Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Insights into Imaging
Published in: Insights into Imaging 1/2023

Open Access 01-12-2023 | Knee Osteoarthritis | Original Article

Dual-energy CT virtual non-calcium: an accurate method for detection of knee osteoarthritis-related edema-like marrow signal intensity

Authors: Heng Zhao, Hui Li, Xia Xie, Hai-yan Tang, Xiao-xin Liu, Yi Wen, Xin Xiao, Lu Ye, You-wei Tang, Gao-yue Dai, Jia-ni He, Li Chen, Qian Wang, De-qiu Tang, Shi-nong Pan

Published in: Insights into Imaging | Issue 1/2023

Login to get access

Abstract

Objectives

To evaluate the performance of a dual-energy computed tomography (DECT) virtual non-calcium (VNCa) technique in the detection of edema-like marrow signal intensity (ELMSI) in patients with knee joint osteoarthritis (OA) compared to magnetic resonance imaging (MRI).

Methods

The study received local ethics board approval, and written informed consent was obtained. DECT and MRI were used to examine 28 knees in 24 patients with OA. VNCa images were generated by dual-energy subtraction of calcium. The knee joint was divided into 15 regions for ELMSI grading, performed independently by two musculoskeletal radiologists, with MRI as the reference standard. We also analyzed CT numbers through receiver operating characteristics and calculated cut-off values.

Results

For the qualitative analysis, we obtained CT sensitivity (Readers 1, 2 = 83.7%, 89.8%), specificity (Readers 1, 2 = 99.5%, 99.5%), positive predictive value (Readers 1, 2 = 95.3%, 95.7%), and negative predictive value (Readers 1, 2 = 97.9%, 98.7%) for ELMSI. The interobserver agreement was excellent (κ = 0.92). The area under the curve for Reader 1 and Reader 2 was 0.961 (95% CI 0.93, 0.99) and 0.992 (95% CI 0.98, 1.00), respectively. CT numbers obtained from the VNCa images were significantly different between regions with and without ELMSI (p < .001).

