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Cheong SCW, Yan YY, Sheikh A, Ouellette HA, Munk PL, Murray N, Mallinson PI. Dual-energy CT applications in musculoskeletal disorders. Br J Radiol 2024; 97:705-715. [PMID: 38291893 PMCID: PMC11027318 DOI: 10.1093/bjr/tqae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/06/2024] [Accepted: 01/24/2024] [Indexed: 02/01/2024] Open
Abstract
Dual-energy CT (DECT) is an exciting application in CT technology conferring many advantages over conventional single-energy CT at no additional with comparable radiation dose to the patient. Various emerging and increasingly established clinical DECT applications in musculoskeletal (MSK) imaging such as bone marrow oedema detection, metal artefact reduction, monosodium urate analysis, and collagen analysis for ligamentous, meniscal, and disc injuries are made possible through its advanced DECT post-processing capabilities. These provide superior information on tissue composition, artefact reduction and image optimization. Newer DECT applications to evaluate fat fraction for sarcopenia, Rho/Z application for soft tissue calcification differentiation, 3D rendering, and AI integration are being assessed for future use. In this article, we will discuss the established and developing applications of DECT in the setting of MSK radiology as well as the basic principles of DECT which facilitate them.
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Affiliation(s)
- Sook Chuei W Cheong
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
- Department of Radiology, Changi General Hospital, Singapore 529889, Singapore
| | - Yet Yen Yan
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
- Department of Radiology, Changi General Hospital, Singapore 529889, Singapore
| | - Adnan Sheikh
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
| | - Hugue A Ouellette
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
| | - Peter L Munk
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
| | - Nicolas Murray
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
| | - Paul I Mallinson
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
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Meer E, Patel M, Chan D, Sheikh AM, Nicolaou S. Dual-Energy Computed Tomography and Beyond: Musculoskeletal System. Radiol Clin North Am 2023; 61:1097-1110. [PMID: 37758359 DOI: 10.1016/j.rcl.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Traditional monoenergetic computed tomography (CT) scans in musculoskeletal imaging provide excellent detail of bones but are limited in the evaluation of soft tissues. Dual-energy CT (DECT) overcomes many of the traditional limitations of CT and offers anatomical details previously seen only on MR imaging. In addition, DECT has benefits in the evaluation and characterization of arthropathies, bone marrow edema, and collagen applications in the evaluation of tendons, ligaments, and vertebral discs. There is current ongoing research in the application of DECT in arthrography and bone mineral density calculation.
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Affiliation(s)
- Emtenen Meer
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada; King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Mitulkumar Patel
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Chan
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Adnan M Sheikh
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
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Legrand J, Marzin C, Neogi T, Norberciak L, Budzik JF, Pascart T. Associations of Changes in Knee Hyaline Cartilage Composition Measured With Dual-Energy Computed Tomography in Gout, Aging and Osteoarthritis. Cartilage 2023:19476035231172152. [PMID: 37312537 DOI: 10.1177/19476035231172152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE To characterize dual-energy computed tomography (DECT) changes depicting hyaline cartilage changes in gout patients with and without osteoarthritis (OA) and in comparators without gout. DESIGN Patients with suspected crystal-associated arthropathy were enrolled and underwent bilateral DECT scans of the knees. Standardized regions of interest were defined in the femorotibial hyaline cartilage. Five DECT parameters were obtained: CT numbers in Hounsfield units (HU) at 80 and 140 kV, the electron density (Rho), the effective atomic number (Zeff), and the dual-energy index (DEI). Zones were compared between patients with gout, with and without knee OA, and between patients with gout and comparators without gout, after adjustment for confounders. RESULTS A total of 113 patients with gout (mean age 63.5 ± 14.3 years) and 15 comparators without gout (mean age 75.8 ± 11.5 years) were included, n = 65 (51%) had knee OA, and 466 zones of hyaline cartilage were analyzed. Older age was associated with lower attenuations at 80 kV (P < 0.01) and 140 kV (P < 0.01), and with Rho (P < 0.01). OA was characterized by lower attenuation at 140 kV (P = 0.03), but the lower Rho was nonsignificant after adjustment for confounders. In gout, hyaline cartilage exhibited lower Rho values (adjusted P = 0.04). Multivariable coefficients of association with Rho were -0.21 [-0.38;-0.04] (P = 0.014) for age, -4.15 [-9.0;0.7] (P = 0.093) for OA and 0.73 [-0.1;1.56] (P = 0.085) for monosodium urate volume. CONCLUSION Gout was associated with DECT-detected changes in cartilage composition, similar to those observed in older patients, with some similarities and some differences to those seen in OA. These results suggest the possibility of potential DECT biomarkers of OA.
