MRI v/s CT ehema detection by dual energy ct scans 3.pptx

MRI VS CT EDEMA

1. TITLE: Comparative analysis of Dual energy-Computed Tomography and Magnetic Resonance Imaging in assessing bone marrow changes in acute vertebral injuries Candidate: Dr Monika JR Dept. of Radiodiagnosis AIIMS Bathinda

2. GUIDE & Co-GUIDES Guide DR HARMEET KAUR Designation Associate Professor Department Radiodiagnosis Co-Guide 1 DR NAVDEEP KAUR Designation Associate P rofessor Department Radiodiagnosis Co-Guide 2 DR NILESH BARWAR Designation Associate P rofessor Department Orthopaedics Co-Guide 3 DR DIVAKAR GOYAL Designation Assistant Professor Department Trauma and General Surgery

3. AIM To Determine the diagnostic accuracy of Dual-energy CT in detecting bone marrow edema (BME) associated with acute vertebral injuries.

4. Primary & Secondary objectives PRIMARY OBJECTIVE To determine the sensitivity, specificity, negative predictive value, and positive predictive value of Dual-energy CT to assess bone marrow edema in acute vertebral injuries. SECONDARY OBJECTIVES To evaluate marrow edema in acute vertebral injuries qualitatively using color-coded VNCa images. Quantitative assessment of marrow edema in terms of Hounsfield Unit (HU) by comparing CT numbers based on color-coded VNCa ( visual non calcium) images. To determine the agreement between Dual-energy CT and MRI in assessing acute vertebral injuries. To assess the diagnostic accuracy of Dual-energy CT in detecting occult vertebral injuries

5. MATERIALS AND METHODES Study Design : Hospital-based cross-sectional study. Study Area : Emergency department, Department of Orthopaedics and Department of Radiodiagnosis, AIIMS Bathinda Study Duration : 18months Study Population : Sampling Frame: Patients visiting the Emergency department/ Orthopaedics department with acute spinal trauma. Study Sample: Patients having a complaint of lower backache, focal neurological deficit of upper or lower limb, and bony tenderness following acute vertebral injury.

6. Eligibility CRITERIA A s per the inclusion and exclusion criteria decided. Inclusion Criteria : Patients in age group 18-65yrs visiting either the Emergency Department or Orthopaedics Department with a suspicion of acute spinal trauma and having any of the following conditions will be included: Any patient with a suspected vertebral injury within 2 days of trauma and/or having bony tenderness , back pain, and or focal neurological deficit in the upper or lower limb.

7. Exclusion CRITERIAS Any suspected vertebral injury of duration more than 48 hours. Unstable patients with a head injury, pelvic trauma, thoracic injury, or abdominal injury Vertebral compression secondary to primary vertebral bone tumors, metastasis, and multiple myeloma or any vertebra with infective etiology. Common contraindications to MRI like ferromagnetic substances in the patient body (Pacemakers, implants, metallic clips, etc.). Claustrophobic patients. Patients who are not willing to give consent for the study. Pregnant ladies Patient with history of contrast allergy in patients getting contrast scans as per trauma protocol. Age <18yrs or >65yrs.

8. STUdy sample size The sample size was calculated using a formula n = P = Prevalence , d=absolute precision , = Confidence interval According to the literature available, prevalence = 40%, d=5%, and specificity =97%. So, using the above-mentioned formula, the sample size came out to be 75. Sampling Technique : we will adopt a convenient sampling technique for the recruitment of our study participants. Study protocol : Patients visiting either the Emergency department/ Orthopaedics department with complaints of acute backache, neurological deficits, following trauma to the spine, will be provided consultations for their presenting complaints, and analyzed as per the inclusion and exclusion criteria of our study for further evaluation with Dual-energy CT and MRI. Such patients will then visit the Radiodiagnosis department and will be recruited in our study following the detailed description of the study to the participants from the participant’s information sheet, and getting written consent from them.  

9. Assessment of Bone marrow edema Bone marrow edema 0 = No edema 1 = Suspicious 2 = Likely 3 = Definite presence Extent of Bone marrow edema Based on 5 Anatomical segments , scoring used will be: 1 = Upper Anterior 2 = Upper Posterior 3 = Lower Anterior 4 = Lower Posterior 5 = Posterior Elements CT Number (HU value ) at site of Bone marrow edema

10. Statistical analysis Statistical software used : Data collected to be entered into Microsoft Excel Worksheet and analysed statistically by using SPSS software version 19. (Statistical Package for Social Sciences). Statistical test(s) to be applied: Mean, Median, Mode, and Standard Deviation values will be calculated after obtaining all the data.