Conclusions

VNCa images have good diagnostic performance for the qualitative and quantitative analysis of knee osteoarthritis-related ELMSI.
Literature
1.
O’Neill TW, McCabe PS, McBeth J (2018) Update on the epidemiology, risk factors and disease outcomes of osteoarthritis. Best Pract Res Clin Rheumatol 32:312–326PubMedCrossRef
2.
Hunter DJ, Zhang Y, Niu J et al (2006) Increase in bone marrow lesions associated with cartilage loss: a longitudinal magnetic resonance imaging study of knee osteoarthritis. Arthritis Rheum 54:1529–1535PubMedCrossRef
3.
Pan F, Tian J, Aitken D, Cicuttini F, Winzenberg T, Jones G (2017) The association of knee structural pathology with pain at the knee is modified by pain at other sites in those with knee osteoarthritis. Clin Rheumatol 36:2549–2555PubMedCrossRef
4.
Qin J, Barbour KE, Murphy LB et al (2017) Lifetime risk of symptomatic hand osteoarthritis: the Johnston County osteoarthritis project. Arthritis Rheumatol 69:1204–1212PubMedPubMedCentralCrossRef
5.
Fukaya T, Mutsuzaki H, Mori K (2019) Influence of pain on knee joint movement and moment during the stance phase in patients with severe bilateral knee osteoarthritis: a pilot study. Medicina (Kaunas) 55:756PubMedCrossRef
6.
7.
8.
Perry TA, Parkes MJ, Hodgson RJ, Felson DT, Arden NK, O’Neill TW (2020) Association between bone marrow lesions & synovitis and symptoms in symptomatic knee osteoarthritis. Osteoarthritis Cartilage 28:316–323PubMedCrossRef
9.
Wang X, Chen T, Liang W et al (2022) Synovitis mediates the association between bone marrow lesions and knee pain in osteoarthritis: data from the Foundation for the National Institute of Health (FNIH) Osteoarthritis Biomarkers Consortium. Osteoarthritis Cartilage 30:1270–1277PubMedCrossRef
10.
Maraghelli D, Brandi ML, Matucci Cerinic M, Peired AJ, Colagrande S (2021) Edema-like marrow signal intensity: a narrative review with a pictorial essay. Skeletal Radiol 50:645–663PubMedCrossRef
11.
Nielsen FK, Egund N, Jorgensen A, Jurik AG (2017) Risk factors for joint replacement in knee osteoarthritis; a 15-year follow-up study. BMC Musculoskelet Disord 18:510PubMedPubMedCentralCrossRef
12.
Saltzman BM, Riboh JC (2018) Subchondral bone and the osteochondral unit: basic science and clinical implications in sports medicine. Sports Health 10:412–418PubMedPubMedCentralCrossRef
13.
Sherwood J (2019) Osteoarthritis year in review 2018: biology. Osteoarthritis Cartilage 27:365–370PubMedCrossRef
14.
Atukorala I, Kwoh CK, Guermazi A et al (2016) Synovitis in knee osteoarthritis: a precursor of disease? Ann Rheum Dis 75:390–395PubMedCrossRef
15.
Geurts J, Patel A, Hirschmann MT et al (2016) Elevated marrow inflammatory cells and osteoclasts in subchondral osteosclerosis in human knee osteoarthritis. J Orthop Res 34:262–269PubMedCrossRef
16.
Hunter DJ, Gerstenfeld L, Bishop G et al (2009) Bone marrow lesions from osteoarthritis knees are characterized by sclerotic bone that is less well mineralized. Arthritis Res Ther 11:1–9CrossRef
17.
18.
Hugle T, Geurts J (2017) What drives osteoarthritis?-synovial versus subchondral bone pathology. Rheumatology (Oxford) 56:1461–1471PubMed
19.
van Vucht N, Santiago R, Lottmann B et al (2019) The Dixon technique for MRI of the bone marrow. Skeletal Radiol 48:1861–1874PubMedCrossRef
20.
Mattap SM, Aitken D, Wills K et al (2018) How do MRI-detected subchondral bone marrow lesions (BMLs) on two different MRI sequences correlate with clinically important outcomes? Calcif Tissue Int 103:131–143PubMedCrossRef
21.
Singh V, Oliashirazi A, Tan T, Fayyad A, Shahi A (2019) Clinical and pathophysiologic significance of MRI identified bone marrow lesions associated with knee osteoarthritis. Arch Bone Jt Surg 7:211–219PubMedPubMedCentral
22.
Bjorkman AS, Koskinen SK, Lindblom M, Persson A (2020) Diagnostic accuracy of dual-energy CT for detection of bone marrow lesions in the subacutely injured knee with MRI as reference method. Acta Radiol 61:749–759PubMedCrossRef
23.
Wang MY, Zhang XY, Xu L et al (2019) Detection of bone marrow oedema in knee joints using a dual-energy CT virtual non-calcium technique. Clin Radiol 74:815 e811-815 e817CrossRef
24.
Booz C, Noske J, Lenga L et al (2020) Color-coded virtual non-calcium dual-energy CT for the depiction of bone marrow edema in patients with acute knee trauma: a multireader diagnostic accuracy study. Eur Radiol 30:141–150PubMedCrossRef
25.
Alizai H, Virayavanich W, Joseph GB et al (2014) Cartilage lesion score: comparison of a quantitative assessment score with established semiquantitative MR scoring systems. Radiology 271:479–487PubMedCrossRef
26.
Hayashi D, Roemer FW, Guermazi A (2016) Imaging for osteoarthritis. Ann Phys Rehabil Med 59:161–169PubMedCrossRef
