Fat Fraction Measurements Using a Three-Material Decomposition Dual-Energy CT Technique Accounting for Bone Minerals: Evaluation in a Bone Marrow Phantom Using MRI as Reference.

Conventional two-material dual-energy CT (DECT) decomposition is insufficient to model bone marrow, which contains three materials [bone minerals, red marrow (water), yellow marrow (fat)]. We explore an image-domain three-material decomposition DECT technique accounting for bone minerals in a bone-water-fat phantom. Three-material decomposition fat fraction (FF3MD) exhibited stronger correlation than two-material decomposition fat fraction (FF2MD) with FFMRI (r=0.95 vs r=0.69). With increasing bone minerals, correlation of FF3MD remained stable (r=0.81-1.02), whereas correlation of FF2MD decreased (r=0.21-0.65).