Diagnostic accuracy of dual-energy computed tomography (DECT) to detect non-traumatic bone marrow edema: A systematic review and meta-analysis.

PURPOSE: This meta-analysis aimed to evaluate the diagnostic performance of dual-energy computed tomography (DECT) for detecting bone marrow edema (BME) in non-traumatic patients. METHODS: A systematic search of PubMed, EMBASE, and the Cochrane Library databases was performed up to October 1, 2021 for relevant original studies. Study details were extracted by two independent reviewers. A bivariate mixed-effects regression model was used to assess comprehensive diagnostic performance, and a subgroup analysis was performed to evaluate sources of variability. The risk of bias was evaluated with the QUADAS-2 tool. RESULTS: Ten studies involving 2463 regions, including hands, ankles, hips, and sacroiliac joints, were evaluated in this meta-analysis. Summary sensitivity, specificity, and area under the receiver operating characteristic curve values for BME were 88.4% (95% confidence interval (CI) 82.4%-92.5%), 96.1% (95% CI 94.4%-97.3%), and 0.98 (95% CI 96%-99%), respectively. The subgroup analysis showed that studies using a thicker slice (≥1 mm) had a higher sensitivity, and studies with older patients (≥60 years), fewer included patients (<40), and bones other than the pelvis had a higher specificity. Studies presented a generally low or unclear risk for bias and applicability concerns. CONCLUSIONS: DECT has an excellent diagnostic performance for detecting BME in non-traumatic patients and may provide an alternative to magnetic resonance imaging (MRI) for the detection of non-traumatic BME in the future, especially when MRI is unavailable or contraindicated.

Prediction of Intracerebral Hemorrhage After Endovascular Treatment of Acute Ischemic Stroke: Combining Quantitative Parameters on Dual-Energy CT with Clinical Related Factors.

OBJECTIVES: To evaluate the predictive value of dual-energy CT (DECT) quantitative parameters and clinical influence factors for intracerebral hemorrhage (ICH) complications after endovascular treatment in patients with acute ischemic stroke (AIS). METHODS: Seventy-two consecutive patients who underwent brain DECT immediately after endovascular treatment for AIS from November 2017 to October 2019 were included. Retrospectively, the volume of brain parenchymal hyperdensity area (HDA), the maximum iodine concentration, and maximum CT value on DECT images was evaluated and measured by two radiologists blinded to any clinical information independently. Follow-up CT imaging (24-72 h) were used to assess the development of ICH complications. DECT parameters and clinical influence factors were analyzed by Chi-square test or Fisher's exact test and Mann-Whitney U test. Receiver operating characteristic curves were generated for continuous variables. RESULTS: Follow-up CT images confirmed that forty of 72 patients (55.6%) developed ICH. The volume of HDA, median maximum iodine concentration and maximum CT value between ICH group and non-ICH group were significantly different (P < 0.001). Combining the DECT quantitative parameters with clinical predictors, receiver operating characteristic analysis revealed an area under the curve of 0.985, for identifying patients developing ICH with sensitivity, specificity, positive predictive value and negative predictive value were 90%, 100%, 100% and 88.9%, respectively. CONCLUSIONS: Three quantitative parameters of DECT and clinical predictors showed great predictive performance in identifing ICH complications in patients with brain parenchyma HDA after endovascular therapy, which may contribute to better clinical decision-making.

Detection of bone marrow edema in osteonecrosis of the femoral head using virtual noncalcium dual-energy computed tomography.

PURPOSE: To determine the diagnostic performance of virtual noncalcium (VNCa) dual-energy computed tomography (DECT) in the detection of bone marrow edema (BME) in participants with osteonecrosis of the femoral head (ONFH). METHODS: In this prospective study, 24 consecutive participants (15 men, 9 women; mean age, 44 years, range, 21-72 years) diagnosed with ONFH who underwent DECT and magnetic resonance imaging (MRI) between September 2019 and January 2020 were involved. Two independent readers visually evaluated color-coded VNCa images using a binary classification (0 = normal bone marrow, 1 = BME). MRI served as the reference standard for the presence of BME. Interobserver agreement for the visual evaluation of VNCa DECT images was calculated with κ statistics. We determined computed tomography (CT) numbers on VNCa images and weighted-average CT sets using region-of-interest-based quantitative analysis. The t-test was used to compare the differences of CT values between BME areas and normal bone marrow areas. Receiver operating characteristic (ROC) curve was used to select an optimal CT values of VNCa images for detecting BME. A p value of <0.05 was considered as statistically significant. RESULTS: The sensitivity, specificity, and accuracy of Reader 1 and Reader 2, respectively, in the identification of BME at DECT were 95 % and 89 % (18 and 17 of 19), 96 % and 96 % (25 and 25 of 26), and 93 % (43 and 42 of 45). Interobserver agreement was excellent (κ = 0.86). The VNCa CT numbers of the BME area and the normal bone marrow area were -28.6 (-17.9--39.4) HU and -97.9 (-91.3--104.4) HU, respectively, with statistical significance (t = -10.6, p < 0.001). The weighted-average CT numbers of the BME area and the normal bone marrow area were 152.4(122.2-182.7) HU and 121.1(103.6-183.6) HU, respectively, with no statistical significance (t = -2.0, p > 0.05). The area under the receiver operating characteristic curve was 0.99 in differentiation of the BME from normal bone marrow. A cut-off value of -57.2 HU yielded overall sensitivity, specificity, and accuracy, respectively, of 95 % (18 of 19), 100 % (26 of 26), and 98 % (44 of 45) detection of BME in participants with ONFH. CONCLUSION: Visual and quantitative analyses of VNCa images shows excellent diagnostic performance for assessing BME in participants with ONFH.