Axial Spondyloarthritis: Dual-Energy Virtual Noncalcium CT in the Detection of Bone Marrow Edema in the Sacroiliac Joints
- 1 January 2019
- journal article
- research article
- Published by Radiological Society of North America (RSNA) in Radiology
- Vol. 290 (1), 157-164
- https://doi.org/10.1148/radiol.2018181168
Abstract
Purpose: To determine the diagnostic performance of dual-energy virtual noncalcium (VNCa) CT in the detection of bone marrow edema in study participants with sacroiliitis associated with axial spondyloarthritis. Materials and Methods: In this prospective study, 47 consecutive participants (mean age, 27 years; age range, 14-41 years [28 male; mean age, 24 years; age range, 14-37 years] [19 female; mean age, 29 years; age range, 17-41 years]) underwent dual-energy CT and 3.0-T MRI between April 2016 and December 2017. Two independent readers visually evaluated all sacroiliac joints for the presence of abnormal marrow attenuation on dual-energy VNCa images using a four-point classification system (0, no edema; 1, mild edema; 2, moderate edema; 3, severe edema). CT numbers on VNCa images were determined with region-of-interestbased quantitative analysis. MRI was the reference standard for presence of bone marrow edema. Results: Sensitivity, specificity, and accuracy of readers 1 and 2, respectively, in the identification of bone edema at CT were 87% and 93% (48 and 51 of 55), 94% and 91% (32 and 31 of 34), and 90% and 92% (80 and 82 of 89). Interobserver agreement was excellent (kappa = 0.81). CT numbers from VNCa images increased from no edema to severe edema (P<.001). The area under the receiver operating characteristic curve was 0.93 for reader 1 and 0.91 for reader 2 in differentiation of the presence of bone marrow edema from no edema. A cutoff value of 233 HU derived from reader 1 yielded overall sensitivity, specificity, and accuracy of 90% (49 of 55), 83% (28 of 34), and 87% (77 of 89) in the detection of any extent of edema in the sacroiliac joints. Conclusion: Dual-energy VNCa CT images had excellent diagnostic performance in evaluation of the extent of bone marrow edema in study participants with sacroiliitis associated with axial spondyloarthritis. (c) RSNA, 2018This publication has 27 references indexed in Scilit:
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