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Electron density dual-energy CT can improve the detection of lumbar disc herniation with higher image quality than standard and virtual non-calcium images

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To compare the diagnostic performance and image quality of dual-energy computed tomography (DECT) with electron density (ED) image reconstruction with those of DECT with standard CT (SC) and virtual non-calcium (VNCa) image reconstructions, for diagnosing lumbar disc herniation (L-HIVD).

Methods

A total of 59 patients (354 intervertebral discs from T12/L1 to L5/S1; mean age, 60 years; 30 women and 29 men) who underwent DECT with spectral reconstruction and 3-T MRI within 2 weeks were enrolled between March 2021 and February 2022. Four radiologists independently assessed three image sets of randomized ED, SC, and VNCa images to detect L-HIVD at 8-week intervals. The coefficient of variance (CV) and the Weber contrast of the ROIs in the normal and diseased disc to cerebrospinal fluid space (NCR-normal/-diseased, respectively) were calculated to compare the image qualities of the noiseless ED and other series.

Results

Overall, 129 L-HIVDs were noted on MRI. In the detection of L-HIVD, ED showed a higher AUC and sensitivity than SC and VNCa; 0.871 vs 0.807 vs 833 (p = 0.002) and 81% vs 70% vs 74% (p = 0.006 for SC), respectively. CV was much lower in all measurements of ED than those for SC and VNCa (p < 0.001). Furthermore, NCR-normal and NCR-diseased were the highest in ED (ED vs SC in NCR-normal and NCR-diseased, p =  0.001 and p = 0.004, respectively; ED vs VNCa in NCR-diseased, p = 0.044).

Conclusion

Compared to SC and VNCa images, DECT with ED reconstruction can enhance the AUC and sensitivity of L-HIVD detection with a lower CV and higher NCR.

Clinical relevance statement

To our knowledge, this is the first study to quantify the image quality of noiseless ED images. ED imaging may be helpful for detecting L-HIVD in patients who cannot undergo MRI.

Key Points

  • ED images have diagnostic potential, but relevant quantitative analyses of image quality are limited.

  • ED images detect disc herniation, with a better coefficient of variance and normalized contrast ratio values.

  • ED images could detect L-HIVD when MRI is not an option.

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Abbreviations

AUC:

Area under the ROC curve

CV:

Coefficient of variance

DECT:

Dual-energy CT

ED:

Electron density

HU:

Hounsfield units

NCR:

Normalized contrast ratio

NPV:

Negative predictive value

PPV:

Positive predictive value

SC:

Standard CT

VNCa:

Virtual non-calcium

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Acknowledgements

The authors thank Youngmi Chun and Seonyoung Kang of Phillips Healthcare for their insightful discussions and assistance.

Funding

This study was supported by a grant from Korea University.

Author information

Author notes

  1. Juhyun Jeong and Sungwon Ham contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, South Korea

    Juhyun Jeong, Euddeum Shim & Baek Hyun Kim

  2. Healthcare Readiness Institute for Unified Korea, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, South Korea

    Sungwon Ham

  3. Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea

    Woo Young Kang

  4. Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea

    Chang Ho Kang, Kyung-Sik Ahn & Kyu-Chong Lee

  5. Medical Science Research Center, Korea University College of Medicine, Seoul, South Korea

    Hangseok Choi

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Correspondence to Euddeum Shim.

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The scientific guarantor of this publication is Euddeum Shim.

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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

Hangseok Choi, PhD has significant statistical expertize.

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Written informed consent was waived by the Institutional Review Board.

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  • Retrospective

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  • Performed at one institution

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Jeong, J., Ham, S., Shim, E. et al. Electron density dual-energy CT can improve the detection of lumbar disc herniation with higher image quality than standard and virtual non-calcium images. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10782-9

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  • DOI: https://doi.org/10.1007/s00330-024-10782-9

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