Single-source dual-energy computed tomography for the detection of bone marrow lesions: impact of iterative reconstructi
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SCIENTIFIC ARTICLE
Single-source dual-energy computed tomography for the detection of bone marrow lesions: impact of iterative reconstruction and algorithms N. Engelhard 1 & K. G. Hermann 1 & J. Greese 1 & M. Fuchs 2 & M. Pumberger 3 & M. Putzier 3 & T. Diekhoff 1 Received: 14 July 2019 / Revised: 29 September 2019 / Accepted: 2 October 2019 # ISS 2019
Abstract Purpose To compare the diagnostic performance of different reconstruction algorithms of single-source dual-energy computed tomography (DECT) for the detection of bone marrow lesions (BML) in patients with vertebral compression fracture using MRI as the standard of reference. Material and Methods Seventeen patients with an age over 50 who underwent single-source DECT of the spine were included. The raw data (RD) were reconstructed using filtered back-projection (FBP) and iterative reconstruction (IR) with three iteration levels (IR1–IR3). Bone marrow images were generated using a three-material decomposition (3MD) and a two-material decomposition (2MD) algorithm and an RD-based approach. Three blinded readers scored the images for image quality and the presence of bone marrow lesions (BML). Only vertebrae with height loss were included. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. The different reconstructions were compared using Dunn’s multiple comparison test. Results Thirty-nine vertebrae were included. IR(1–3) showed superior sensitivity (87.5%) compared to FBP (75%) using 3MD but was comparable to RD (83.3%). All 2MD images were inferior (sensitivity < 38%). The image quality score was significantly higher for 3MD-IR(1–3) compared to 3MD-FBP (p < 0.0001) and all 2MD data sets (p < 0.03). This pattern was also supported by the SNR and CNR measurements. RD showed no significant improvement compared to IR. Conclusion The image quality of bone marrow images acquired with DECT can be improved by using IR compared with FBP. RD-based reconstruction does not offer significant improvement over image data-based reconstruction. 2MD algorithms are not suitable for BML detection. Keywords Single-source dual-energy CT . Virtual non-calcium technique . Black bone technique . Iterative reconstruction . Bone marrow oedema
Introduction
* T. Diekhoff [email protected] 1
Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
2
Department for Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
3
Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
Dual-energy computed tomography (DECT) allows the detection of infiltration of bone marrow by a malignant tumour or posttraumatic bone marrow lesions (BML), also often referred to as bone marrow oedema. [1–6]. Several studies suggest that, especially in patients with vertebral compression fractures, DECT provides valuable additional diagnostic information compared with standard clinical CT for th
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