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European Radiology
Published in: European Radiology 7/2021

01-07-2021 | Edema | Computed Tomography

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

Authors: Vitali Koch, Felix Christoph Müller, Kasper Gosvig, Moritz H. Albrecht, Ibrahim Yel, Lukas Lenga, Simon S. Martin, Marco Cavallaro, Julian L. Wichmann, Christoph Mader, Tommaso D’Angelo, Silvio Mazziotti, Giuseppe Cicero, Thomas J. Vogl, Christian Booz

Published in: European Radiology | Issue 7/2021

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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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Metadata
Title
Incremental diagnostic value of color-coded virtual non-calcium dual-energy CT for the assessment of traumatic bone marrow edema of the scaphoid
Authors
Vitali Koch
Felix Christoph Müller
Kasper Gosvig
Moritz H. Albrecht
Ibrahim Yel
Lukas Lenga
Simon S. Martin
Marco Cavallaro
Julian L. Wichmann
Christoph Mader
Tommaso D’Angelo
Silvio Mazziotti
Giuseppe Cicero
Thomas J. Vogl
Christian Booz
Publication date
01-07-2021
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 7/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07541-x

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