11. Statistical analysis Sensitivity, Specificity, Positive predictive value (PPV), and negative predictive value (NPV) of Dual-energy CT will be calculated taking MRI findings as reference and accuracy values with 95% confidence intervals (CI) on VNCa series for the presence of BME. Bone marrow edema will be expressed in Percentage. Chi Square test will be used to compare the presence of edema on DECT and MRI. Kappa analysis for agreement between Dual-Energy CT and MRI for assessment of Bone marrow edema will be evaluated.

12. STUDY FLOW CHART Inclusion criteria : Patients with acute spinal trauma of duration within 2days and/or having backache, tenderness and neurological deficit of upper or lower limb . Patients presenting to Emergency/ Orthopedics department exclusion criteria: patients presenting with spinal trauma of>48hrs,polytrauma patients ,unstable patients with head injury ,thoracic injury or abdominal injury ,with vertebral metastasis disease, contraindications to MRI. Enrolled in the study after taking informed consent Yes Excl u ded Conventional and Dual-Energy CT for any fracture and Bone marrow edema

13. Confirmation on Gold standard MRI within 48hrs of Dual-Energy CT Data collection and statistical analysis Inferences and conclusion

14. references   1.Foti G, Serra G, Iacono V, Zorzi C. Identification of Traumatic Bone Marrow Oedema: The Pearls and Pitfalls of Dual-Energy CT (DECT). Tomogr Ann Arbor Mich. 2021 Sep 3;7(3):424–33.   2.Yadav H, Khanduri S, Yadav P, Pandey S, Yadav VK, Khan S. Diagnostic accuracy of dual energy CT in the assessment of traumatic bone marrow edema of lower limb and its correlation with MRI. Indian J Radiol Imaging. 2020;30(1):59–63.   3.Cavallaro M, D’Angelo T, Albrecht MH, Yel I, Martin SS, Wichmann JL, et al. Comprehensive comparison of dual-energy computed tomography and magnetic resonance imaging for the assessment of bone marrow edema and fracture lines in acute vertebral fractures. Eur Radiol . 2022;32(1):561–71. 4.Li Z, Chen X, Fang H, Li C, Shi L, Fan X, et al. Diagnostic accuracy of dual-energy CT for bone marrow edema in patients with acute knee injury: a systematic review and meta-analysis. J Orthop Surg. 2023 Nov 2;18(1):826.   5.Simonetti I, Verde F, Palumbo L, Di Pietto F, Puglia M, Scaglione M, et al. Dual energy computed tomography evaluation of skeletal traumas. Eur J Radiol . 2021 Jan;134:109456. 6.Ajn W, M W, P K, Kk L. Dual-energy CT in musculoskeletal trauma. Clin Radiol [Internet]. 2021 Jan [cited 2024 Apr 25];76(1). Available from: https:// pubmed.ncbi.nlm.nih.gov /32891408/   7.Bierry G, Venkatasamy A, Kremer S, Dosch JC, Dietemann JL. Dual-energy CT in vertebral compression fractures: performance of visual and quantitative analysis for bone marrow edema demonstration with comparison to MRI. Skeletal Radiol . 2014 Apr 1;43(4):485–92. 8.Jeong SY, Jeon SJ, Seol M, Ahn TH, Juhng SK. Diagnostic performance of dual-energy computed tomography for detection of acute spinal fractures. Skeletal Radiol . 2020 Oct;49(10):1589–95.   9.Bäcker HC, Wu CH, Perka C, Panics G. Dual-Energy Computed Tomography in Spine Fractures: A Systematic Review and Meta-Analysis. Int J Spine Surg. 2021 Jun;15(3):525–35. 10.Diekhoff T, Hermann KG, Pumberger M, Hamm B, Putzier M, Fuchs M. Dual-energy CT virtual non-calcium technique for detection of bone marrow edema in patients with vertebral fractures: A prospective feasibility study on a single- source volume CT scanner. Eur J Radiol . 2017 Feb;87:59–65.   11.Suh CH, Yun SJ, Jin W, Lee SH, Park SY, Ryu CW. Diagnostic performance of dual-energy CT for the detection of bone marrow oedema: a systematic review and meta-analysis. Eur Radiol . 2018 Oct;28(10):4182–94. 12.Yang P, Wu G, Chang X. Diagnostic accuracy of dual-energy computed tomography in bone marrow edema with vertebral compression fractures: A meta-analysis. Eur J Radiol . 2018 Feb;99:124–9. 13.Saba L, De Filippo M, Saba F, Fellini F, Marcy PY, Dagan R, et al. Dual energy CT and research of the bone marrow edema : Comparison with MRI imaging. Indian J Radiol Imaging. 2019;29(4):386–90.   14.Karaca L, Yuceler Z, Kantarci M, Çakır M, Sade R, Calıkoglu C, et al. The feasibility of dual-energy CT in differentiation of vertebral compression fractures. Br J Radiol . 2016;89(1057):20150300.

