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Diagnostic accuracy of dual-energy CT for the detection of bone marrow edema in the appendicular skeleton: a systematic review and meta-analysis

  • Musculoskeletal
  • Published:
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Abstract

Objectives

This meta-analysis evaluated the diagnostic accuracy of dual-energy CT (DECT) for detecting bone marrow edema (BME) in the appendicular skeleton.

Methods

A systematic review of MEDLINE, EMBASE, Scopus, the Cochrane Library, and gray literature from inception through January 31, 2020, was performed. Original articles with > 10 patients evaluating the accuracy of DECT for detecting BME in the appendicular skeleton with a reference standard of MRI and/or clinical follow-up were included. Study details were independently extracted by two reviewers. Meta-analysis was performed using a bivariate random-effects model with multivariable meta-regression. Risk of bias (RoB) was evaluated with QUADAS-2.

Results

Twenty studies evaluating 790 patients for BME in the appendicular skeleton were included in analysis. The summary sensitivity, specificity, and AUC values for BME in the appendicular skeleton were 86% (95% confidence interval [CI] 82–89%), 93% (95% CI 90–95%), and 0.95, respectively. Quantitative analysis had a higher sensitivity than qualitative analysis on meta-regression (p = 0.01), but no difference in specificity (p = 0.28). No other covariates contributed to variability in accuracy (etiology (trauma vs non-trauma); location (upper vs lower extremity); and RoB). Studies demonstrated generally low or unclear RoB and applicability. Eight studies included index tests with high RoB when quantitative assessments used a retrospective cut-off value.

Conclusions

DECT demonstrates a higher specificity than sensitivity and AUC > 0.9. In scenarios where MRI availability is limited or contraindicated, DECT could be an alternative to MRI for detecting BME in the appendicular skeleton. However, limitations in sources of variability and RoB warrant continued study.

Key Points

• Twenty studies evaluating 790 patients for bone marrow edema in the appendicular skeleton with dual-energy CT were included in analysis.

• The summary sensitivity, specificity, and AUC values for detecting bone marrow in the appendicular skeleton were 86% (95% confidence interval [CI] 82–89%), 93% (95% CI 90–95%), and 0.95, respectively.

• In scenarios where MRI availability is limited or is contraindicated, DECT could be an alternative to MRI for detecting bone marrow edema in the appendicular skeleton.

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Abbreviations

BME:

Bone marrow edema

DECT:

Dual-energy computed tomography

FN:

False negative

FN:

False positive

MRI:

Magnetic resonance imaging

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies-2

ROC:

Receiver operator characteristic

TN:

True negative

TP:

True positive

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Funding

Studentship funding for this systematic review was provided through an Office of the Provost and VP (Academic) Summer Student Award from the University of Alberta Faculty of Medicine and Dentistry, and through the Radiology Endowment Fund from the University of Alberta Department of Radiology and Diagnostic Imaging.

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Authors and Affiliations

  1. Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada

    Mitchell P. Wilson, Kevin Lui, Dorian Nobbee, Prayash Katlariwala & Gavin Low

  2. Evidence-Based Practice Center, Mayo Clinic, Room 2-54, 205 3rd Ave SW, Rochester, MN, 55905, USA

    Mohammad H. Murad

  3. Departments of Radiology and Epidemiology, University of Ottawa/The Ottawa Hospital Research Institute, 501 Smyth Road, Box 232, Ottawa, Ontario, K1H-8L6, Canada

    Matthew D. F. McInnes

  4. Department of Radiology, University of Ottawa, 501 Smyth Road, Box 232, Ottawa, Ontario, K1H-8L6, Canada

    Trevor A. McGrath

Authors
  1. Mitchell P. Wilson
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  3. Dorian Nobbee
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  5. Matthew D. F. McInnes
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  7. Prayash Katlariwala
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Corresponding author

Correspondence to Mitchell P. Wilson.

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Guarantor

The scientific guarantor of this publication is Mitchell P Wilson.

Conflict of interest

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

Three of the authors have significant statistical expertise (MHM, MDFM, TAM).

Informed consent

Written informed consent was not required for this study because it included only de-identified data with individual studies acquiring ethical approval from their home institution where necessary.

Ethical approval

Institutional review board approval was not required because it included only de-identified data with individual studies acquiring ethical approval from their home institution where necessary.

Methodology

• Systematic review and meta-analysis using a bivariate random-effects model with multivariable meta-regression

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Appendix

Appendix

Table 6 Search strategy by database
Full size table
Table 7 Performance results for individual studies by site of pathology
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Wilson, M.P., Lui, K., Nobbee, D. et al. Diagnostic accuracy of dual-energy CT for the detection of bone marrow edema in the appendicular skeleton: a systematic review and meta-analysis. Eur Radiol 31, 1558–1568 (2021). https://doi.org/10.1007/s00330-020-07236-3

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