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. 2021 Jun;15(3):525-535.
doi: 10.14444/8074. Epub 2021 May 7.

Dual-Energy Computed Tomography in Spine Fractures: A Systematic Review and Meta-Analysis

Henrik C Bäcker  1 , Chia H Wu  2 , Carsten Perka  1 , Gergely Panics  3
Affiliations

Dual-Energy Computed Tomography in Spine Fractures: A Systematic Review and Meta-Analysis

Henrik C Bäcker et al. Int J Spine Surg. 2021 Jun.

Abstract

Background: The purpose of this study was to perform a systematic literature review and meta-analysis to evaluate the sensitivity, specificity, and accuracy of dual-energy computed tomography (DE-CT) of bone marrow edema and disc edema in spine injuries.In vertebral injuries, prompt diagnosis is essential to avoid any delays in treatment. Conventional radiography may only reveal indirect signs of fractures, such as when it is displaced. Therefore, to detect the presence of bone marrow or disc edemas, adjunctive tools are required, such as magnetic resonance imaging (MRI) or DE-CT.

Methods: Search terms included ((DECT) OR (DE-CT) OR (dual-energy CT) OR "Dual energy CT" OR (dual-energy computed tomography) OR (dual energy computed tomography)) AND ((spine) OR (vertebral)), and the PubMed, EMBASE, and MEDLINE databases and the Cochrane Library and Google were used. We found 1233 articles on our preliminary search, but only 13 articles met all criteria. Data were extracted to calculate the pooled sensitivity, specificity, and diagnostic odds ratio for analysis using R software.

Results: Within the 13 studies, 515 patients, 3335 vertebrae, and 926 acute fractures (27.8%) defined by MRI were included. The largest cohort included 76 patients with 774 vertebrae. In 12 publications, MRI was reported for comparison. For DE-CT, the overall sensitivity was 86.2% with a specificity of 91.2% and accuracy of 89.3%. Furthermore, 5 studies reported the accuracy of CT with an overall sensitivity of 81.3%, specificity of 80.7%, and accuracy with 80.9%. Significant differences were found for specificity (P < .001) and accuracy (P = .023). However, significant interobserver differences were reported.

Conclusions: DE-CT seems to be a promising diagnostic tool to detect bone marrow and disc edemas, which can potentially replace the current gold standard, the MRI.

Level of evidence: 2.

Clinical relevance: This study shows that DE-CT seems to be a promising diagnostic tool with an accuracy of 89.3%.

Keywords: CT; DECT; bone marrow edema; computed tomography; disc edema; dual-energy; spine; vertebra.

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Conflict of interest statement

Disclosures and COI: The authors declare no conflict of interest related to this study.

Figures

Figure 1
Figure 1
Included articles according to the PRISMA guidelines.
Figure 2
Figure 2
(a) Forest plots for sensitivity, (b) specificity, and (c) diagnostic odds ratio showing the individual proportions including 95% confidence interval and the heterogeneity.
Figure 3
Figure 3
SROC (summary receiver operating characteristic) curve for diagnostic test accuracy between sensitivity and false positive rate for dual-energy computed tomography.
Figure 4
Figure 4
(a) Forest plots for sensitivity, (b) specificity, and (c) diagnostic odds ratio showing the individual proportions including 95% confidence interval and the heterogeneity.
Figure 5
Figure 5
SROC (summary receiver operating characteristic) curve for diagnostic test accuracy between sensitivity and false positive rate for computed tomography.
See this image and copyright information in PMC

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