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Extent of bone marrow edema on dual-energy CT aids in differentiation of acute from post-acute fractures of lower legs

  • Computed Tomography
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Abstract

Objectives

Bone marrow edema (BME) from dual-energy CT is useful to direct attention to radiographically occult fractures. The aim was to characterize utility of BME of lower extremity (LE) fractures with the hypothesis that stabilized and post-acute fractures exhibit decreased extent and frequency of BME than non-stabilized and acute fractures, respectively.

Methods

An IRB-approved retrospective review of known LE fractures. A total of 141 cases met inclusion criteria, including 82 fractures without splint/cast stabilization, and 59 cases with stabilization. Two readers independently recorded BME, and its multiplicity and area (mm2). A separate reader assessed fracture location, comminution, and chronicity. Wilcoxon rank sum test, multiple regression, intraclass correlation (ICC), kappa statistics, and chi-square tests were used.

Results

BME was significantly larger in non-stabilized (859.3 mm2 (420.6–1451.8)) than stabilized fractures (493.5 mm2 (288.8–883.2)), p = .011). Comminuted (p = 0.006), non-stabilized (p = 0.0004), and acute fractures (p = 0.036) were all associated with larger BME area. BME presence had excellent results for both stabilized (Cohen’s Kappa = 0.81) and non-stabilized fractures (Cohen’s Kappa = 0.84). ICC for BME area showed excellent correlation for both stabilized (ICC = 0.78) and non-stabilized groups (ICC = 0.86). BME multiplicity showed excellent agreement for stabilized (ICC = 0.81) and good agreement for non-stabilized (ICC = 0.67) fractures. Lastly, stabilized cases showed increased multiplicity of BME compared to non-stabilized fractures (p < 0.001).

Conclusions

BME evaluation can assist in differentiation of acute versus post-acute fractures. Extent of BME is reduced with splint/cast stabilization, which may limit its accuracy in detection of lower extremity fractures.

Key Points

• Evaluation of bone marrow edema on dual-energy CT aids in differentiation of acute versus post-acute fracture.

• Bone marrow edema evaluation is limited in the setting of post-acute or stabilized fractures.

• There is decreased frequency and extent of bone marrow edema in post-acute, non-comminuted, and stabilized fractures.

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Abbreviations

BME:

Bone marrow edema

DECT:

Dual-energy computed tomography

EMR:

Electronic medical records

HIPAA:

Health Insurance Portability and Accountability Act

ICC:

Intraclass correlation

IRB:

Institutional review board

LE:

Lower extremity

mm:

Millimeter

MSK:

Musculoskeletal

ORIF:

Open reduction and internal fixation

PACS:

Picture Archiving and Communications System

XR:

X-ray

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Funding

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

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Authors and Affiliations

  1. Radiology, UT Southwestern Medical Center, Dallas, TX, 75022, USA

    Shamrez Haider, Parham Pezeshk, Yin Xi, Waleed Abdellatif & Avneesh Chhabra

  2. Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Shamrez Haider & Avneesh Chhabra

  3. Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA

    Yin Xi

Authors
  1. Shamrez Haider
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  2. Parham Pezeshk
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  3. Yin Xi
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  4. Waleed Abdellatif
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  5. Avneesh Chhabra
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Corresponding author

Correspondence to Shamrez Haider.

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Guarantor

The scientific guarantor of this publication is Dr. Avneesh Chhabra (MD, MBA).

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

AC serves as a consultant for ICON Medical and Treace Medical Concepts, Inc. AC also receives royalties from Jaypee and Wolters. AC is a medical advisor and received research grant from ImageBiopsy Lab Inc.

The remaining authors do not report any relationships with any companies.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• cross-sectional study

• performed at one institution

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Haider, S., Pezeshk, P., Xi, Y. et al. Extent of bone marrow edema on dual-energy CT aids in differentiation of acute from post-acute fractures of lower legs. Eur Radiol 33, 4094–4102 (2023). https://doi.org/10.1007/s00330-022-09373-3

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  • DOI: https://doi.org/10.1007/s00330-022-09373-3

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