Department of Diagnostic Radiology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.
Skeletal Radiol. 2022 Sep;51(9):1731-1741. doi: 10.1007/s00256-022-04032-6. Epub 2022 Mar 16.
Computed tomography (CT) is routinely used to diagnose and evaluate metastatic lesions in oncology. CT alone suffers from lack of sensitivity, especially for skeletal lesions in the bone marrow and lesions that have similar attenuation profiles to surrounding bone. Magnetic resonance imaging and nuclear medicine imaging remain the gold standard in evaluating skeletal lesions. However, compared to CT, these modalities are not as widely available or suitable for all patients. Dual energy computed tomography (DECT) exploits variations in linear attenuation coefficient of materials at different photon energy levels to reconstruct images based on material composition. DECT in musculoskeletal imaging is used in the imaging of crystal arthropathy and detecting subtle fractures, but it is not broadly utilized in evaluating infiltrative skeletal lesions. Malignant skeletal lesions have different tissue and molecular compositions compared to normal bone. DECT may exploit these physical differences to delineate infiltrative skeletal lesions from surrounding bone better than conventional monoenergetic CT. Studies so far have examined the utility of DECT in evaluating skeletal metastases, multiple myeloma lesions, pathologic fractures, and performing image-guided biopsies with promising results. These studies were mostly retrospective analyses and case reports containing small samples sizes. As DECT becomes more widely used clinically and more scientific studies evaluating the performance of DECT are published, DECT may eventually become an important modality in the work-up of infiltrative skeletal lesions. It may even challenge MRI and nuclear medicine because of relatively faster scanning times and ease of access.
计算机断层扫描（CT）常用于肿瘤学中诊断和评估转移性病变。但 CT 单独应用存在敏感性不足的问题，特别是对骨髓中的骨病变和与周围骨衰减谱相似的病变。磁共振成像（MRI）和核医学成像仍然是评估骨骼病变的金标准。然而，与 CT 相比，这些方法并非在所有患者中都广泛适用或适用。双能量 CT（DECT）利用不同物质在不同光子能量水平下线性衰减系数的差异，根据物质成分重建图像。DECT 在肌肉骨骼成像中用于晶体性关节炎的成像和检测细微骨折，但在评估浸润性骨骼病变方面尚未广泛应用。与正常骨骼相比，恶性骨骼病变具有不同的组织和分子组成。DECT 可能会利用这些物理差异，更好地将浸润性骨骼病变与周围骨骼区分开来，优于传统的单能量 CT。迄今为止，已有研究检查了 DECT 在评估骨骼转移、多发性骨髓瘤病变、病理性骨折以及进行图像引导活检中的效用，结果令人鼓舞。这些研究大多是回顾性分析和包含小样本量的病例报告。随着 DECT 在临床上的应用越来越广泛，以及更多评估 DECT 性能的科学研究的发表，DECT 最终可能成为评估浸润性骨骼病变的重要方法。它甚至可能会因为扫描时间相对较快且易于获取而挑战 MRI 和核医学。
