European Radiology

, Volume 28, Issue 10, pp 4182–4194 | Cite as

Diagnostic performance of dual-energy CT for the detection of bone marrow oedema: a systematic review and meta-analysis

  • Chong Hyun Suh
  • Seong Jong YunEmail author
  • Wook Jin
  • Sun Hwa Lee
  • So Young Park
  • Chang-Woo Ryu



The aim of this systematic review and meta-analysis was to assess the sensitivity and specificity of dual-energy CT (DECT) for the detection of bone marrow oedema (BME).


An electronic search of the PubMed and EMBASE databases was conducted. Bivariate modelling and hierarchical summary receiver-operating characteristic modelling were performed to evaluate the overall diagnostic performance of DECT for BME. Subgroup analysis was performed according to the assessment type (qualitative vs. quantitative) and anatomical location (spine vs. appendicular skeleton). Meta-regression analyses were performed according to the subject, study, and DECT characteristics.


Twelve eligible studies (1901 lesions, 450 patients) were included. DECT exhibited a pooled sensitivity of 0.85 [95% confidence interval (CI): 0.78–0.90] and a pooled specificity of 0.97 (95% CI: 0.92–0.98) for BME detection. In addition, the diagnostic performance of qualitative assessment (sensitivity, 0.85; specificity, 0.97) was higher than that of quantitative assessment (sensitivity, 0.84; specificity, 0.88) of DECT findings. The diagnostic performance of DECT for the spine (sensitivity, 0.84; specificity, 0.98) and appendicular skeleton (sensitivity, 0.84; specificity, 0.93) were excellent. According to meta-regression analysis, the use of a tin filter, ≥ 2 image planes, and a slice thickness < 1 mm tended to exhibit higher sensitivity and hyperacute stage BME (< 24 h) tended to exhibit lower sensitivity.


These findings indicate that DECT has excellent sensitivity and specificity for BME detection. Qualitative assessment of DECT findings obtained using a tin filter, ≥ 2 image planes, and a 0.5-1-mm slice thickness in the acute stage BME (≥24 h) is recommended for more sensitive diagnosis.

Key Points

• Overall, DECT is useful for the detection of BME (sensitivity, 85%; specificity-97%).

• Qualitative assessment (sensitivity-85%; specificity-97%) is more accurate than quantitative assessment (sensitivity-84%; specificity-88%).

• DECT showed excellent diagnostic performance for both the spine/appendicular skeleton (sensitivity-84%/84%; specificity-98%/93%).


Meta-analysis Dual-energy scanned projection radiography Multidetector computed tomography Bone marrow Sensitivity 



Bone marrow oedema


Dual-energy computed tomography


Hierarchical summary receiver-operating characteristic


Quality assessment of diagnostic accuracy studies-2


Virtual non-calcium



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Seong Jong Yun, MD, PhD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Chong Hyun Suh, MD) has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because the nature of our study was a systemic review and meta-analysis.

Ethical approval

Institutional Review Board approval was not required because the nature of our study was a systemic review and meta-analysis.


• Meta-analysis

• performed at one institution

Supplementary material

330_2018_5411_MOESM1_ESM.doc (4.4 mb)
ESM 1 (DOC 4468 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology and Research Institute of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Radiology, Kyung Hee University Hospital at GangdongKyung Hee University School of MedicineSeoulRepublic of Korea
  3. 3.Department of RadiologyKyung Hee UniversitySeoulRepublic of Korea
  4. 4.Department of Emergency Medicine, Sanggye Paik HospitalInje University College of MedicineSeoulRepublic of Korea

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