma center.
Background: Traumatic vertebral fractures present a significant diagnostic challenge in emergency settings. Magnetic resonance imaging (MRI) excels in detecting bone marrow edema but faces practical limitations in acute trauma care. This prospective study evaluates the diagnostic accuracy of Dual-Energy Computed Tomography (DECT) in detecting traumatic vertebral bone marrow edema within a Level I trauma center environment.
Methods: Between May 2020 and July 2023, 291 DECT examinations were performed on adult patients presenting with suspected or confirmed spinal injury. From these, 233 (80.1%) met quality criteria for analysis. A subgroup of 47 patients underwent additional MRI as reference standard, with 44 (93.6%) providing diagnostically evaluable images. Two board-certified radiologists independently assessed vertebral bone marrow edema presence in blinded, randomized evaluations using both modalities. Diagnostic parameters, examination times, radiation exposure, and cost-efficiency were analyzed.
Results: DECT demonstrated an overall sensitivity of 82.9% and specificity of 96.6% for detecting vertebral bone marrow edema compared to MRI. The thoracolumbar junction showed highest sensitivity (91.7% for L3). DECT examination time was 7.2 minutes (including post-processing) versus 12 minutes for MRI, meaning MRI required 66.7% more time than DECT. DECT radiation exposure showed a mean dose-length product increase of only 3% compared to conventional CT. Body mass index showed no significant influence on DECT interpretability (p=0.196) or diagnostic accuracy except in isolated segments (L3, T11). Cost-benefit analysis revealed potential savings of 49.1% (€104.40) per spinal segment with DECT-based diagnostic pathways.
Conclusion: DECT offers high diagnostic accuracy for detecting traumatic vertebral bone marrow edema with substantial time and cost advantages compared to MRI. The technique demonstrates particular value in acute trauma settings, while acknowledging limitations from artifacts (19.9% of cases) primarily caused by medical devices. These findings support implementing DECT as an efficient alternative to MRI in spinal trauma diagnostics.
期刊介绍:
Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.