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. 2024 Nov 18;28(1):3000.
doi: 10.4102/sajr.v28i1.3000. eCollection 2024.

Diagnostic performance of dual-energy CT with electron-density reconstruction for lumbar disc herniation

Umamaheshwari K Basavaraju  1 , Sushmita Balol  1 , Vittal Manohar  1 , Yashwanth Naik  1
Affiliations

Diagnostic performance of dual-energy CT with electron-density reconstruction for lumbar disc herniation

Umamaheshwari K Basavaraju et al. SA J Radiol. .

Abstract

Background: Magnetic resonance imaging (MRI) is used for the evaluation of degenerative spinal disease. However, its utility is restricted in routine practice because of contraindications and a lack of widespread availability. Dual-energy computed tomography (DECT) is a newer technique for the evaluation of degenerative spinal disease.

Objectives: This study aimed to evaluate the diagnostic performance of DECT with electron-density (ED) image reconstruction compared to standard CT for the detection of lumbar disc herniation, with MRI as the gold standard.

Method: The retrospective study included 84 patients between 01 July 2023 to 31 December 2023 who underwent DECT and 1.5-T MRI within 1 week. Four radiologists, blinded to the clinical and MRI information, independently evaluated the standard CT series and DECT series with ED reconstructions for lumbar disc herniation and spinal nerve root impingement. The gold standard for comparison was lumbar spine MRI, and diagnostic accuracy was measured with sensitivity and specificity.

Results: MRI revealed 417 lumbar disc herniations. Dual-energy computed tomography with ED reconstruction showed higher sensitivity (86.36% [532/616] vs. 57.79% [356/616]) and specificity (96.86% [1019/1052] vs. 95.82% [1008/1052]) for the detection of lumbar disc herniation compared to standard CT.

Conclusion: Dual-energy computed tomography with ED reconstruction shows better diagnostic performance for the detection of lumbar disc herniation compared to standard CT and can be a useful alternative imaging modality when MRI is contraindicated or unavailable.

Contribution: This study shows the usefulness of DECT as an alternative imaging technique for screening of degenerative spinal disease whenever MRI is contraindicated or unavailable.

Keywords: dual-energy computed tomography; electron-density reconstruction; intervertebral disc herniation; lumbar disc; magnetic resonance imaging; retrospective study; spinal nerve root impingement; standard computed tomography.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Figures

FIGURE 1
FIGURE 1
Flowchart showing selection of study population.
FIGURE 2
FIGURE 2
A 40-year-old man who presented with chronic lower back pain with recent aggravation: (a) The lumbar disc protrusions at L3/L4 and L4/L5 levels were initially not clearly depicted on the sagittal grayscale standard CT reconstructions. (b) The lumbar disc protrusions (orange and red arrows) depicted on the sagittal colour-coded electron-density reconstruction images optimised for analysis of intervertebral discs. (c) Non-contrast sagittal T2-weighted MRI confirmed the diagnosis.
FIGURE 3
FIGURE 3
A 58-year-old man who presented with lower back pain and paraesthesia in the right lower limb: (a) Bulging L5/S1 intervertebral disc with impingement of the traversing right S1 nerve root was underestimated on standard grayscale axial CT. (b) Diagnosis of spinal nerve root impingement was made by all readers on the axial colour-coded electron-density reconstruction images. (c) Spinal nerve root impingement was confirmed on axial T2-weighted MRI (red arrow).
FIGURE 4
FIGURE 4
A 53-year-old woman who presented with lower back pain: (a) Bulging L4/L5 intervertebral disc with nerve root impingement of the exiting right L4 nerve root was underestimated on standard grayscale axial CT images. (b) Diagnosis of spinal nerve root impingement was made by all readers on the axial colour-coded electron-density reconstruction images. (c) Spinal nerve root impingement was confirmed on axial T2-weighted MRI (red arrow).
See this image and copyright information in PMC

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