Dual-Energy CT of Material Decomposition Analysis for Detection with Bone Marrow Edema in Patients with Vertebral Compression Fractures

Rationale and Objectives This study investigated detecting bone marrow edema (BME) in patients with vertebral compression fractures. We compared dual-energy material density analysis images to magnetic resonance imaging (MRI), which is considered the gold standard. Materials and Methods In this retrospective study, 260 vertebral bodies from 30 patients (11 males, 19 females, mean age of 81) were assessed by MRI and dual-energy material density analysis. Diagnostic accuracy was assessed using the receiver operating characteristic (ROC) curve. Fifty-two of the 260 vertebral bodies were considered to have BME based on the dual-energy material density analysis images; 50 were deemed to have BME by MRI. Results ROC analysis of the dual-energy material density analysis values revealed an area under the ROC curve of 0.95 for radiologist 1, 0.97 for radiologist 2, and 0.96 for radiologist 3. A mean cutoff value of 1032.6 mg/cm3 provided an overall sensitivity of 93.0% (95% confidence intervals [CI]: 86.0%–99.9%), specificity of 98.0% (95% CI: 95.5%–99.0%), accuracy of 97.0% (95% CI: 95.2%–99.0%), positive predictive value of 95.0% (95% CI: 81.0%–97.5%), and negative predictive value of 98.0% (95% CI: 93.0%–99.9%). Conclusion BME in patients with vertebral compression fractures can be detected using dual-energy material density analysis images.