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Bone marrow edema in sacroiliitis : detection with dual-energy CT

Min Chen (UGent) , Nele Herregods (UGent) , Jacob Jaremko, Philippe Carron (UGent) , Dirk Elewaut (UGent) , Filip Van den Bosch (UGent) and Lennart Jans (UGent)
(2020) EUROPEAN RADIOLOGY. 30(6). p.3393-3400
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Abstract
Objectives: To evaluate the feasibility and diagnostic accuracy of dual-energy computed tomography (DECT) for the detection of bone marrow edema (BME) in patients suspected for sacroiliitis. Methods: Patients aged 18-55 years with clinical suspicion for sacroiliitis were enrolled. All patients underwent DECT and 3.0 T MRI of the sacroiliac joints on the same day. Virtual non-calcium (VNCa) images were calculated from DECT images for demonstration of BME. VNCa images were scored by two readers independently using a binary system (0 = normal bone marrow, 1 = BME). Diagnostic performance was assessed with fluid-sensitive MRI as the reference standard. ROIs were placed on VNCa images, and CT numbers were displayed. Cutoff values for BME detection were determined based on ROC curves. Results: Forty patients (16 men, 24 women, mean age 37.1 years +/- 9.6 years) were included. Overall inter-reader agreement for visual image reading of BME on VNCa images was good (kappa = 0.70). The sensitivity and specificity of BME detection by DECT were 65.4% and 94.2% on the quadrant level and 81.3% and 91.7% on the patient level. ROC analyses revealed AUCs of 0.90 and 0.87 for CT numbers in the ilium and sacrum, respectively. Cutoff values of - 44.4 HU (for iliac quadrants) and - 40.8 HU (for sacral quadrants) yielded sensitivities of 76.9% and 76.7% and specificities of 91.5% and 87.5%, respectively. Conclusions: Inflammatory sacroiliac BME can be detected by VNCa images calculated from DECT, with a good interobserver agreement, moderate sensitivity, and high specificity.
Keywords
Radiography, dual-energy scanned projection, Tomography, X-ray computed, AXIAL SPONDYLOARTHRITIS, INFLAMMATION, PERFORMANCE, LESIONS

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MLA
Chen, Min, et al. “Bone Marrow Edema in Sacroiliitis : Detection with Dual-Energy CT.” EUROPEAN RADIOLOGY, vol. 30, no. 6, 2020, pp. 3393–400, doi:10.1007/s00330-020-06670-7.
APA
Chen, M., Herregods, N., Jaremko, J., Carron, P., Elewaut, D., Van den Bosch, F., & Jans, L. (2020). Bone marrow edema in sacroiliitis : detection with dual-energy CT. EUROPEAN RADIOLOGY, 30(6), 3393–3400. https://doi.org/10.1007/s00330-020-06670-7
Chicago author-date
Chen, Min, Nele Herregods, Jacob Jaremko, Philippe Carron, Dirk Elewaut, Filip Van den Bosch, and Lennart Jans. 2020. “Bone Marrow Edema in Sacroiliitis : Detection with Dual-Energy CT.” EUROPEAN RADIOLOGY 30 (6): 3393–3400. https://doi.org/10.1007/s00330-020-06670-7.
Chicago author-date (all authors)
Chen, Min, Nele Herregods, Jacob Jaremko, Philippe Carron, Dirk Elewaut, Filip Van den Bosch, and Lennart Jans. 2020. “Bone Marrow Edema in Sacroiliitis : Detection with Dual-Energy CT.” EUROPEAN RADIOLOGY 30 (6): 3393–3400. doi:10.1007/s00330-020-06670-7.
Vancouver
1.
Chen M, Herregods N, Jaremko J, Carron P, Elewaut D, Van den Bosch F, et al. Bone marrow edema in sacroiliitis : detection with dual-energy CT. EUROPEAN RADIOLOGY. 2020;30(6):3393–400.
IEEE
[1]
M. Chen et al., “Bone marrow edema in sacroiliitis : detection with dual-energy CT,” EUROPEAN RADIOLOGY, vol. 30, no. 6, pp. 3393–3400, 2020.
@article{8647733,
  abstract     = {{Objectives: To evaluate the feasibility and diagnostic accuracy of dual-energy computed tomography (DECT) for the detection of bone marrow edema (BME) in patients suspected for sacroiliitis. 
Methods: Patients aged 18-55 years with clinical suspicion for sacroiliitis were enrolled. All patients underwent DECT and 3.0 T MRI of the sacroiliac joints on the same day. Virtual non-calcium (VNCa) images were calculated from DECT images for demonstration of BME. VNCa images were scored by two readers independently using a binary system (0 = normal bone marrow, 1 = BME). Diagnostic performance was assessed with fluid-sensitive MRI as the reference standard. ROIs were placed on VNCa images, and CT numbers were displayed. Cutoff values for BME detection were determined based on ROC curves. 
Results: Forty patients (16 men, 24 women, mean age 37.1 years +/- 9.6 years) were included. Overall inter-reader agreement for visual image reading of BME on VNCa images was good (kappa = 0.70). The sensitivity and specificity of BME detection by DECT were 65.4% and 94.2% on the quadrant level and 81.3% and 91.7% on the patient level. ROC analyses revealed AUCs of 0.90 and 0.87 for CT numbers in the ilium and sacrum, respectively. Cutoff values of - 44.4 HU (for iliac quadrants) and - 40.8 HU (for sacral quadrants) yielded sensitivities of 76.9% and 76.7% and specificities of 91.5% and 87.5%, respectively. 
Conclusions: Inflammatory sacroiliac BME can be detected by VNCa images calculated from DECT, with a good interobserver agreement, moderate sensitivity, and high specificity.}},
  author       = {{Chen, Min and Herregods, Nele and Jaremko, Jacob and Carron, Philippe and Elewaut, Dirk and Van den Bosch, Filip and Jans, Lennart}},
  issn         = {{0938-7994}},
  journal      = {{EUROPEAN RADIOLOGY}},
  keywords     = {{Radiography,dual-energy scanned projection,Tomography,X-ray computed,AXIAL SPONDYLOARTHRITIS,INFLAMMATION,PERFORMANCE,LESIONS}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{3393--3400}},
  title        = {{Bone marrow edema in sacroiliitis : detection with dual-energy CT}},
  url          = {{http://dx.doi.org/10.1007/s00330-020-06670-7}},
  volume       = {{30}},
  year         = {{2020}},
}

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