Piacentino Filippo, Fontana Federico, Beltramini Cecilia, Coppola Andrea, Mesiano Daniele, Venturini Gloria, Recaldini Chiara, Minici Roberto, Ierardi Anna Maria, Ascenti Velio, Barbera Simone, D'Angelo Fabio, Laganà Domenico, Carrafiello Gianpaolo, Ascenti Giorgio, Venturini Massimo
Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, 21100 Varese, Italy.
Department of Medicine and Technological Innovation (DiMIT), Insubria University, 21100 Varese, Italy.
J Clin Med. 2025 Jul 28;14(15):5319. doi: 10.3390/jcm14155319.
: Although MRI with fat-suppression sequences is the gold standard for diagnosis of bone marrow edema (BME), Dual-Layer Spectral CT (DL-SCT) with electron density (ED) provides a viable alternative, particularly in situations where an MRI is not accessible. Using MRI as the reference standard, this study analyzed how DL-SCT with ED reconstructions may be a valid alternative in the detection of BME. : This retrospective study included 28 patients with a suspected diagnosis of BME via MRI conducted between March and September 2024. Patients underwent DL-SCT using ED reconstructions obtained through IntelliSpace software v. 12.1. Images were evaluated by two experienced radiologists and one young radiologist in a blinded way, giving a grade from 0 to 3 to classify BME (0 absence; 1 mild; 2 moderate; 3 severe). To reduce the recall bias effect, the order of image evaluations was set differently for each reader. -Values were considered significant when <0.05. Fleiss' Kappa was used to assess inter-rater reliability: agreement was considered poor for k < 0; slight for k 0.01-0.20; fair for 0.21-0.40; moderate for 0.41-0.60; substantial for 0.61-0.80; and almost perfect for 0.81-1.00. : All the readers detected the presence or absence of BME using DL-SCT. Inter-rater reliability for grade 0 resulted in 1 (-value < 0.001); for grade 1: 0.21 (-value < 0.001); for grade 2: 0.197 (-value < 0.001); and for grade 3: 0.515 (-value < 0.001). : ED reconstructions allowed the identification of BME presence or absence in all analyzed cases, thus suggesting DL-SCT as a potentially effective method for its detection.
虽然采用脂肪抑制序列的磁共振成像（MRI）是诊断骨髓水肿（BME）的金标准，但具有电子密度（ED）的双层光谱CT（DL-SCT）提供了一种可行的替代方法，特别是在无法进行MRI检查的情况下。本研究以MRI作为参考标准，分析了采用ED重建的DL-SCT在检测BME方面如何可能成为一种有效的替代方法。：这项回顾性研究纳入了2024年3月至9月间通过MRI疑似诊断为BME的28例患者。患者接受了使用通过IntelliSpace软件v. 12.1获得的ED重建的DL-SCT检查。图像由两名经验丰富的放射科医生和一名年轻放射科医生以盲法进行评估，对BME进行0至3级分类（0级为无；1级为轻度；2级为中度；3级为重度）。为减少召回偏倚效应，为每位读者设置了不同的图像评估顺序。当P值<0.05时，差异具有统计学意义。使用Fleiss' Kappa评估评分者间的可靠性：kappa<0时一致性较差；kappa为0.01 - 0.20时为轻微；0.21 - 0.40时为中等；0.41 - 0.60时为 substantial；0.61 - 0.80时为 substantial；0.81 - 1.00时为几乎完美。：所有读者均使用DL-SCT检测到了BME的存在与否。0级的评分者间可靠性kappa为1（P值<0.001）；1级为0.21（P值<0.001）；2级为0.197（P值<0.001）；3级为0.515（P值<0.001）。：ED重建能够在所有分析病例中识别BME的存在与否，因此表明DL-SCT是一种潜在有效的检测方法。
