Department of Radiology, S. Maria delle Grazie Hospital, Pozzuoli, Italy.
Department of Radiology, S. Maria delle Grazie Hospital, Pozzuoli, Italy; Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
Eur J Radiol. 2021 Jan;134:109456. doi: 10.1016/j.ejrad.2020.109456. Epub 2020 Dec 1.
Skeletal traumas are among the most common routine challenges faced by Emergency Radiologists, in particular in case of radiographically occult nondisplaced fractures or in case of soft tissue injuries. With the development of Dual Energy Computed Tomography (DECT) technology, new post-processing applications have gained a useful diagnostic role in many fields of musculoskeletal imaging including acute skeletal trauma imaging. In addition to conventional CT images, DECT allows for the generation of virtual calcium-suppressed images subtracting calcium from unenhanced CT images based on the fact that material attenuation varies at different energy levels. In this way, virtual-non-calcium (VNC) images can precisely characterize traumatic bone marrow edema in both axial and appendicular skeleton, facilitating prompt clinical decision, especially when magnetic resonance method is contraindicated or unavailable. Other DECT emerging applications in the trauma setting include metal artifact reduction and collagen mapping for the evaluation of injuries affecting ligament, tendon, and intervertebral disk. This review focuses on the basic principles of DECT and related post-processing algorithms, highlighting the current advantages and limitations of these new imaging advances in the Emergency Department related to skeletal traumas.
骨骼创伤是急诊放射科医生最常遇到的常规挑战之一，特别是在影像学上隐匿性无移位骨折或软组织损伤的情况下。随着双能计算机断层扫描（DECT）技术的发展，新的后处理应用在包括急性骨骼创伤成像在内的许多肌肉骨骼成像领域获得了有用的诊断作用。除了常规 CT 图像外，DECT 还允许根据物质衰减在不同能级上变化的事实，从未增强的 CT 图像中减去钙，生成虚拟钙抑制图像。这样，虚拟非钙（VNC）图像可以精确地描述轴向和附肢骨骼中的创伤性骨髓水肿，有助于快速做出临床决策，尤其是在磁共振方法禁忌或不可用时。创伤环境中的其他 DECT 新兴应用包括金属伪影减少和胶原映射，用于评估影响韧带、肌腱和椎间盘的损伤。本综述重点介绍了 DECT 的基本原理和相关的后处理算法，强调了这些新的成像技术在急诊科与骨骼创伤相关的当前优势和局限性。
