European Radiology

, Volume 29, Issue 1, pp 31–39 | Cite as

Single-source dual-energy computed tomography for the assessment of bone marrow oedema in vertebral compression fractures: a prospective diagnostic accuracy study

  • Torsten DiekhoffEmail author
  • Nils Engelhard
  • Michael Fuchs
  • Matthias Pumberger
  • Michael Putzier
  • Jürgen Mews
  • Marcus Makowski
  • Bernd Hamm
  • Kay-Geert A. Hermann



To evaluate the diagnostic accuracy of single-source dual-energy computed tomography (DECT) for the detection of bone marrow oedema (BME) in patients with vertebral compression fractures.


Patients over 50 years of age with radiographically suspected vertebral compression fracture of the thoracic or lumbar spine were prospectively enrolled. All patients underwent DECT with sequential acquisition of 80 and 135 kVp datasets on a 320-row detector CT scanner and 1.5-Tesla magnetic resonance imaging (MRI) including T1-weighted and short-tau inversion recovery (STIR) sequences. Virtual non-calcium (VNCa) images were reconstructed using a three-material decomposition algorithm. Vertebrae with height loss in CT were scored for the presence of BME in both MRI and DECT and used to determine signal- and contrast-to-noise ratios (SNR and CNR). Contingency analysis using MRI as standard of reference and Fleiss’s kappa were calculated. IRB approval was obtained.


In total 192 vertebral compression fractures in 70 patients (23 men, 47 women; mean age 70.7 years (SD 9.8)) were included in our analysis. DECT showed a reader-dependent sensitivity of 72% and specificity of 70% for BME. Fleiss’s kappa was .40 for DECT and .58 for MRI. T1-weighted images had significantly better SNR and CNR compared to STIR, CT, and VNCa (p < .0001); however, there was no difference between STIR and VNCa.


VNCa images depict BME with adequate sensitivity and specificity and can be acquired on a single-source system. Image quality is adequate but trained readers are needed for image interpretation.

Key Points

• Dual-energy CT in a single-source technique can help to detect bone marrow oedema in patients with vertebral compression fractures.

• However, given the inferior inter-rater reliability and limited specificity compared to MRI, experienced readers are needed for image interpretation.

• Dual-energy CT of the spine has limited sensitivity for the detection of bone marrow oedema in vertebra with previous surgical intervention.


Fractures, compression Tomography, x-ray computed Oedema Spine 



Bone marrow oedema


Contrast-to-noise ratio


Dual-energy computed tomography


Intervertebral ratio


Standard deviation


Signal-to-noise ratio


Short-tau inversion recovery


Virtual non-calcium reconstruction



The Department of Radiology at Charité – Universitätsmedizin Berlin received a research grant by Canon MS. Canon MS provided the software for image-evaluation. The study itself did not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Torsten Diekhoff.

Conflict of interest

The authors of this article declare relationships with the following companies: JM is an employee of Canon MS.

Statistics and biometry

Andrea Stroux kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• cross-sectional study/diagnostic study

• performed at one institution

Supplementary material

330_2018_5568_MOESM1_ESM.docx (4.2 mb)
ESM 1 (DOCX 4308 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, Charité - Universitätsmedizin Berlin, Campus MitteHumboldt-Universität zu Berlin, Freie Universität BerlinBerlinGermany
  2. 2.Department of Spine Surgery, Center for Musculoskeletal SurgeryCharité - Universitätsmedizin Berlin Campus MitteBerlinGermany
  3. 3.Canon Medical Systems Corporation Europe BVZoetermeerThe Netherlands

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