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Affiliation(s)
- Julie Legrand
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lomme, France
- Imaging Department, Saint-Philibert Hospital, Lomme, France
| | - Claire Marzin
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Laurène Norberciak
- Department of Medical Research, Biostatistics, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Jean-François Budzik
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lomme, France
- MabLab UR4490/Lille and Boulogne-sur-Mer Universities/University of Lille Nord de France, Lomme, France
| | - Tristan Pascart
- MabLab UR4490/Lille and Boulogne-sur-Mer Universities/University of Lille Nord de France, Lomme, France
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, Lomme, France
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Bai R, He X, Huang J. A basic study for the molecular imaging of dual-energy CT in diagnosing anterior cruciate ligament injury of knee joint. Acta Radiol 2022; 64:1589-1599. [PMID: 36357954 DOI: 10.1177/02841851221135853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Anterior cruciate ligament (ACL) injury is a common disease in clinical practice that seriously affects the daily life of patients. Purpose To explore the molecular imaging basis of “diminution sign on dual-energy colour mapping” for the diagnosis of ACL injury by dual-energy computed tomography (DECT). Material and Methods The hydroxylysine and hydroxyproline reagents were prepared in different concentrations. The grouping was shown as follows: a simple concentration change group of an amino acid (group 1/2); a mixed solution group with the concentration increasing synchronously (group 3); a mixed solution group with the concentration reverse increasing and decreasing (group 4); and a mixed solution group that fix one amino acid with increasing concentration of the other (group 5/6). The samples were scanned by DECT. The solution CT value and image signal-to-noise ratio were analyzed. Results In group 1/2, the brightness of the dual-energy color mapping of each test tube solution and the CT value increased with increasing the concentration of amino acid. In group 6, there was no significant change in the brightness and brilliance of the dual-energy color mapping and the CT value. The remaining three groups showed an increase in the brightness and brilliance of the dual-energy color mapping and the CT value, and this increase was positively associated with the hydroxylysine concentration. Conclusion The dual-energy staining of the DECT imaging in “tendon” mode is related to hydroxylysine and hydroxyproline. Moreover, the degree of dual-energy color mapping is positively correlated with the change of CT value.
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Affiliation(s)
- Rui Bai
- Radiology Department, Gosun Medical Imaging Diagnostic Center, Guangzhou, PR China
| | - Xiaohua He
- Radiology Department, General Hospital of the Southern Theater, Guangzhou, PR China
| | - Juncheng Huang
- Radiology Department, Gosun Medical Imaging Diagnostic Center, Guangzhou, PR China
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Ditges AK, Diekhoff T, Engelhard N, Muellner M, Pumberger M, Schömig F. Neuroforamen stenosis remains a challenge in conventional computed tomography and new dual-energy techniques. Sci Rep 2022; 12:6678. [PMID: 35461368 PMCID: PMC9035174 DOI: 10.1038/s41598-022-10673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/04/2022] [Indexed: 12/01/2022] Open
Abstract
Lumbar foraminal stenosis may be caused by osseous and soft tissue structures. Thus, both computed tomography (CT) and magnetic resonance imaging (MRI) play a role in the diagnostic algorithm. Recently, dual-energy CT (DECT) has been introduced for the detection of spinal disorders. Our study’s aim was to investigate the diagnostic accuracy of collagen-sensitive maps derived from DECT in detecting lumbar foraminal stenosis compared with standard CT and MRI. We retrospectively reviewed CT, DECT, and MRI datasets in patients with vertebral fractures between January 2015 and February 2017. Images were scored for presence and type of lumbar neuroforaminal stenosis. Contingency tables were calculated to determine diagnostic accuracy and interrater agreement was evaluated. 612 neuroforamina in 51 patients were included. Intraclass correlation coefficients for interrater reliability in detecting foraminal stenoses were 0.778 (95%-CI 0.643–0.851) for DECT, 0.769 (95%-CI 0.650–0.839) for CT, and 0.820 (95%-CI 0.673–0.888) for MRI. Both DECT and conventional CT showed good diagnostic accuracy in detecting lumbar foraminal stenosis but low sensitivities in detecting discoid stenosis. Thus, even though previous studies suggest that DECT has high diagnostic accuracy in assessing lumbar disc pathologies, we show that DECT does not provide additional information for detecting discoid stenosis compared with conventional CT.
