Detection of Bone Marrow Edema in the Head and Neck With Dual-Energy CT: Ready for Clinical Use?

The aim of this study is to evaluate the ability of dual-energy CT (DECT) to identify bone marrow edema (BME) in the head and neck region in comparison with MRI as the standard of reference. A total of 33 patients who underwent imaging between February 2016 and February 2018 were included in this retrospective study. All patients underwent both DECT and MRI for head and neck abnormalities. Two radiologists independently visually assessed virtual noncalcium (VNCa) reconstructions with color-coded maps for the presence of BME. STIR or T2-weighted MRI reconstructions with fat suppression were used as the standard of reference for BME. Subjective quality assessment and severity of metal artifacts were scored on both imaging modalities. BME was detected in 18 patients on DECT compared with 20 patients on MRI. Most BME seen on DECT was located in the mandible. VNCa DECT images had a sensitivity, specificity, positive predictive value, and negative predictive value for BME of 85%, 92%, 94%, and 80% respectively, using MRI as the reference. The quality of the images was rated as excellent to moderate in 94% of the patients for VNCa DECT compared with 82% of the patients for MRI, but this difference was not statistically significant. Significantly more metal artifacts were scored on the mixed DECT images than on the MR images, but these artifacts did not interfere with diagnosis. BME detection in the head and neck region seems possible with VNCa DECT images and has the potential to provide an alternative for MRI in clinical practice.