27.
Hayashi D, Roemer FW, Jarraya M, Guermazi A (2017) Imaging in osteoarthritis. Radiol Clin N Am 55:1085–1102PubMedCrossRef
28.
Wang Y, Wluka AE, Pelletier JP et al (2010) Meniscal extrusion predicts increases in subchondral bone marrow lesions and bone cysts and expansion of subchondral bone in osteoarthritic knees. Rheumatology (Oxford) 49:997–1004PubMedCrossRef
29.
Pouders C, De Maeseneer M, Van Roy P, Gielen J, Goossens A, Shahabpour M (2008) Prevalence and MRI-anatomic correlation of bone cysts in osteoarthritic knees. AJR Am J Roentgenol 190:17–21PubMedCrossRef
30.
Dumovich J, Singh P (2020) Physiology, trauma. StatPearls, Treasure Island
31.
Dong B, Kong Y, Zhang L, Qiang Y (2017) Severity and distribution of cartilage damage and bone marrow edema in the patellofemoral and tibiofemoral joints in knee osteoarthritis determined by MRI. Exp Ther Med 13:2079–2084PubMedPubMedCentralCrossRef
32.
Cronstrom A, Creaby MW, Nae J, Ageberg E (2016) Modifiable factors associated with knee abduction during weight-bearing activities: a systematic review and meta-analysis. Sports Med 46:1647–1662PubMedCrossRef
33.
Roi GS, Monticone M, Salvoni M, Sassi R, Alberti G (2015) Self-reported knee symptoms assessed by KOOS questionnaire in downhill runners (skyrunners). PLoS One 10:e0126382PubMedPubMedCentralCrossRef
34.
35.
Amano K, Li AK, Pedoia V et al (2017) Effects of surgical factors on cartilage can be detected using quantitative magnetic resonance imaging after anterior cruciate ligament reconstruction. Am J Sports Med 45:1075–1084PubMedCrossRef
36.
Peterfy CG, Guermazi A, Zaim S et al (2004) Whole-organ magnetic resonance imaging score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 12:177–190PubMedCrossRef
37.
Ren QP, Tang DQ, Zhao H et al (2018) Diagnostic performance of dual-energy CT for the detection of bone bruise in the wrist. Chin Clin Med imaging 29:56–60
38.
Guggenberger R, Gnannt R, Hodler J et al (2012) Diagnostic performance of dual-energy CT for the detection of traumatic bone marrow lesions in the ankle: comparison with MR imaging. Radiology 264:164–173PubMedCrossRef
39.
Cao JX, Wang YM, Kong XQ, Yang C, Wang P (2015) Good interrater reliability of a new grading system in detecting traumatic bone marrow lesions in the knee by dual energy CT virtual non-calcium images. Eur J Radiol 84:1109–1115PubMedCrossRef
40.
Wu H, Zhang G, Shi L et al (2019) Axial spondyloarthritis: dual-energy virtual noncalcium CT in the detection of bone marrow edema in the sacroiliac joints. Radiology 290:157–164PubMedCrossRef
41.
Petritsch B, Kosmala A, Weng AM et al (2017) Vertebral compression fractures: third-generation dual-energy CT for detection of bone marrow edema at visual and quantitative analyses. Radiology 284:161–168PubMedCrossRef
42.
Victor N, Simon L, Nuran A et al (2018) Bone marrow edema in traumatic vertebral compression fractures: diagnostic accuracy of dual-layer detector CT using calcium suppressed images. Eur J Radiol 105:216–220CrossRef
43.
Foti G, Catania M, Caia S et al (2019) Identification of bone marrow edema of the ankle: diagnostic accuracy of dual-energy CT in comparison with MRI. Radiol Med 124:1028–1036PubMedCrossRef
44.
Rajiah P, Sundaram M, Subhas N (2019) Dual-energy CT in musculoskeletal imaging: what is the role beyond gout? AJR Am J Roentgenol 213:493–505PubMedCrossRef
Metadata
Title
Dual-energy CT virtual non-calcium: an accurate method for detection of knee osteoarthritis-related edema-like marrow signal intensity
Authors
Heng Zhao
Hui Li
Xia Xie
Hai-yan Tang
Xiao-xin Liu
Yi Wen
Xin Xiao
Lu Ye
You-wei Tang
Gao-yue Dai
Jia-ni He
Li Chen
Qian Wang
De-qiu Tang
Shi-nong Pan
Publication date
01-12-2023

Other articles of this Issue 1/2023

Insights into Imaging 1/2023 Go to the issue

Original Article

The use of low-value imaging: the role of referral practice and access to imaging services in a representative area of Norway

Original Article

Core and penumbra estimation using deep learning-based AIF in association with clinical measures in computed tomography perfusion (CTP)

Original Article

Natural language processing for automatic evaluation of free-text answers — a feasibility study based on the European Diploma in Radiology examination

Opinion

Why mild contrast medium-induced reactions are sometimes over-treated and moderate/severe reactions of internal organs are undertreated: a summary based on RadioComics

Original Article

Correlation of androgen receptor with ultrasound, clinicopathological features and clinical outcomes in breast cancer

Original Article

Implementation of structured reporting in clinical routine: a review of 7 years of institutional experience