A quantitative assessment of dual energy computed tomography‐based material decomposition for imaging bone marrow edema associated with acute knee injury

Purpose This study developed methods to quantify and improve the accuracy of dual‐energy CT (DECT)‐based bone marrow edema imaging using a clinical CT system. Objectives were: (a) to quantitatively compare DECT with gold‐standard, fluid‐sensitive MRI for imaging of edema‐like marrow signal intensity (EMSI) and (b) to identify image analysis parameters that improve delineation of EMSI associated with acute knee injury on DECT images. Methods DECT images from ten participants with acute knee injury were decomposed into estimated fractions of bone, healthy marrow, and edema based on energy‐dependent differences in tissue attenuation. Fluid‐sensitive MR images were registered to DECT for quantitative, voxel‐by‐voxel comparison between the two modalities. An optimization scheme was developed to find attenuation coefficients for healthy marrow and edema that improved EMSI delineation, compared to MRI. DECT method accuracy was evaluated by measuring dice coefficients, mutual information, and normalized cross correlation between the DECT result and registered MRI. Results When applying the optimized three‐material decomposition method, dice coefficients for EMSI identified through DECT vs MRI were 0.32 at the tibia and 0.13 at the femur. Optimization of attenuation coefficients improved dice coefficient, mutual information, and cross‐correlation between DECT and gold‐standard MRI by 48%–107% compared to three‐material decomposition using non‐optimized parameters, and improved mutual information and cross‐correlation by 39%–58% compared to the manufacturer‐provided two‐material decomposition. Conclusions This study quantitatively evaluated the performance of DECT in imaging knee injury‐associated EMSI and identified a method to optimize DECT‐based visualization of complex tissues (marrow and edema) whose attenuation parameters cannot be easily characterized. Further studies are needed to improve DECT‐based EMSI imaging at the femur.