Diagnostic accuracy of dual-energy CT and virtual non-calcium techniques to evaluate bone marrow edema in vertebral compression fractures

  • Giovanni FotiEmail author
  • Alberto Beltramello
  • Matteo Catania
  • Stefano Rigotti
  • Gerardo Serra
  • Giovanni Carbognin



The aim of this study was to evaluate DECT diagnostic accuracy in the identification of vertebral bone marrow edema, using MRI as standard of reference.


This prospective institutional review board-approved study included 76 consecutive patients (29 males and 47 females; mean age 62.3, range 51–82 years) studied with DECT (90 kV and tin filter 150 kV) and MRI within 7 days. Three radiologists evaluated DECT (reader 1 and 2) and MRI images (reader 3). Diagnostic accuracy of the DECT maps (qualitative assessment) and of the CT numbers (quantitative assessment), interobserver and intraobserver agreements were calculated.


MRI revealed 61 edematous vertebrae and 52 collapsed non-edematous vertebrae. The sensitivity, specificity, PPV and NPV and accuracy of the qualitative assessment of the DECT maps were 88.6, 92.3, 93.1, 87.3 and 90.3%, for reader 1, 90.2, 90.3, 91.6, 88.7 and 90.3, for reader 2, and 91.8, 90.4, 91.6, 90.4 and 91.1% for quantitative analysis, respectively. DECT numbers were significantly different between positive (mean − 23 HU, range − 189, 29 HU) and negative cases (mean − 126 HU, range − 321, − 66 HU) with p < 0.001. The ROC curve analysis revealed an AUC of 0.886 (95% confidence interval 0.722–0.913). The interobserver and intraobserver agreements were near perfect (k = 0.87 and k = 0.83, respectively).


DECT represents an accurate imaging technique for demonstrating bone marrow edema in vertebral compression fracture, if compared to MRI.


Vertebral compression fractures MRI TIRM Dual-energy CT Bone marrow edema 



Dual-energy computed tomography


Magnetic resonance imaging


Positive predictive value


Negative predictive value


Receiver operator curve


Area under the curve


Turbo inversion-recovery magnitude sequences


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standard.

Informed consent

Informed consent was obtained from all patients enrolled for this prospective study.


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Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyIRCCS Sacro Cuore Don Calabria HospitalNegrarItaly
  2. 2.Department of Orthopaedic SurgeryIRCCS Sacro Cuore Don Calabria HospitalNegrarItaly
  3. 3.Department of Anesthesia and Analgesic TherapyIRCCS Sacro Cuore Don Calabria HospitalNegrarItaly

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