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Affiliation(s)
- Ann-Kathrin Ditges
- Department of Radiology, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Nils Engelhard
- Department of Radiology, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Ziegeler K, Richter ST, Hermann S, Hermann KGA, Hamm B, Diekhoff T. Dual-energy CT collagen density mapping of wrist ligaments reveals tissue remodeling in CPPD patients: first results from a clinical cohort. Skeletal Radiol 2021; 50:417-423. [PMID: 32803375 PMCID: PMC8189950 DOI: 10.1007/s00256-020-03580-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate differences in collagen density as detected by dual-energy computed tomography (DECT) of wrist ligaments between patients with calcium pyrophosphate-dihydrate deposition disease (CPPD) and a control group in order to gain insight into changes of the extracellular matrix in response to crystal deposition. MATERIALS AND METHODS This retrospective study included 28 patients (18 with CPPD, 10 controls) who underwent DECT of the wrist. Collagen density maps were reconstructed from the DECT datasets and used to measure densities in regions of interest (ROIs) placed in the scapholunate (SL) ligament (dorsal, palmar, proximal), lunotriquetral (LT) ligament, and extensor carpi radialis (ECR) tendon, (n = 260 measurements). The presence of calcifications on standard CT images in these regions was assessed by a blinded reader. Densities were compared with nonparametric tests, and linear regression analysis was performed to investigate the impact of age, sex, and CT- detected calcium deposition on collagen density. RESULTS Collagen density in the SL ligament was significantly higher in CPPD patients than in controls (overall mean: 265.4 ± 32.1 HU vs. 196.3 ± 33.8 HU; p < 0.001). In the ECR tendon, collagen densities did not differ significantly (p = 0.672): 161.3 ± 20.1 HU in CPPD vs. 163.6 ± 12.0 HU in controls. Regression analysis showed that diagnosis, but not age or calcification, had a significant impact on collagen density. CONCLUSION Collagen density of the SL ligament is significantly higher in CPPD patients than in control patients. Further research is needed to understand these changes in the extracellular matrix of ligaments in CPPD.
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Affiliation(s)
- Katharina Ziegeler
- Department of Radiology, Charité–Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sophia-Theresa Richter
- Department of Radiology, Charité–Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sandra Hermann
- Department of Rheumatology and Clinical Immunology, Charité–Universitätsmedizin, Charitéplatz 1, Berlin, 10117 Germany
| | - Kay Geert A. Hermann
- Department of Radiology, Charité–Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité–Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité–Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Germany
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Bai R, Li X, Li R, He X, Wen Z. Optimization of low-dose scan parameters in dual-energy computed tomography for displaying the anterior cruciate ligament. J Int Med Res 2020; 48:300060520927874. [PMID: 32720539 PMCID: PMC7388117 DOI: 10.1177/0300060520927874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective This study was performed to assess low-dose scan parameters in dual-energy computed
tomography (CT) for displaying the anterior cruciate ligament. Methods Dual-energy CT scans with low and standard dose parameters, respectively, were
performed in nine human knee joint specimens. Eighteen imaging data sets for cruciate
ligament specimens were obtained and processed. Statistical analysis was performed for
signal-to-noise ratios of the CT images and subjective scores. Results Comparable signal-to-noise ratios and subjective image quality scores by evaluators in
dual-energy CT anterior cruciate ligament images between the low and standard-dose
groups were observed. Conclusion Low-dose scan parameters do not compromise the outcomes of anterior cruciate ligament
imaging.
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Affiliation(s)
- Rui Bai
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Radiology, Gosun Medical Imaging Diagnostic Center, Guangzhou, China
| | - Xiangdong Li
- Department of Radiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Rurui Li
- Department of Radiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Xiaohua He
- Department of Radiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Hickle J, Walstra F, Duggan P, Ouellette H, Munk P, Mallinson P. Dual-energy CT characterization of winter sports injuries. Br J Radiol 2020; 93:20190620. [PMID: 31573325 DOI: 10.1259/bjr.20190620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
CT is a readily available imaging modality for cross-sectional characterization of acute musculoskeletal injuries in trauma. Dual-energy CT provides several additional benefits over conventional CT, namely assessment for bone marrow edema, metal artifact reduction, and enhanced assessment of ligamentous injuries. Winter sports such as skiing, snowboarding, and skating can result in high speed and high energy injury mechanisms; dual-energy CT is well suited for the characterization of those injuries.
