TY  - JOUR
A1  - Grunz, Jan-Peter
A1  - Sailer, Lukas
A1  - Lang, Patricia
A1  - Schüle, Simone
A1  - Kunz, Andreas Steven
A1  - Beer, Meinrad
A1  - Hackenbroch, Carsten
T1  - Dual-energy CT in sacral fragility fractures: defining a cut-off Hounsfield unit value for the presence of traumatic bone marrow edema in patients with osteoporosis
JF  - BMC Musculoskeletal Disorders
N2  - Background
Demographic change entails an increasing incidence of fragility fractures. Dual-energy CT (DECT) with virtual non-calcium (VNCa) reconstructions has been introduced as a promising diagnostic method for evaluating bone microarchitecture and marrow simultaneously. This study aims to define the most accurate cut-off value in Hounsfield units (HU) for discriminating the presence and absence of bone marrow edema (BME) in sacral fragility fractures.
Methods
Forty-six patients (40 women, 6 men; 79.7 ± 9.2 years) with suspected fragility fractures of the sacrum underwent both DECT (90 kVp / 150 kVp with tin prefiltration) and MRI. Nine regions-of-interest were placed in each sacrum on DECT-VNCa images. The resulting 414 HU measurements were stratified into “edema” (n = 80) and “no edema” groups (n = 334) based on reference BME detection in T2-weighted MRI sequences. Area under the receiver operating characteristic curve was calculated to determine the desired cut-off value and an associated conspicuity range for edema detection.
Results
The mean density within the “edema” group of measurements (+ 3.1 ± 8.3 HU) was substantially higher compared to the “no edema” group (-51.7 ± 21.8 HU; p < 0.010). Analysis in DECT-VNCa images suggested a cut-off value of -12.9 HU that enabled sensitivity and specificity of 100% for BME detection compared to MRI. A range of HU values between -14.0 and + 20.0 is considered indicative of BME in the sacrum.
Conclusions
Quantitative analysis of DECT-VNCa with a cut-off of -12.9 HU allows for excellent diagnostic accuracy in the assessment of sacral fragility fractures with associated BME. A diagnostic “one-stop-shop” approach without additional MRI is feasible.
KW  - virtual noncalcium imaging
KW  - dual-energy computed tomography
KW  - fragility fracture
KW  - bone bruise
KW  - bone marrow edema
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-301125
VL  - 23
IS  - 1
ER  -