Yap Jiawei Alexander, Ong Yu Xuan Nicholas, Weber Marc-André
Department of Radiology, Woodlands Health, Singapore, Singapore.
University Medical Center Rostock, Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock, Germany.
Rofo. 2025 Aug 1. doi: 10.1055/a-2653-9256.
Bone marrow edema (BME) is a significant imaging finding in musculoskeletal and emergency radiology, often associated with trauma or nontraumatic etiologies such as inflammation, infection, or neoplasms. Magnetic resonance imaging (MRI) remains the gold standard for BME evaluation. However, dual-energy CT (DECT) has emerged as a valuable alternative due to its faster acquisition times, lower costs, and more rapid access in emergency settings (when compared with MRI), facilitating timely decision-making when MRI is impractical or contraindicated. Despite its benefits, accurate interpretation of BME on DECT requires careful understanding of its limitations and potential pitfalls. This article addresses the technical and clinical challenges in DECT-based BME assessment and proposes strategies to enhance diagnostic accuracy.A review of the literature was performed by searching the PubMed and ScienceDirect databases, using the keywords ("DECT" or "Dual-Energy") and ("BME" or "bone marrow edema") and ("musculoskeletal" or "bone" or "skeleton") for the title and abstract query. The inclusion criteria were scientific papers presented in the English language. Exclusion criteria included articles which had no relevant focus on BME and case reports. Of the 168 articles initially identified, 75 were deemed relevant and were reviewed in detail. Insight from this literature search and the authors' clinical experience forms the basis of this review, highlighting key pitfalls and strategies for accurate BME interpretation.DECT provides significant advantages for detecting BME, such as material-specific color overlays and high anatomical correlation. However, key pitfalls include the misinterpretation of artifacts, difficulties in cases of severe displacement or sclerosis, and challenges posed by imaging artifacts in large-sized patients or those with metallic implants. Radiologists can improve diagnostic accuracy by understanding the limitations and pitfalls of DECT, and by adopting the solutions outlined in the article to optimize its use. · DECT effectively identifies BME in both traumatic and non-traumatic conditions, with sensitivity and specificity comparable to magnetic resonance imaging (MRI).. · Key interpretation pitfalls include artifacts from photon starvation, metallic implants, severe displacement, and motion, as well as limitations in algorithm processing.. · Misdiagnoses can arise due to mimics of BME, such as sclerosis, red marrow, or pathological fractures, necessitating clinical and imaging correlation.. · Parameter optimization (e.g., spectral FOV, kernel selection, image calibration) enhances diagnostic accuracy and reduces errors.. · Yap JA, Ong YX, Weber M. Pitfalls in Bone Marrow Edema Interpretation on Dual-Energy CT: Challenges and Solutions. Rofo 2025; DOI 10.1055/a-2653-9256.
骨髓水肿（BME）是肌肉骨骼和急诊放射学中的一项重要影像学表现，常与创伤或非创伤性病因相关，如炎症、感染或肿瘤。磁共振成像（MRI）仍然是评估BME的金标准。然而，双能CT（DECT）因其采集时间更快、成本更低以及在急诊情况下（与MRI相比）更容易获取，已成为一种有价值的替代方法，当MRI不实用或禁忌时，有助于及时做出决策。尽管有这些优点，但在DECT上准确解读BME需要仔细了解其局限性和潜在陷阱。本文探讨了基于DECT的BME评估中的技术和临床挑战，并提出了提高诊断准确性的策略。通过在PubMed和ScienceDirect数据库中搜索，使用关键词（“DECT”或“双能”）以及（“BME”或“骨髓水肿”）和（“肌肉骨骼”或“骨骼”或“骨架”）进行标题和摘要查询，对文献进行了综述。纳入标准为以英文发表的科学论文。排除标准包括与BME无关的文章和病例报告。在最初识别的168篇文章中，75篇被认为相关并进行了详细审查。这次文献检索的见解和作者的临床经验构成了本综述的基础，突出了准确解读BME的关键陷阱和策略。DECT在检测BME方面具有显著优势，如物质特异性颜色叠加和高解剖相关性。然而，关键陷阱包括对伪影的错误解读、严重移位或硬化病例中的困难，以及在体型较大的患者或有金属植入物的患者中成像伪影带来的挑战。放射科医生可以通过了解DECT的局限性和陷阱，并采用本文概述的解决方案来优化其使用，从而提高诊断准确性。·DECT在创伤性和非创伤性情况下均能有效识别BME，其敏感性和特异性与磁共振成像（MRI）相当。·关键的解读陷阱包括光子饥饿、金属植入物、严重移位和运动产生的伪影，以及算法处理的局限性。·由于BME的模仿物，如硬化、红骨髓或病理性骨折，可能会出现误诊，因此需要临床和影像学的相关性。·参数优化（如光谱视野、内核选择、图像校准）可提高诊断准确性并减少误差。·Yap JA，Ong YX，Weber M。双能CT上骨髓水肿解读的陷阱：挑战与解决方案。Rofo 2025；DOI 10.1055/a - 2653 - 9256。