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Affiliation(s)
- Jonathan Hickle
- Victoria, British Columbia, V8W 0A9 1505 - 707 Courtney Street, Canada
| | - Frances Walstra
- Victoria, British Columbia, V8W 0A9 1505 - 707 Courtney Street, Canada
| | - Peter Duggan
- Victoria, British Columbia, V8W 0A9 1505 - 707 Courtney Street, Canada
| | - Hugue Ouellette
- Victoria, British Columbia, V8W 0A9 1505 - 707 Courtney Street, Canada
| | - Peter Munk
- Victoria, British Columbia, V8W 0A9 1505 - 707 Courtney Street, Canada
| | - Paul Mallinson
- Victoria, British Columbia, V8W 0A9 1505 - 707 Courtney Street, Canada
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Dual-Energy CT in Musculoskeletal Imaging: What Is the Role Beyond Gout? AJR Am J Roentgenol 2019; 213:493-505. [DOI: 10.2214/ajr.19.21095] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Jeon JY, Lee SW, Jeong YM, Yu S. The utility of dual-energy CT collagen material decomposition technique for the visualization of tendon grafts after knee ligament reconstruction. Eur J Radiol 2019; 116:225-230. [DOI: 10.1016/j.ejrad.2019.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/29/2018] [Accepted: 03/17/2019] [Indexed: 11/29/2022]
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Kooraki S, Assadi M, Gholamrezanezhad A. Hot Topics of Research in Musculoskeletal Imaging. PET Clin 2019; 14:175-182. [DOI: 10.1016/j.cpet.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Dual-energy computed tomography (DECT) enables material decomposition and virtual monochromatic images by acquiring 2 different energy X-ray data sets. DECT can detect musculoskeletal pathologic conditions that CT alone cannot, and that would otherwise require MR imaging. In this review, the authors discuss several useful techniques and applications of DECT in musculoskeletal research: virtual monochromatic images, virtual noncalcium images, gout, iodine map, and tendons.
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Affiliation(s)
- Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-ku, Tokyo 105-8471, Japan; Department of Radiology, Stony Brook Medicine, HSC Level 4, Room 120, Stony Brook, NY 11794, USA.
| | - Kunihiko Fukuda
- Centre for International Affairs, The Jikei University, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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Wong WD, Shah S, Murray N, Walstra F, Khosa F, Nicolaou S. Advanced Musculoskeletal Applications of Dual-Energy Computed Tomography. Radiol Clin North Am 2018; 56:587-600. [DOI: 10.1016/j.rcl.2018.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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14
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Du YM, Yang QF, Shen WT, Huang HM. Development of a Dual-Energy Computed Tomography-Based Segmentation Method for Collateral Ligaments: A Porcine Knee Model. J Med Biol Eng 2018. [DOI: 10.1007/s40846-018-0424-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Khanduri S, Goyal A, Singh B, Chaudhary M, Sabharwal T, Jain S, Sharma H. The Utility of Dual Energy Computed Tomography in Musculoskeletal Imaging. J Clin Imaging Sci 2017; 7:34. [PMID: 28900555 PMCID: PMC5582533 DOI: 10.4103/jcis.jcis_46_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/11/2017] [Indexed: 12/27/2022] Open
Abstract
The objective of this article is to review the mechanisms, advantages and disadvantages of dual energy computed tomography (DECT) over conventional tomography (CT) in musculoskeletal imaging as DECT provides additional information about tissue composition and artifact reduction. This provides clinical utility in detection of urate crystals, bone marrow edema, reduction of beam hardening metallic artifact, and ligament and tendon analysis.
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Affiliation(s)
- Sachin Khanduri
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Aakshit Goyal
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Bhumika Singh
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Mriganki Chaudhary
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Tushar Sabharwal
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Shreshtha Jain
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Hritik Sharma
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
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Mallinson PI, Coupal TM, McLaughlin PD, Nicolaou S, Munk PL, Ouellette HA. Dual-Energy CT for the Musculoskeletal System. Radiology 2017; 281:690-707. [PMID: 27870622 DOI: 10.1148/radiol.2016151109] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The principal advantages of dual-energy computed tomography (CT) over conventional CT in the musculoskeletal setting relate to the additional information provided regarding tissue composition, artifact reduction, and image optimization. This article discusses the manifestations of these in clinical practice-urate and bone marrow edema detection, metal artifact reduction, and tendon analysis, with potential in arthrography, bone densitometry, and metastases surveillance. The basic principles of dual-energy CT physics and scanner design will also be discussed. © RSNA, 2016.
