Incremental diagnostic value of color-coded virtual non-calcium dual-energy CT for the assessment of traumatic bone marrow edema of the scaphoid

Vitali Koch; Felix Christoph Müller; Kasper Gosvig; Moritz H. Albrecht; Ibrahim Yel; Lukas Lenga; Simon S. Martin; Marco Cavallaro; Julian L. Wichmann; Christoph Mader; Tommaso D’Angelo; Silvio Mazziotti; Giuseppe Cicero; Thomas J. Vogl; Christian Booz

doi:10.1007/s00330-020-07541-x

Incremental diagnostic value of color-coded virtual non-calcium dual-energy CT for the assessment of traumatic bone marrow edema of the scaphoid

Vitali Koch, Felix Christoph Müller, Kasper Gosvig, Moritz H. Albrecht, Ibrahim Yel, Lukas Lenga, Simon S. Martin, Marco Cavallaro, Julian L. Wichmann, Christoph Mader, Tommaso D’Angelo, Silvio Mazziotti, Giuseppe Cicero, Thomas J. Vogl, Christian Booz^*

^*Corresponding author for this work

Radiology

19 Citations (Scopus)

Abstract

OBJECTIVES: To investigate the diagnostic accuracy of color-coded dual-energy CT virtual non-calcium (VNCa) reconstructions for the assessment of bone marrow edema (BME) of the scaphoid in patients with acute wrist trauma.

METHODS: Our retrospective study included data from 141 patients (67 women, 74 men; mean age 43 years, range 19-80 years) with acute wrist trauma who had undergone third-generation dual-source dual-energy CT and 3-T MRI within 7 days. Eight weeks after assessment of conventional grayscale dual-energy CT scans for the presence of fractures, corresponding color-coded VNCa reconstructions were independently analyzed by the same six radiologists for the presence of BME. CT numbers on VNCa reconstructions were evaluated by a seventh radiologist. Consensus reading of MRI series by two additional radiologists served as the reference standard.

RESULTS: MRI depicted 103 scaphoideal zones with BME in 76 patients. On qualitative analysis, VNCa images yielded high overall sensitivity (580/618 [94%]), specificity (1880/1920 [98%]), and accuracy (2460/2538 [97%]) for assessing BME as compared with MRI as reference standard. The interobserver agreement was excellent (κ = 0.98). CT numbers derived from VNCa images were significantly different in zones with and without edema (p < 0.001). A cutoff value of - 46 Hounsfield units provided a sensitivity of 91% and specificity of 97% for differentiating edematous scaphoid lesions. Receiver operating characteristic curve analysis revealed an overall area under the curve of 0.98.

CONCLUSIONS: Qualitative and quantitative analyses showed excellent diagnostic accuracy of color-coded VNCa reconstructions for assessing traumatic BME of the scaphoid compared to MRI.

KEY POINTS: • Color-coded virtual non-calcium (VNCa) reconstructions yield excellent diagnostic accuracy in assessing bone marrow edema of the scaphoid. • VNCa imaging enables detection of non-displaced fractures that are occult on standard grayscale CT. • Diagnostic confidence is comparable between VNCa imaging and MRI.

Original language	English
Journal	European Radiology
Volume	31
Issue number	7
Pages (from-to)	4428-4437
Number of pages	10
ISSN	0938-7994
DOIs	https://doi.org/10.1007/s00330-020-07541-x
Publication status	Published - Jul 2021

Keywords

Adult
Aged
Aged, 80 and over
Bone Marrow/diagnostic imaging
Calcium
Edema/diagnostic imaging
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Retrospective Studies
Scaphoid Bone/diagnostic imaging
Sensitivity and Specificity
Tomography, X-Ray Computed
Young Adult

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Koch, V., Müller, F. C., Gosvig, K., Albrecht, M. H., Yel, I., Lenga, L., Martin, S. S., Cavallaro, M., Wichmann, J. L., Mader, C., D’Angelo, T., Mazziotti, S., Cicero, G., Vogl, T. J., & Booz, C. (2021). Incremental diagnostic value of color-coded virtual non-calcium dual-energy CT for the assessment of traumatic bone marrow edema of the scaphoid. European Radiology, 31(7), 4428-4437. https://doi.org/10.1007/s00330-020-07541-x

