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European Radiology

16-05-2024 | Lumbar Disc Herniation | Musculoskeletal

Electron density dual-energy CT can improve the detection of lumbar disc herniation with higher image quality than standard and virtual non-calcium images

Authors: Juhyun Jeong, Sungwon Ham, Euddeum Shim, Baek Hyun Kim, Woo Young Kang, Chang Ho Kang, Kyung-Sik Ahn, Kyu-Chong Lee, Hangseok Choi

Published in: European Radiology

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Abstract

Objectives

To compare the diagnostic performance and image quality of dual-energy computed tomography (DECT) with electron density (ED) image reconstruction with those of DECT with standard CT (SC) and virtual non-calcium (VNCa) image reconstructions, for diagnosing lumbar disc herniation (L-HIVD).

Methods

A total of 59 patients (354 intervertebral discs from T12/L1 to L5/S1; mean age, 60 years; 30 women and 29 men) who underwent DECT with spectral reconstruction and 3-T MRI within 2 weeks were enrolled between March 2021 and February 2022. Four radiologists independently assessed three image sets of randomized ED, SC, and VNCa images to detect L-HIVD at 8-week intervals. The coefficient of variance (CV) and the Weber contrast of the ROIs in the normal and diseased disc to cerebrospinal fluid space (NCR-normal/-diseased, respectively) were calculated to compare the image qualities of the noiseless ED and other series.

Results

Overall, 129 L-HIVDs were noted on MRI. In the detection of L-HIVD, ED showed a higher AUC and sensitivity than SC and VNCa; 0.871 vs 0.807 vs 833 (p = 0.002) and 81% vs 70% vs 74% (p = 0.006 for SC), respectively. CV was much lower in all measurements of ED than those for SC and VNCa (p < 0.001). Furthermore, NCR-normal and NCR-diseased were the highest in ED (ED vs SC in NCR-normal and NCR-diseased, p =  0.001 and p = 0.004, respectively; ED vs VNCa in NCR-diseased, p = 0.044).

Conclusion

Compared to SC and VNCa images, DECT with ED reconstruction can enhance the AUC and sensitivity of L-HIVD detection with a lower CV and higher NCR.

Clinical relevance statement

To our knowledge, this is the first study to quantify the image quality of noiseless ED images. ED imaging may be helpful for detecting L-HIVD in patients who cannot undergo MRI.

Key Points

  • ED images have diagnostic potential, but relevant quantitative analyses of image quality are limited.
  • ED images detect disc herniation, with a better coefficient of variance and normalized contrast ratio values.
  • ED images could detect L-HIVD when MRI is not an option.
Appendix
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Metadata
Title
Electron density dual-energy CT can improve the detection of lumbar disc herniation with higher image quality than standard and virtual non-calcium images
Authors
Juhyun Jeong
Sungwon Ham
Euddeum Shim
Baek Hyun Kim
Woo Young Kang
Chang Ho Kang
Kyung-Sik Ahn
Kyu-Chong Lee
Hangseok Choi
Publication date
16-05-2024
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-024-10782-9