15. references   1.Foti G, Serra G, Iacono V, Zorzi C. Identification of Traumatic Bone Marrow Oedema: The Pearls and Pitfalls of Dual-Energy CT (DECT). Tomogr Ann Arbor Mich. 2021 Sep 3;7(3):424–33.   2.Yadav H, Khanduri S, Yadav P, Pandey S, Yadav VK, Khan S. Diagnostic accuracy of dual energy CT in the assessment of traumatic bone marrow edema of lower limb and its correlation with MRI. Indian J Radiol Imaging. 2020;30(1):59–63.   3.Cavallaro M, D’Angelo T, Albrecht MH, Yel I, Martin SS, Wichmann JL, et al. Comprehensive comparison of dual-energy computed tomography and magnetic resonance imaging for the assessment of bone marrow edema and fracture lines in acute vertebral fractures. Eur Radiol . 2022;32(1):561–71. 4.Li Z, Chen X, Fang H, Li C, Shi L, Fan X, et al. Diagnostic accuracy of dual-energy CT for bone marrow edema in patients with acute knee injury: a systematic review and meta-analysis. J Orthop Surg. 2023 Nov 2;18(1):826.   5.Simonetti I, Verde F, Palumbo L, Di Pietto F, Puglia M, Scaglione M, et al. Dual energy computed tomography evaluation of skeletal traumas. Eur J Radiol . 2021 Jan;134:109456. 6.Ajn W, M W, P K, Kk L. Dual-energy CT in musculoskeletal trauma. Clin Radiol [Internet]. 2021 Jan [cited 2024 Apr 25];76(1). Available from: https:// pubmed.ncbi.nlm.nih.gov /32891408/  7.Bierry G, Venkatasamy A, Kremer S, Dosch JC, Dietemann JL. Dual-energy CT in vertebral compression fractures: performance of visual and quantitative analysis for bone marrow edema demonstration with comparison to MRI. Skeletal Radiol . 2014 Apr 1;43(4):485–92.

16. references   8.Jeong SY, Jeon SJ, Seol M, Ahn TH, Juhng SK. Diagnostic performance of dual-energy computed tomography for detection of acute spinal fractures. Skeletal Radiol . 2020 Oct;49(10):1589–95.   9.Bäcker HC, Wu CH, Perka C, Panics G. Dual-Energy Computed Tomography in Spine Fractures: A Systematic Review and Meta-Analysis. Int J Spine Surg. 2021 Jun;15(3):525–35. 10.Diekhoff T, Hermann KG, Pumberger M, Hamm B, Putzier M, Fuchs M. Dual-energy CT virtual non-calcium technique for detection of bone marrow edema in patients with vertebral fractures: A prospective feasibility study on a single- source volume CT scanner. Eur J Radiol . 2017 Feb;87:59–65.   11.Suh CH, Yun SJ, Jin W, Lee SH, Park SY, Ryu CW. Diagnostic performance of dual-energy CT for the detection of bone marrow oedema: a systematic review and meta-analysis. Eur Radiol . 2018 Oct;28(10):4182–94. 12.Yang P, Wu G, Chang X. Diagnostic accuracy of dual-energy computed tomography in bone marrow edema with vertebral compression fractures: A meta-analysis. Eur J Radiol . 2018 Feb;99:124–9. 13.Saba L, De Filippo M, Saba F, Fellini F, Marcy PY, Dagan R, et al. Dual energy CT and research of the bone marrow edema : Comparison with MRI imaging. Indian J Radiol Imaging. 2019;29(4):386–90.   14.Karaca L, Yuceler Z, Kantarci M, Çakır M, Sade R, Calıkoglu C, et al. The feasibility of dual-energy CT in differentiation of vertebral compression fractures. Br J Radiol . 2016;89(1057):20150300.

