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Dual-energy CT as an innovative method for diagnosing fragility fractures of the pelvic ring: a retrospective comparison with MRI as the gold standard

Archives of Orthopaedic and Trauma Surgery volume 140, pages 473–480 (2020)Cite this article

Abstract

Introduction

As the average age of society increases, so does the number of cases of fragility fractures of the pelvis (FFP). Magnetic resonance imaging (MRI) can visualise associated oedema and is thus the gold standard for diagnosing such fractures. MRI, however, is costly, not always available, and involves certain exclusion criteria. Dual-energy computed tomography (DECT) appears to be a promising alternative. It is unclear, however, whether it could be used for diagnosing FFP with similar sensitivity/specificity. The aim of our study was thus to compare conventional CT and DECT with MRI in cases of suspected FFP.

Materials and methods

A total of 46 patients with suspected FFP underwent MRI, CT and DECT scans. There were three comparison groups for each of these patients: conventional CT image analysis without dual-energy modification (Arm 1), DECT analysis (Arm 2) and MRI as the gold standard (Arm 3). Diagnosis and FFP classification were performed by a radiologist in random order and without clinical information. The sensitivity and specificity of conventional CT and DECT were calculated in comparison with MRI as the reference standard.

Results

With 100% sensitivity and specificity, DECT is on par with MRI when it comes to diagnosing fragility fractures of the pelvis and is superior to conventional CT (90.3% sensitivity, 100% specificity). In terms of classification as well, there were no differences between DECT and MRI. On conventional CT, on the other hand, 16 patients were classified differently than they were on MRI.

Conclusions

Our study shows DECT to be reliable and superior to conventional CT in terms of oedema detection and specific fracture classification in FFP. DECT thus combines the advantages of conventional CT (good visualisation of bone matter) and MRI (medullary cavity and visualisation of occult fractures).

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Affiliations

  1. Department of Trauma Surgery and Orthopaedics, Bundeswehr Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany

    Hans-Georg Palm, Patricia Lang, Lukas Sailer & Benedikt Friemert

  2. Department of Radiology, Bundeswehr Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany

    Carsten Hackenbroch

Authors
  1. Hans-Georg Palm
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  2. Patricia Lang
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  3. Carsten Hackenbroch
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  4. Lukas Sailer
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  5. Benedikt Friemert
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Correspondence to Hans-Georg Palm.

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Palm, HG., Lang, P., Hackenbroch, C. et al. Dual-energy CT as an innovative method for diagnosing fragility fractures of the pelvic ring: a retrospective comparison with MRI as the gold standard. Arch Orthop Trauma Surg 140, 473–480 (2020). https://doi.org/10.1007/s00402-019-03283-8

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  • DOI: https://doi.org/10.1007/s00402-019-03283-8

Keywords

  • Dual-energy CT
  • MRI
  • Fragility fracture
  • Pelvis
  • Sacrum
  • FFP classification