Osteomyelitis is defined as a primary bone marrow infection resulting in cortical bone involvement. Osteomyelitis most commonly develops exogenously, from trauma, surgery, or direct spread from adjacent soft tissues. Osteomyelitis can be a diagnostic challenge, further complicated by structural changes in the bone marrow in terms of disuse osteopenia due to prolonged immobilisation, or sclerotic reaction of the bone which makes recognition of bone marrow edema (BME) more difficult. The gold standard for the diagnosis of osteomyelitis is the growth of pathogens from invasively obtained...

From August 2021 to October 2022, 32 patients (21 men, 11 women; mean age 63.6±16.3 years), with infected skin lesions and suspected osteomyelitis underwent single source DECT (Aquilion Prime SP, Canon Medical System) with sequential acquisition of 80 and 135 kVp datasets. Virtual non-calcium (VNCa) images were reconstructed using a two-material (fat and water) decomposition algorithm. Contrast enhanced CT scan was also performed and iodine maps were generated using a dedicated subtraction algorithm (SURE Subtraction Imaging - SCT). A fast MRI protocol with T1, STIR...

Bone marrow edema was detected in 25 patients. Interobserver agreement was very good for MR (k=0.91), moderate for VNCa (k=0.49) and good for SCT (k=0.62) images. DECT and SCT showed sensitivity of 70% and 78%, specificity of 80% and 93%, and diagnostic accuracy of 72% and 81.5%, respectively. In two patients who developed an intense sclerotic bone reaction, DECT gave false positive results showing a hyperdensity, while in SCT and MRI no bone edema was evidenced.

This first study examined the ability of single source DECT to correctly diagnose osteomyelitis in terms of bone marrow edema. SCT and VNCa obtained adequate sensitivity, specificity and diagnostic accuracy, when compared to the gold standard MRI. SCT was more accurate than VNCa in those patients who developed contextual reactive bone sclerosis. To conclude, CT can represent a valid alternative to MRI especially in those patients with pressure ulcers being faster and more comfortable.

M. Porta: Nothing to disclose C. Fanciullo: Nothing to disclose A. Bonfanti: Nothing to disclose A. Surace: Nothing to disclose F. Stanco: Nothing to disclose A. Aliprandi: Nothing to disclose S. Sironi: Nothing to disclose

Yan YY, Ouellette HA, Saththianathan M, Munk PL, Mallinson PI, Sheikh A. The Role of a Virtual Noncalcium Dual-Energy CT Application in the Detection of Bone Marrow Edema in Peripheral Osteomyelitis. Can Assoc Radiol J. 2022 Aug;73(3):549-556. doi: 10.1177/08465371211065181. Epub 2022 Jan 10. PMID: 35006011. 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):4182-4194. doi: 10.1007/s00330-018-5411-5. Epub 2018 Apr 20. PMID:...