François Marie-Agathe, Comby Pierre-Olivier, Goueslard Karine, Lebeaupin François, Lemogne Brivaël, Ricolfi Frédéric, Lenfant Marc
University Hospital of Dijon, Department of Diagnostic and Therapeutic Neuroradiology, 14 boulevard Gaffarel, 21000 Dijon, France.
University Hospital of Dijon, Department of Diagnostic and Therapeutic Neuroradiology, 14 boulevard Gaffarel, 21000 Dijon, France.
Eur J Radiol. 2025 Jan;182:111857. doi: 10.1016/j.ejrad.2024.111857. Epub 2024 Nov 28.
To evaluate the spectral scanner (Aquilion One PRISM Edition, Canon Medical Systems Corporation, Otawara, Japan) diagnostic performance to identify bone marrow edema (BME) in vertebrae of patients managed for suspected vertebral compression fracture in the emergency department of Dijon University Hospital.
14 consecutive patients underwent spectral imaging and MRI spinal imaging, from January 2023 to March 2024 were retrospectively analyzed. 85 vertebrae were assessed for the detection of fracture on conventional CT images and the presence of bone marrow edema (BME) in all vertebral bodies on VNCa mapping for both Bone and Research preset, who was judged to indicate a fresh fracture. The mean attenuation coefficients and standard deviations were measured for both Bone and Research preset and each mapping (VNCa 1 mm and 3 mm, water and electron density mapping) using the t-test. Sensitivity, specificity, PPV and NPV analyses for diagnostic performance were performed.
The proportion of true positive cases among the positive cases detected by both Bone and Research preset was respectively 95 % and 100 %, and the proportion of true negative cases among the negative cases was respectively 94 % and 95 %. Positive and negative likelihood ratios were excellent, particularly for the Research preset. The attenuation values of vertebral bodies with BME on spectral CT, measured using ROI on virtual non-calcium maps, were statistically higher than those in vertebral bodies without edema.
Spectral CT showed good diagnostic accuracy, but also good discrimination capability in identifying the presence of BME in a vertebral body. Its diagnostic performance was very close to that of MRI. Thus, the detection of BME in a vertebral body by spectral CT greatly increased the probability of a recent or unhealed fracture in this vertebra. The present results suggest that the use of the spectral scanner to discriminate a recent or unhealed vertebral fracture from a union fracture could be considered.
评估光谱扫描仪（Aquilion One PRISM Edition，佳能医疗系统公司，日本大田原）在第戎大学医院急诊科对疑似椎体压缩骨折患者的椎体骨髓水肿（BME）进行诊断的性能。
回顾性分析2023年1月至2024年3月期间连续14例接受光谱成像和脊柱MRI成像的患者。对85个椎体进行评估，以在常规CT图像上检测骨折，并在用于骨骼和研究预设的VNCa映射上评估所有椎体中骨髓水肿（BME）的存在情况，判断其是否表明为新鲜骨折。使用t检验测量骨骼和研究预设以及每个映射（VNCa 1毫米和3毫米、水和电子密度映射）的平均衰减系数和标准差。对诊断性能进行敏感性、特异性、阳性预测值和阴性预测值分析。
骨骼和研究预设检测到的阳性病例中真阳性病例的比例分别为95%和100%，阴性病例中真阴性病例的比例分别为94%和95%。阳性和阴性似然比极佳，特别是对于研究预设。在虚拟非钙映射上使用ROI测量的光谱CT上有BME的椎体的衰减值在统计学上高于无水肿椎体的衰减值。
光谱CT显示出良好的诊断准确性，在识别椎体中BME的存在方面也具有良好的鉴别能力。其诊断性能与MRI非常接近。因此，光谱CT检测椎体中的BME大大增加了该椎体近期或未愈合骨折的可能性。目前的结果表明，可以考虑使用光谱扫描仪来区分近期或未愈合的椎体骨折与愈合骨折。
