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Bone marrow edema in non-traumatic hip: high accuracy of dual-energy CT with water-hydroxyapatite decomposition imaging

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To evaluate the diagnostic performance of dual-energy CT with water-hydroxyapatite (HAP) imaging for bone marrow edema in patients with non-traumatic hip pain.

Methods

Forty patients (mean age, 58 years; 16 male and 24 female) who underwent rapid kVp-switching dual-energy CT and MRI within 1 month between April 2018 and February 2019 with hip pain but no trauma were enrolled. Two radiologists retrospectively evaluated 80 hip joints for the presence, extent (femoral head involved, head and neck, and head to intertrochanter), and severity (mild edema, moderate, severe) of bone marrow edema on dual-energy water-HAP images. Water mass density (mg/cm3) on water-HAP images was determined with region of interest–based quantitative analysis. MRI served as the standard of reference.

Results

Sensitivity, specificity, and accuracy of readers 1 and 2 for the identification of bone marrow edema in water-HAP images were 85% and 85%, 93% and 73%, and 89% and 79%, respectively. The area under the receiver operating characteristic curve was 0.96 for reader 1 and 0.91 for reader 2 for differentiation of the presence of edema from no edema. The optimal water mass density to classify the presence of edema for reader 1 was 951 mg/cm3 with 93% sensitivity and 93% specificity and for reader 2 was 957 mg/cm3 with 80% sensitivity and 80% specificity. The more severe the edema, the higher was the mean water density value (p < 0.035).

Conclusion

Dual-energy water-HAP images showed good diagnostic performance for bone marrow edema in patients with non-traumatic hip pain.

Key Points

• Dual-energy water-HAP imaging depicts bone marrow edema in patients with non-traumatic hip pain and may serve as an alternative to MRI in select patients.

• A cutoff value of 951 mg/cm 3 mean water mass density results in 93% sensitivity and 93% specificity for the detection of bone marrow edema.

• The more severe the bone marrow edema, the higher the mean water density value.

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Abbreviations

AUROC:

Area under the receiver operating characteristic

CI:

Confidence interval

CT:

Computed tomography

CTDI:

Computed tomography dose index

DECT:

Dual-energy computed tomography

HAP:

Hydroxyapatite

ICC:

Interclass correlation coefficient

MR:

Magnetic resonance

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

ROI:

Region of interest

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Acknowledgments

The authors thank research scientist Yunsub Jung and CT application specialist Kyoung-A Um for their technical support and help in preparing the manuscript.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Korea

    Wookon Son, Chankue Park & Hee Seok Jeong

  2. Department of Radiology, Pusan National University Hospital, Busan, Korea

    You Seon Song & In Sook Lee

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  1. Wookon Son
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  2. Chankue Park
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  3. Hee Seok Jeong
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Correspondence to Chankue Park.

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The scientific guarantor of this publication is Chankue Park.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Chankue Park) has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Son, W., Park, C., Jeong, H.S. et al. Bone marrow edema in non-traumatic hip: high accuracy of dual-energy CT with water-hydroxyapatite decomposition imaging. Eur Radiol 30, 2191–2198 (2020). https://doi.org/10.1007/s00330-019-06519-8

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