Koch, V, Müller, FC, Gosvig, K, Albrecht, MH, Yel, I, Lenga, L, Martin, SS, Cavallaro, M, Wichmann, JL, Mader, C, D’Angelo, T, Mazziotti, S, Cicero, G, Vogl, TJ & Booz, C 2021, 'Incremental diagnostic value of color-coded virtual non-calcium dual-energy CT for the assessment of traumatic bone marrow edema of the scaphoid', European Radiology, vol. 31, no. 7, pp. 4428-4437. https://doi.org/10.1007/s00330-020-07541-x

@article{3fda4ee2ff30445a8a76d01085c3cea7,

title = "Incremental diagnostic value of color-coded virtual non-calcium dual-energy CT for the assessment of traumatic bone marrow edema of the scaphoid",

abstract = "OBJECTIVES: To investigate the diagnostic accuracy of color-coded dual-energy CT virtual non-calcium (VNCa) reconstructions for the assessment of bone marrow edema (BME) of the scaphoid in patients with acute wrist trauma.METHODS: Our retrospective study included data from 141 patients (67 women, 74 men; mean age 43 years, range 19-80 years) with acute wrist trauma who had undergone third-generation dual-source dual-energy CT and 3-T MRI within 7 days. Eight weeks after assessment of conventional grayscale dual-energy CT scans for the presence of fractures, corresponding color-coded VNCa reconstructions were independently analyzed by the same six radiologists for the presence of BME. CT numbers on VNCa reconstructions were evaluated by a seventh radiologist. Consensus reading of MRI series by two additional radiologists served as the reference standard.RESULTS: MRI depicted 103 scaphoideal zones with BME in 76 patients. On qualitative analysis, VNCa images yielded high overall sensitivity (580/618 [94%]), specificity (1880/1920 [98%]), and accuracy (2460/2538 [97%]) for assessing BME as compared with MRI as reference standard. The interobserver agreement was excellent (κ = 0.98). CT numbers derived from VNCa images were significantly different in zones with and without edema (p < 0.001). A cutoff value of - 46 Hounsfield units provided a sensitivity of 91% and specificity of 97% for differentiating edematous scaphoid lesions. Receiver operating characteristic curve analysis revealed an overall area under the curve of 0.98.CONCLUSIONS: Qualitative and quantitative analyses showed excellent diagnostic accuracy of color-coded VNCa reconstructions for assessing traumatic BME of the scaphoid compared to MRI.KEY POINTS: • Color-coded virtual non-calcium (VNCa) reconstructions yield excellent diagnostic accuracy in assessing bone marrow edema of the scaphoid. • VNCa imaging enables detection of non-displaced fractures that are occult on standard grayscale CT. • Diagnostic confidence is comparable between VNCa imaging and MRI.",

keywords = "Adult, Aged, Aged, 80 and over, Bone Marrow/diagnostic imaging, Calcium, Edema/diagnostic imaging, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Retrospective Studies, Scaphoid Bone/diagnostic imaging, Sensitivity and Specificity, Tomography, X-Ray Computed, Young Adult",

author = "Vitali Koch and M{\"u}ller, {Felix Christoph} and Kasper Gosvig and Albrecht, {Moritz H.} and Ibrahim Yel and Lukas Lenga and Martin, {Simon S.} and Marco Cavallaro and Wichmann, {Julian L.} and Christoph Mader and Tommaso D{\textquoteright}Angelo and Silvio Mazziotti and Giuseppe Cicero and Vogl, {Thomas J.} and Christian Booz",

note = "Publisher Copyright: {\textcopyright} 2021, European Society of Radiology.",

year = "2021",

month = jul,

doi = "10.1007/s00330-020-07541-x",

language = "English",

volume = "31",

pages = "4428--4437",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer",

number = "7",

}

TY - JOUR

T1 - Incremental diagnostic value of color-coded virtual non-calcium dual-energy CT for the assessment of traumatic bone marrow edema of the scaphoid

AU - Koch, Vitali

AU - Müller, Felix Christoph

AU - Gosvig, Kasper

AU - Albrecht, Moritz H.

AU - Yel, Ibrahim

AU - Lenga, Lukas

AU - Martin, Simon S.

AU - Cavallaro, Marco

AU - Wichmann, Julian L.

AU - Mader, Christoph

AU - D’Angelo, Tommaso

AU - Mazziotti, Silvio

AU - Cicero, Giuseppe

AU - Vogl, Thomas J.