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Affiliation(s)
- Paul I Mallinson
- From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Tyler M Coupal
- From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Patrick D McLaughlin
- From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Savvas Nicolaou
- From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Peter L Munk
- From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Hugue A Ouellette
- From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9
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White Paper of the Society of Computed Body Tomography and Magnetic Resonance on Dual-Energy CT, Part 3. J Comput Assist Tomogr 2017; 41:1-7. [DOI: 10.1097/rct.0000000000000538] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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18
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Dual-energy computed tomography of cruciate ligament injuries in acute knee trauma. Skeletal Radiol 2015; 44:1295-301. [PMID: 26025120 DOI: 10.1007/s00256-015-2173-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine dual-energy computed tomography (DECT) in evaluating cruciate ligament injuries. More specifically, the purpose was to assess the optimal keV level in DECT gemstone spectral imaging (GSI) images and to examine the usefulness of collagen-specific color mapping and dual-energy bone removal in the evaluation of cruciate ligaments and the popliteus tendon. MATERIALS AND METHODS At a level 1 trauma center, a 29-month period of emergency department DECT examinations for acute knee trauma was reviewed by two radiologists for presence of cruciate ligament injuries, visualization of the popliteus tendon and the optimal keV level in GSI images. Three different evaluating protocols (GSI, bone removal and collagen-specific color mapping) were rated. Subsequent MRI served as a reference standard for intraarticular injuries. RESULTS A total of 18 patients who had an acute knee trauma, DECT and MRI were found. On MRI, six patients had an ACL rupture. DECT's sensitivity and specificity to detect ACL rupture were 79% and 100%, respectively. The DECT vs. MRI intra- and interobserver proportions of agreement for ACL rupture were excellent or good (kappa values 0.72-0.87). Only one patient had a PCL rupture. In GSI images, the optimal keV level was 63 keV. GSI of 40-140 keV was considered to be the best evaluation protocol in the majority of cases. CONCLUSION DECT is a usable method to evaluate ACL in acute knee trauma patients with rather good sensitivity and high specificity. GSI is generally a better evaluation protocol than bone removal or collagen-specific color mapping in the evaluation of cruciate ligaments and popliteus tendon.
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McLaughlin PD, Mallinson P, Lourenco P, Nicolaou S. Dual-Energy Computed Tomography: Advantages in the Acute Setting. Radiol Clin North Am 2015; 53:619-38, vii. [PMID: 26046502 DOI: 10.1016/j.rcl.2015.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of this article is to inform and update emergency radiologists in respect of the clinically relevant benefits that dual-energy computed tomography (CT) contributes over conventional single-energy CT in the emergency setting using practical imaging examples. Particular emphasis will be placed on acute gout, bone marrow edema, acute renal colic, acute cardiovascular and neurovascular emergencies aswell as characterization of abdominal incidentalomas. The relevant scientific literature will be summarized and limitations of the technique also will be emphasized to provide the reader with a rounded concept of the current state of technology.
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Affiliation(s)
- Patrick D McLaughlin
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver V5Z 1M9, Canada.
