Dual-Energy CT Virtual Noncalcium Technique: Detecting Posttraumatic Bone Marrow Lesions Feasibility Study

To evaluate traumatized bone marrow with a dual-energy (DE) computed tomographic (CT) virtual noncalcium technique. In this prospective institutional review board-approved study, 21 patients with an acute knee trauma underwent DE CT and magnetic resonance (MR) imaging. A software application was used to virtually subtract calcium from the images. Presence of fractures was noted, and presence of bone bruise was rated on a four-point scale for six femoral and tibial regions by two radiologists. CT numbers were obtained in the same regions. Consensus reading of independently read MR images served as the reference standard. Image ratings and CT numbers were subjected to receiver operating characteristic curve analysis. After exclusion of 16 regions owing to artifacts, MR imaging revealed 59 bone bruises in the remaining 236 regions (19 of 114 femoral, 40 of 122 tibial). Fractures were present in eight patients. Visual rating revealed areas under the curve of 0.886 and 0.897 in the femur and 0.974 and 0.953 in the tibia for observers 1 and 2, respectively. For CT numbers, the respective areas under the curve were 0.922 and 0.974. If scores of 1 and 2 (strong or mild bone bruise) were counted as positive, sensitivities were 86.4% and 86.4% and specificities were 94.4% and 95.5% for observers 1 and 2, respectively. The kappa statistic demonstrated good to excellent agreement (femur, kappa = 0.78; tibia, kappa = 0.87). This DE CT virtual noncalcium technique can subtract calcium from cancellous bone, allowing bone marrow assessment and potentially making posttraumatic bone bruises of the knee detectable with CT.