Stelbrink Carsten, Jahnke Paul, Goehler Friedemann, Klosterkemper Yan, Pumberger Matthias, Schömig Friederike, Tuttle Niklas, Rubarth Kerstin, Diekhoff Torsten, Pohlan Julian
Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Sci Rep. 2025 Jun 10;15(1):20040. doi: 10.1038/s41598-025-04216-9.
While magnetic resonance imaging (MRI) is the diagnostic method of choice, we here analyze the diagnostic potential of dual-energy computed tomography (DECT) in differentiating abnormal discs from normal-appearing discs and in differentiating between infectious and degenerative conditions. Twenty-eight patients with suspected spondylodiscitis who underwent DECT and MRI of the spine were retrospectively included. Eighteen patients were diagnosed with spondylodiscitis and ten patients with degenerative disc disease. A combined clinical reference standard for the diagnosis was used. One abnormal disc and one normal-appearing disc per patient were included. Three blinded readers analyzed CT, DECT cMaps and MRI images. Quantitative analysis was performed in standardized regions of interest placed in each of the two discs included. Mixed-model analysis was used to identify correlations between CT density alterations and spondylodiscitis or degenerative disc disease. Diagnostic accuracy for differentiating abnormal discs and normal-appearing discs: 69.7% (95% CI, 56.0 to 81.2) for CT, 76.8% (95% CI, 63.6 to 87.0) for CT + DECT, 58.9% (95% CI, 45.0 to 71.9) for MRI; for differentiating spondylodiscitis and degenerative disc disease: 64.3% (95% CI, 44.1 to 81.4) for CT, 60.7% (95% CI, 40.6 to 78.5) for CT + DECT, 53.6% (95% CI, 33.9 to 72.5) for MRI. Mixed-model analysis revealed that normal-appearing discs had higher average density than abnormal discs in DECT (mean difference = 47.0 HU (95% CI, 32.8 to 61.3), p = < 0.001). In summary, both qualitative and quantitative DECT can distinguish normal-appearing discs from abnormal discs. Spondylodiscitis and degenerative disc disease were not distinguished accurately by DECT in this study.
虽然磁共振成像（MRI）是首选的诊断方法，但我们在此分析双能计算机断层扫描（DECT）在区分异常椎间盘与外观正常的椎间盘以及区分感染性和退行性疾病方面的诊断潜力。回顾性纳入了28例接受脊柱DECT和MRI检查的疑似脊椎椎间盘炎患者。18例患者被诊断为脊椎椎间盘炎，10例患者被诊断为退行性椎间盘疾病。采用综合临床诊断参考标准。每位患者纳入一个异常椎间盘和一个外观正常的椎间盘。三位盲法阅片者分析CT、DECT彩色图谱和MRI图像。在纳入的两个椎间盘中的每个椎间盘的标准化感兴趣区域进行定量分析。采用混合模型分析来确定CT密度改变与脊椎椎间盘炎或退行性椎间盘疾病之间的相关性。区分异常椎间盘与外观正常的椎间盘的诊断准确性：CT为69.7%（95%CI，56.0至81.2），CT + DECT为76.8%（95%CI，63.6至87.0），MRI为58.9%（95%CI，45.0至71.9）；区分脊椎椎间盘炎和退行性椎间盘疾病的诊断准确性：CT为64.3%（95%CI，44.1至81.4），CT + DECT为60.7%（95%CI，40.6至78.5），MRI为53.6%（95%CI，33.9至72.5）。混合模型分析显示，在DECT中，外观正常的椎间盘平均密度高于异常椎间盘（平均差值 = 47.0 HU（95%CI，32.8至61.3），p = < 0.001）。总之，DECT的定性和定量分析均可区分外观正常的椎间盘与异常椎间盘。在本研究中，DECT未能准确区分脊椎椎间盘炎和退行性椎间盘疾病。
