Schierenbeck Marie, Grözinger Martin, Reichardt Benjamin, Jansen Olav, Kauczor Hans-Ulrich, Campbell Graeme M, Sedaghat Sam
Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany.
German Cancer Research Center, University Hospital Heidelberg, 69120 Heidelberg, Germany.
Diagnostics (Basel). 2023 Aug 24;13(17):2745. doi: 10.3390/diagnostics13172745.
Detecting bone marrow edema (BME) as a sign of acute fractures is challenging on conventional computed tomography (CT). This study evaluated the diagnostic performance of a three-material decomposition (TMD) approach for detecting traumatic BME of the extremities on spectral computed tomography (SCT).
This retrospective diagnostic study included 81 bone compartments with and 80 without BME. A TMD application to visualize BME was developed in collaboration with Philips Healthcare. The following bone compartments were included: distal radius, proximal femur, proximal tibia, distal tibia and fibula, and long bone diaphysis. Two blinded radiologists reviewed each case independently in random order for the presence or absence of BME.
The interrater reliability was 0.84 ( < 0.001). The different bone compartments showed sensitivities of 86.7% to 93.8%, specificities of 84.2% to 94.1%, positive predictive values of 82.4% to 94.7%, negative predictive values of 87.5% to 93.3%, and area under the curve (AUC) values of 85.7% to 93.1%. The distal radius showed the highest sensitivity and the proximal femur showed the lowest sensitivity, while the proximal femur presented the highest specificity and the distal tibia presented the lowest specificity.
Our TMD approach provides high diagnostic performance for detecting BME of the extremities. Therefore, this approach could be used routinely in the emergency setting.
在传统计算机断层扫描（CT）上检测作为急性骨折征象的骨髓水肿（BME）具有挑战性。本研究评估了一种三物质分解（TMD）方法在光谱计算机断层扫描（SCT）上检测四肢创伤性BME的诊断性能。
这项回顾性诊断研究纳入了81个有BME的骨区和80个无BME的骨区。与飞利浦医疗合作开发了一种用于可视化BME的TMD应用程序。纳入的骨区包括：桡骨远端、股骨近端、胫骨近端、胫腓骨远端以及长骨干。两名盲法放射科医生以随机顺序独立审查每个病例，判断是否存在BME。
评分者间信度为0.84（<0.001）。不同骨区的敏感性为86.7%至93.8%，特异性为84.2%至94.1%，阳性预测值为82.4%至94.7%，阴性预测值为87.5%至93.3%，曲线下面积（AUC）值为85.7%至93.1%。桡骨远端敏感性最高，股骨近端敏感性最低，而股骨近端特异性最高，胫腓骨远端特异性最低。
我们的TMD方法在检测四肢BME方面具有较高的诊断性能。因此，这种方法可在急诊环境中常规使用。
