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Incremental diagnostic value of color-coded virtual non-calcium dual-energy CT for the assessment of traumatic bone marrow edema of the scaphoid

  • Computed Tomography
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Abstract

Objectives

To investigate the diagnostic accuracy of color-coded dual-energy CT virtual non-calcium (VNCa) reconstructions for the assessment of bone marrow edema (BME) of the scaphoid in patients with acute wrist trauma.

Methods

Our retrospective study included data from 141 patients (67 women, 74 men; mean age 43 years, range 19–80 years) with acute wrist trauma who had undergone third-generation dual-source dual-energy CT and 3-T MRI within 7 days. Eight weeks after assessment of conventional grayscale dual-energy CT scans for the presence of fractures, corresponding color-coded VNCa reconstructions were independently analyzed by the same six radiologists for the presence of BME. CT numbers on VNCa reconstructions were evaluated by a seventh radiologist. Consensus reading of MRI series by two additional radiologists served as the reference standard.

Results

MRI depicted 103 scaphoideal zones with BME in 76 patients. On qualitative analysis, VNCa images yielded high overall sensitivity (580/618 [94%]), specificity (1880/1920 [98%]), and accuracy (2460/2538 [97%]) for assessing BME as compared with MRI as reference standard. The interobserver agreement was excellent (κ = 0.98). CT numbers derived from VNCa images were significantly different in zones with and without edema (p < 0.001). A cutoff value of – 46 Hounsfield units provided a sensitivity of 91% and specificity of 97% for differentiating edematous scaphoid lesions. Receiver operating characteristic curve analysis revealed an overall area under the curve of 0.98.

Conclusions

Qualitative and quantitative analyses showed excellent diagnostic accuracy of color-coded VNCa reconstructions for assessing traumatic BME of the scaphoid compared to MRI.

Key Points

• Color-coded virtual non-calcium (VNCa) reconstructions yield excellent diagnostic accuracy in assessing bone marrow edema of the scaphoid.

• VNCa imaging enables detection of non-displaced fractures that are occult on standard grayscale CT.

• Diagnostic confidence is comparable between VNCa imaging and MRI.

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Abbreviations

AUC:

Area under the curve

BME:

Bone marrow edema

BMI:

Body mass index

HU:

Hounsfield unit

MSK:

Musculoskeletal

NPV:

Negative predictive value

PD:

Proton density

PPV:

Positive predictive value

ROC:

Receiver-operating characteristic

ROI:

Region of interest

SD:

Standard deviation

STARD:

Standards for Reporting of Diagnostic Accuracy Studies

STIR:

Short tau inversion recovery

VNCa:

Virtual non-calcium

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Funding

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

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Authors and Affiliations

  1. Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany

    Vitali Koch, Moritz H. Albrecht, Ibrahim Yel, Lukas Lenga, Simon S. Martin, Julian L. Wichmann, Christoph Mader & Christian Booz

  2. Department of Radiology, Herlev and Gentofte Hospital, Herlev, Denmark

    Felix Christoph Müller & Kasper Gosvig

  3. Department of Biomedical Sciences and Morphological and Functional Imaging, “G. Martino” University Hospital Messina, Messina, Italy

    Marco Cavallaro, Tommaso D’Angelo, Silvio Mazziotti & Giuseppe Cicero

  4. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany

    Thomas J. Vogl

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  1. Vitali Koch
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  2. Felix Christoph Müller
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  15. Christian Booz
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Corresponding author

Correspondence to Christian Booz.

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Guarantor

The scientific guarantor of this publication is Prof. Dr. Thomas J. Vogl (Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany).

Conflict of interest

The authors of this manuscript declare relationships with the following companies: C.B. received speaking fees from Siemens Healthineers. M.H.A. received speaking fees from Siemens Healthineers and Bracco. J.L.W. received speaking fees from Siemens Healthineers and GE Healthcare in the past. I.Y. received a speaking fee from Siemens Healthineers. The other authors have no potential conflict of interest to disclose.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Koch, V., Müller, F.C., Gosvig, K. et al. Incremental diagnostic value of color-coded virtual non-calcium dual-energy CT for the assessment of traumatic bone marrow edema of the scaphoid. Eur Radiol 31, 4428–4437 (2021). https://doi.org/10.1007/s00330-020-07541-x

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  • DOI: https://doi.org/10.1007/s00330-020-07541-x

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