AU - Booz, Christian

PY - 2021/7

Y1 - 2021/7

N2 - OBJECTIVES: To investigate the diagnostic accuracy of color-coded dual-energy CT virtual non-calcium (VNCa) reconstructions for the assessment of bone marrow edema (BME) of the scaphoid in patients with acute wrist trauma.METHODS: Our retrospective study included data from 141 patients (67 women, 74 men; mean age 43 years, range 19-80 years) with acute wrist trauma who had undergone third-generation dual-source dual-energy CT and 3-T MRI within 7 days. Eight weeks after assessment of conventional grayscale dual-energy CT scans for the presence of fractures, corresponding color-coded VNCa reconstructions were independently analyzed by the same six radiologists for the presence of BME. CT numbers on VNCa reconstructions were evaluated by a seventh radiologist. Consensus reading of MRI series by two additional radiologists served as the reference standard.RESULTS: MRI depicted 103 scaphoideal zones with BME in 76 patients. On qualitative analysis, VNCa images yielded high overall sensitivity (580/618 [94%]), specificity (1880/1920 [98%]), and accuracy (2460/2538 [97%]) for assessing BME as compared with MRI as reference standard. The interobserver agreement was excellent (κ = 0.98). CT numbers derived from VNCa images were significantly different in zones with and without edema (p < 0.001). A cutoff value of - 46 Hounsfield units provided a sensitivity of 91% and specificity of 97% for differentiating edematous scaphoid lesions. Receiver operating characteristic curve analysis revealed an overall area under the curve of 0.98.CONCLUSIONS: Qualitative and quantitative analyses showed excellent diagnostic accuracy of color-coded VNCa reconstructions for assessing traumatic BME of the scaphoid compared to MRI.KEY POINTS: • Color-coded virtual non-calcium (VNCa) reconstructions yield excellent diagnostic accuracy in assessing bone marrow edema of the scaphoid. • VNCa imaging enables detection of non-displaced fractures that are occult on standard grayscale CT. • Diagnostic confidence is comparable between VNCa imaging and MRI.

AB - OBJECTIVES: To investigate the diagnostic accuracy of color-coded dual-energy CT virtual non-calcium (VNCa) reconstructions for the assessment of bone marrow edema (BME) of the scaphoid in patients with acute wrist trauma.METHODS: Our retrospective study included data from 141 patients (67 women, 74 men; mean age 43 years, range 19-80 years) with acute wrist trauma who had undergone third-generation dual-source dual-energy CT and 3-T MRI within 7 days. Eight weeks after assessment of conventional grayscale dual-energy CT scans for the presence of fractures, corresponding color-coded VNCa reconstructions were independently analyzed by the same six radiologists for the presence of BME. CT numbers on VNCa reconstructions were evaluated by a seventh radiologist. Consensus reading of MRI series by two additional radiologists served as the reference standard.RESULTS: MRI depicted 103 scaphoideal zones with BME in 76 patients. On qualitative analysis, VNCa images yielded high overall sensitivity (580/618 [94%]), specificity (1880/1920 [98%]), and accuracy (2460/2538 [97%]) for assessing BME as compared with MRI as reference standard. The interobserver agreement was excellent (κ = 0.98). CT numbers derived from VNCa images were significantly different in zones with and without edema (p < 0.001). A cutoff value of - 46 Hounsfield units provided a sensitivity of 91% and specificity of 97% for differentiating edematous scaphoid lesions. Receiver operating characteristic curve analysis revealed an overall area under the curve of 0.98.CONCLUSIONS: Qualitative and quantitative analyses showed excellent diagnostic accuracy of color-coded VNCa reconstructions for assessing traumatic BME of the scaphoid compared to MRI.KEY POINTS: • Color-coded virtual non-calcium (VNCa) reconstructions yield excellent diagnostic accuracy in assessing bone marrow edema of the scaphoid. • VNCa imaging enables detection of non-displaced fractures that are occult on standard grayscale CT. • Diagnostic confidence is comparable between VNCa imaging and MRI.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Bone Marrow/diagnostic imaging

KW - Calcium

KW - Edema/diagnostic imaging

KW - Female

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Scaphoid Bone/diagnostic imaging

KW - Sensitivity and Specificity

KW - Tomography, X-Ray Computed

KW - Young Adult

UR - http://www.scopus.com/inward/record.url?scp=85099035740&partnerID=8YFLogxK

U2 - 10.1007/s00330-020-07541-x

DO - 10.1007/s00330-020-07541-x

M3 - Journal article

C2 - 33409799

AN - SCOPUS:85099035740

SN - 0938-7994

VL - 31

SP - 4428

EP - 4437

JO - European Radiology

JF - European Radiology

IS - 7

ER -

Incremental diagnostic value of color-coded virtual non-calcium dual-energy CT for the assessment of traumatic bone marrow edema of the scaphoid

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