| | - Paul Mallinson
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver V5Z 1M9, Canada
| | - Pedro Lourenco
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver V5Z 1M9, Canada
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver V5Z 1M9, Canada
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Cao JX, Wang YM, Kong XQ, Yang C, Wang P. Good interrater reliability of a new grading system in detecting traumatic bone marrow lesions in the knee by dual energy CT virtual non-calcium images. Eur J Radiol 2015; 84:1109-15. [PMID: 25816992 DOI: 10.1016/j.ejrad.2015.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 02/12/2015] [Accepted: 03/02/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the capacity of dual-energy computed tomography (DECT) virtual non-calcium (VNCa) images in detecting post-traumatic bone marrow lesions (BMLs) in the knee with a new grading system. METHODS DECT and magnetic resonance (MR) imaging were used to examine acute trauma of the knee in 32 patients. VNCa images were generated by dual-energy subtraction of calcium, and the lower end of the femur and upper end of the tibia each were divided into six regions for grading of bone marrow by two musculoskeletal radiologists using a four-grading system (Grade 4, very obvious lesions; Grade 3, relatively obvious lesions; Grade 2, slight or suspicious lesion on VNCa image and mild lesion on MR image; Grade 1, normal bone marrow). CT values were obtained in the BMLs. MR images were used as the reference standard. Grade 3-4 bone marrow was regarded as a positive result to evaluate the performance of VNCa images in detecting traumatic BMLs in the knee, and receiver operating characteristic (ROC) curve analysis of VNCa images for detection of knee BMLs was performed based on CT value of the bone marrow. RESULTS Bone marrow rating by the two radiologists showed very good consistency (κ=0.850 and 0.869 for VNCa and MR images, respectively). VNCa and MR images had good consistency (κ=0.799 for lower end of the femur; κ=0.659 for upper end of the tibia). When Grade 3-4 bone marrow was regarded as a positive result, the sensitivity, specificity, positive predictive value, and negative predictive value of VNCa images for detection of BMLs in the lower end of the femur were 73.5%, 98.6%, 94.7%, and 91.6%, respectively, and the values in the upper end of the tibia were 91.0%, 100.0%, 100.0%, and 95.4%, respectively. The CT values of bone marrow were (-52.5 ± 31.3) HU in positive area and (-91.2 ± 16.9) HU in negative area for the lower end of the femur, and those were (-51.3 ± 30.2) HU in positive area and (-104.7 ± 17.5) HU in negative area for the upper end of the tibia (all p values<0.0001). The areas under the ROC curve of VNCa images for detection of BMLs were 0.875 for the lower end of the femur and 0.939 for the upper end of the tibia. CONCLUSION Good interrater reliability of this new grading system in detecting traumatic BMLs in the knee by VNCa images of DECT can be obtained with good diagnostic predictive values.
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Affiliation(s)
- Jian-Xin Cao
- Department of Radiology, Wuhan 161th Hospital, 68 Huangpu Road, Wuhan 430010, China
| | - Yi-Min Wang
- Department of Radiology, Wuhan 161th Hospital, 68 Huangpu Road, Wuhan 430010, China
| | - Xiang-Quan Kong
- Department of Radiology, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China.
| | - Cheng Yang
- Department of Radiology, Wuhan 161th Hospital, 68 Huangpu Road, Wuhan 430010, China
| | - Peng Wang
- Department of Radiology, Wuhan 161th Hospital, 68 Huangpu Road, Wuhan 430010, China
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Glazebrook KN, Brewerton LJ, Leng S, Carter RE, Rhee PC, Murthy NS, Howe BM, Ringler MD, Dahm DL, Stuart MJ, McCollough CH, Fletcher JG. Case-control study to estimate the performance of dual-energy computed tomography for anterior cruciate ligament tears in patients with history of knee trauma. Skeletal Radiol 2014; 43:297-305. [PMID: 24337491 DOI: 10.1007/s00256-013-1784-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/06/2013] [Accepted: 11/10/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Computed tomography (CT) is used to assess for fracture after knee trauma, but identification of ligamentous injuries may also be beneficial. Our purpose is to assess the potential of dual-energy computed tomography (DECT) for the detection of complete anterior cruciate ligament (ACL) disruption. METHODS Sixteen patients with unilateral traumatic ACL disruption (average of 58 days following trauma) confirmed by MRI, and 11 control patients without trauma, underwent DECT of both knees. For each knee, axial, sagittal, and oblique sagittal images (with DECT bone removal, single-energy (SE) bone removal, and DECT tendon-specific color mapping) were reconstructed. Four musculoskeletal radiologists randomly evaluated the 324 DECT reconstructed series (54 knees with 6 displays) separately, to assess for ACL disruption using a five-point scale (1 = definitely not torn, to 5 = definitely torn). ROC analysis was used to compare performance across readers and displays. RESULTS Sagittal oblique displays (mixed kV soft tissue, SE bone removal, and DECT bone removal) demonstrated higher areas under the curve for ACL disruption (AUC = 0.95, 0.93 and 0.95 respectively) without significant differences in performance between readers (p > 0.23). Inter-reader agreement was also better for these display methods (ICC range 0.62-0.69) compared with other techniques (ICC range 0.41-0.57). Mean sensitivity for ACL disruption was worst for DECT tendon-specific color map and axial images (24 % and 63 % respectively). CONCLUSION DECT knee images with oblique sagittal reconstructions using either mixed kV or bone removal displays (either DECT or SE) depict ACL disruption in the subacute or chronic setting with reliable identification by musculoskeletal radiologists.
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Affiliation(s)
- Katrina N Glazebrook
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA,
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