17. references   1.Foti G, Serra G, Iacono V, Zorzi C. Identification of Traumatic Bone Marrow Oedema: The Pearls and Pitfalls of Dual-Energy CT (DECT). Tomogr Ann Arbor Mich. 2021 Sep 3;7(3):424–33.   2.Yadav H, Khanduri S, Yadav P, Pandey S, Yadav VK, Khan S. Diagnostic accuracy of dual energy CT in the assessment of traumatic bone marrow edema of lower limb and its correlation with MRI. Indian J Radiol Imaging. 2020;30(1):59–63.   3.Cavallaro M, D’Angelo T, Albrecht MH, Yel I, Martin SS, Wichmann JL, et al. Comprehensive comparison of dual-energy computed tomography and magnetic resonance imaging for the assessment of bone marrow edema and fracture lines in acute vertebral fractures. Eur Radiol . 2022;32(1):561–71. 4.Li Z, Chen X, Fang H, Li C, Shi L, Fan X, et al. Diagnostic accuracy of dual-energy CT for bone marrow edema in patients with acute knee injury: a systematic review and meta-analysis. J Orthop Surg. 2023 Nov 2;18(1):826.   5.Simonetti I, Verde F, Palumbo L, Di Pietto F, Puglia M, Scaglione M, et al. Dual energy computed tomography evaluation of skeletal traumas. Eur J Radiol . 2021 Jan;134:109456. 6.Ajn W, M W, P K, Kk L. Dual-energy CT in musculoskeletal trauma. Clin Radiol [Internet]. 2021 Jan [cited 2024 Apr 25];76(1). Available from: https:// pubmed.ncbi.nlm.nih.gov /32891408/   7.Bierry G, Venkatasamy A, Kremer S, Dosch JC, Dietemann JL. Dual-energy CT in vertebral compression fractures: performance of visual and quantitative analysis for bone marrow edema demonstration with comparison to MRI. Skeletal Radiol . 2014 Apr 1;43(4):485–92. 8.Jeong SY, Jeon SJ, Seol M, Ahn TH, Juhng SK. Diagnostic performance of dual-energy computed tomography for detection of acute spinal fractures. Skeletal Radiol . 2020 Oct;49(10):1589–95.   9.Bäcker HC, Wu CH, Perka C, Panics G. Dual-Energy Computed Tomography in Spine Fractures: A Systematic Review and Meta-Analysis. Int J Spine Surg. 2021 Jun;15(3):525–35. 10.Diekhoff T, Hermann KG, Pumberger M, Hamm B, Putzier M, Fuchs M. Dual-energy CT virtual non-calcium technique for detection of bone marrow edema in patients with vertebral fractures: A prospective feasibility study on a single- source volume CT scanner. Eur J Radiol . 2017 Feb;87:59–65.   11.Suh CH, Yun SJ, Jin W, Lee SH, Park SY, Ryu CW. Diagnostic performance of dual-energy CT for the detection of bone marrow oedema: a systematic review and meta-analysis. Eur Radiol . 2018 Oct;28(10):4182–94. 12.Yang P, Wu G, Chang X. Diagnostic accuracy of dual-energy computed tomography in bone marrow edema with vertebral compression fractures: A meta-analysis. Eur J Radiol . 2018 Feb;99:124–9. 13.Saba L, De Filippo M, Saba F, Fellini F, Marcy PY, Dagan R, et al. Dual energy CT and research of the bone marrow edema : Comparison with MRI imaging. Indian J Radiol Imaging. 2019;29(4):386–90.   14.Karaca L, Yuceler Z, Kantarci M, Çakır M, Sade R, Calıkoglu C, et al. The feasibility of dual-energy CT in differentiation of vertebral compression fractures. Br J Radiol . 2016;89(1057):20150300.

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