Rationale and Objectives
The study aimed to evaluate the usefulness of dual-energy computed tomography (DECT) before and after calcium subtraction in the diagnosis of spinal bone bruise.
Materials and Methods
Among the patients who visited our emergency department between January 2013 and July 2014 who underwent both spinal DECT and magnetic resonance imaging, 38 patients (men:women = 25:13; mean age: 55.6 years, range: 28–82) were included. The patients were divided into two groups, those with and without acute spinal compression fracture, based on magnetic resonance imaging findings. In the fracture group ( n = 22), the ratio of Hounsfield unit (HU) values was calculated between the fracture level and the next normal inferior vertebra in the DECT before and after calcium subtraction. In the non-fracture group ( n = 16), the ratios of HU values were calculated between two normal adjacent vertebrae. The mean HU ratios were compared between the two groups.
Results
The mean HU ratio was higher in the fracture group (calcium subtraction: before: 1.57 and 1.59; after: 1.74 and 1.76) than the non-fracture group (before: 1.07 and 1.08; after: 1.07 and 1.07) ( P < 0.001). The mean HU ratio between before and after calcium subtraction images was different only in the fracture group ( P < 0.05). There was no significant difference in the area under the curve, sensitivity, specificity, positive and negative predictive values, and accuracy (before: 0.846, 87.5%, 81.2%, 87.5%, 81.2%, 85%; after: 0.865, 91.7%, 81.2%, 88%, 86.7%, 87.5% in high energy) between the images before and after calcium subtraction.
Conclusion
The HU ratio between the fractured and next normal vertebra was diagnostic for spinal bone bruise on DECT images both before and after calcium subtraction.
Introduction
Vertebral compression fractures are very common and are associated with decreased quality of life and increased mortality. Patients with a diagnosed vertebral compression fracture have 15% higher mortality rates than those without . Thus, accurate diagnosis and appropriate treatment are important for the improvement of mobility and function . However, the determination of a recent fracture is sometimes challenging, such as when the fractures are occult bone lesions (often referred to as bone bruises), which may not be revealed by conventional radiography, or when patients have multiple compression fractures of variable chronicity .
In acute vertebral compression fractures, such as those due to trauma, bone marrow lesions commonly present a “bone bruise” pattern, which is histologically heterogeneous in nature and associated with microtrabecular fractures of cancellous bone, hemorrhage, and swelling of the marrow with or without substantial disruption of the adjacent bone or overlying articular cartilage .
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Materials and Methods
Patients
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CT Protocol
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CT Image Reconstruction and Post-processing
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MR Imaging Protocol
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Image Analysis
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Statistical Analysis
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Results
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TABLE 1
HU Ratios Between Two Groups on Before and After Calcium Subtraction Images
Before Subtraction After Subtraction Low Energy (100 kVp) High Energy (135 kVp) Low Energy (100 kVp) High Energy (135 kVp) Fracture group ( n = 24) 1.57 ± 0.60 \* 1.59 ± 0.60 ** 1.74 ± 0.70 \* 1.76 ± 0.81 ** Non-fractured group ( n = 16) 1.07 ± 0.22 1.08 ± 0.25 1.07 ± 0.31 1.07 ± 0.31P value <0.001 <0.001 <0.001 <0.001
HU, Hounsfield unit.
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TABLE 2
Diagnostic Performances of HU Ratios From Before and After Calcium Subtraction Images in the Detection of Bone Marrow Contusion of Vertebral Compression Fractures
Sensitivity (%) Specificity (%) PPV (%) NPV (%) Accuracy (%) Before 100 kVp 79.2 87.5 90.5 73.7 82.5 135 kVp 87.5 81.2 87.5 81.2 85.0 After 100 kVp 87.5 87.5 91.3 82.4 87.5 135 kVp 91.7 81.2 88 86.7 87.5
HU, Hounsfield unit; NPV, negative predictive value; PPV, positive predictive value.
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TABLE 3
Mean HU Values of Fractured and Non-fractured Vertebrae on Before and After Calcium Subtraction Images in the Fracture Group ( n = 24)
Before Subtraction After Subtraction Low Energy (100 kVp) High Energy (135 kVp) Low Energy (100 kVp) High Energy (135 kVp) Fractured vertebrae 179.72 ± 52.39 154.06 ± 43.49 129.49 ± 32.70 107.39 ± 27.16 Non-fractured vertebrae 124.87 ± 50.34 107.72 ± 42.81 83.55 ± 32.96 69.29 ± 26.08P value 0.001 0.001 <0.001 <0.001
HU, Hounsfield unit.
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Discussion
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Conclusion
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