The use of Dual Energy Computed Tomography for review of bone marrow oedema in patients presenting with back pain

Congress:

2022 ASM

Poster Number:

R-0153

Type:

Scientific Exhibit

Keywords:

Musculoskeletal bone, CT-Quantitative, Audit and standards, Trauma

Authors:

S. Chaudhary, W. Y. Lim, L. Kruse, L. Emanuele, K. Gormly

DOI:

10.26044/ranzcr2022/R-0153

DOI-Link:

https://dx.doi.org/10.26044/ranzcr2022/R-0153

Purpose

Many patients experiencing back pain are referred by Emergency doctors or general practitioners for CT imaging of the thoracic and lumbar spine +/- pelvis, depending upon the location of the pain. CT findings may include a number of spinal crush fractures or pelvic changes which are of uncertain age, and therefore it is difficult to confirm if the anatomical finding is causing the pain. Acute fractures and areas of irritation are usually associated with bone marrow oedema, whereas chronic findings usually do not have bone...

Methods and materials

Inclusion criteria: Two metropolitan private hospital sites with Emergency (ED) departments ALLED CT referralsfor Thoracic spine &/or lumbar spine &/or bony pelvis (regardless of history) Two public hospitals with ED departments (rural and outer metropolitan) All CT referrals for Thoracic spine &/or lumbar spine &/or bony pelvis (GP & ED referrals, regardless of history) Exclusion criteria: Younger than 50 years of age Have metal in their Spine or Pelvis/Hip BME maps were created automatically after selection by the CT technologist. 2D axial, sagittal and coronal...

Results

82 patients were identified between 2/5/22 – 11/7/22. Demographics Age: Median age - 72.5 (Mean - 70.7) Gender: 61% female, 39% male Referral source: 69.5% GP, 31.5% from ED. Clinical history: 80.5% no history of trauma, 19.5% history trauma Presence of BME on DECT: Yes 19.5% n=16 No 80.5% n=66 [Fig 1] Of those with BME (19.5% - 16 patients) 56% (9/16) had a history of trauma (so a much higher proportion than the rest) 10/16 ED referrals, 6/16 GP referrals 63% (10/16) of patients...

Conclusion

Our study looked at the implemenation of a DECT scanning protocol for all patients presenting with back pain at certain sites. Our major questions were is it accurate? is it useful? who is it useful for? Our data showed DECT has a high concordance with CT and subsequent imaging in detecting acute BME, comparable with the published data. DECT was particularly useful in confirming old fractures, highlighting subtle fractures and suggesting new fractures and an explanation for acute pain. It was useful in both the...

Personal information

References

1. Chang MY, Lee SH, Ha JW, Park Y, Zhang HY, Lee SH. Predicting Bone Marrow Edema and FractureAge in Vertebral Fragility Fractures Using MDCT. AJR Am J Roentgenol. 2020 Oct;215(4):970-977. doi:10.2214/AJR.19.22606. Epub 2020 Aug 18. PMID: 32809864. 2. Brinckman MA, Chau C, Ross JS. Marrow edema variability in acute spine fractures. Spine J. 2015Mar 1;15(3):454-60. doi: 10.1016/j.spinee.2014.09.032. Epub 2014 Oct 7. PMID: 25304448. 3. Ghazi Sherbaf F, Sair HI, Shakoor D, Fritz J, Schwaiger BJ, Johnson MH, Demehri S. DECT inDetection of Vertebral Fracture-associated...

Fig 1: Figure 1 - sensitivity and specificity of BME detected on DECT compared to the...

Fig 2: Figure 2 - reconstructed 3D image with marrow map highlights oedema (green) in...

$Fig 3: Figure 3 - coronal CT of the same patient showing a subtle medial right inferior pubic ramus fracture, that may have otherwise been missed$

Fig 3: Figure 3 - coronal CT of the same patient showing a subtle medial right...

$Fig 4: Figure 5 - sagittal 2D BME map of a 60-year-old female with a history of colorectal cancer, showing diffuse BME. The amount of green colour is greater than expected for a patient of this age. The patient had no corresponding fracture on CT, however, had a repeat CT 1 month later with a new L1 fracture.$

Fig 4: Figure 5 - sagittal 2D BME map of a 60-year-old female with a history of...

$Fig 5: Figure 5 - sagittal CT showing T12 and L1 compression fractures in a 78-year-old female referred by her GP with chronic back pain$

Fig 5: Figure 5 - sagittal CT showing T12 and L1 compression fractures in a...

$Fig 6: Figure 6 - sagittal 2D BME map of the same patient showing no BME at T12 or L1 (absence of green), indicating old fractures. This was confirmed on previous imaging.$

Fig 6: Figure 6 - sagittal 2D BME map of the same patient showing no BME at T12 or L1...

$Fig 7: Figure 7 - Sagittal CT showing a new T8 compression fracture in an 80-year-old female presenting post trauma. The T7, T12 and L2 compression fractures were present on an old CT$

Fig 7: Figure 7 - Sagittal CT showing a new T8 compression fracture in an 80-year-old...

$Fig 8: Figure 8 - sagittal 2D BME map of the same patient shows BME (increased green within the marrow) at T8 level, consistent with an acute fracture. This would be particularly useful if there was no prior imaging available for comparison.$

Fig 8: Figure 8 - sagittal 2D BME map of the same patient shows BME (increased green...

$Fig 9: Sagittal 2D marrow map with anatomical overlay demonstrates marrow oedema in L2 and S2 levels consistent with acute fractures, confirmed on the CT. The S2 marrow oedema is slightly obscured due to the misregistration in marrow map with the anatomical images due to the cortical discontinuity. Subsequent MR demonstrates oedema at L2 and S2, concordant with the CT and marrow maps. "All images © Dr Jones & Partners Medical Imaging, South Australia, 2022"$

Fig 9: Sagittal 2D marrow map with anatomical overlay demonstrates marrow oedema in L2...