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European Radiology
Published in: European Radiology 4/2022

Open Access 01-04-2022 | Computed Tomography

Diagnostic accuracy of color-coded virtual noncalcium reconstructions derived from portal venous phase dual-energy CT in the assessment of lumbar disk herniation

Authors: Vitali Koch, Moritz H. Albrecht, Leon D. Gruenewald, Ibrahim Yel, Katrin Eichler, Tatjana Gruber-Rouh, Renate M. Hammerstingl, Iris Burck, Julian L. Wichmann, Leona S. Alizadeh, Thomas J. Vogl, Lukas Lenga, Christoph Mader, Simon S. Martin, Silvio Mazziotti, Tommaso D’Angelo, Christian Booz

Published in: European Radiology | Issue 4/2022

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Abstract

Objectives

To investigate the diagnostic accuracy of color-coded contrast-enhanced dual-energy CT virtual noncalcium (VNCa) reconstructions for the assessment of lumbar disk herniation compared to unenhanced VNCa imaging.

Methods

A total of 91 patients were retrospectively evaluated (65 years ± 16; 43 women) who had undergone third-generation dual-source dual-energy CT and 3.0-T MRI within an examination interval up to 3 weeks between November 2019 and December 2020. Eight weeks after assessing unenhanced color-coded VNCa reconstructions for the presence and degree of lumbar disk herniation, corresponding contrast-enhanced portal venous phase color-coded VNCa reconstructions were independently analyzed by the same five radiologists. MRI series were additionally analyzed by one highly experienced musculoskeletal radiologist and served as reference standard.

Results

MRI depicted 210 herniated lumbar disks in 91 patients. VNCa reconstructions derived from contrast-enhanced CT scans showed similar high overall sensitivity (93% vs 95%), specificity (94% vs 95%), and accuracy (94% vs 95%) for the assessment of lumbar disk herniation compared to unenhanced VNCa images (all p > .05). Interrater agreement in VNCa imaging was excellent for both, unenhanced and contrast-enhanced CT (κ = 0.84 vs κ = 0.86; p > .05). Moreover, ratings for diagnostic confidence, image quality, and noise differed not significantly between unenhanced and contrast-enhanced VNCa series (all p > .05).

Conclusions

Color-coded VNCa reconstructions derived from contrast-enhanced dual-energy CT yield similar diagnostic accuracy for the depiction of lumbar disk herniation compared to unenhanced VNCa imaging and therefore may improve opportunistic retrospective lumbar disk herniation assessment, particularly in case of staging CT examinations.

Key Points

• Color-coded dual-source dual-energy CT virtual noncalcium (VNCa) reconstructions derived from portal venous phase yield similar high diagnostic accuracy for the assessment of lumbar disk herniation compared to unenhanced VNCa CT series (94% vs 95%) with MRI serving as a standard of reference.
• Diagnostic confidence, image quality, and noise levels differ not significantly between unenhanced and contrast-enhanced portal venous phase VNCa dual-energy CT series.
• Dual-source dual-energy CT might have the potential to improve opportunistic retrospective lumbar disk herniation assessment in CT examinations performed for other indications through reconstruction of VNCa images.
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Metadata
Title
Diagnostic accuracy of color-coded virtual noncalcium reconstructions derived from portal venous phase dual-energy CT in the assessment of lumbar disk herniation
Authors
Vitali Koch
Moritz H. Albrecht
Leon D. Gruenewald
Ibrahim Yel
Katrin Eichler
Tatjana Gruber-Rouh
Renate M. Hammerstingl
Iris Burck
Julian L. Wichmann
Leona S. Alizadeh
Thomas J. Vogl
Lukas Lenga
Christoph Mader
Simon S. Martin
Silvio Mazziotti
Tommaso D’Angelo
Christian Booz
Publication date
01-04-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-021-08354-2

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