J Korean Soc Radiol.  2013 Dec;69(6):487-494.

Dual-Energy CT for Detection of Traumatic Bone Bruises in the Knee Joint

• Seo SH
• Sohn YJ
• Lee CH
• Park SH
• Kim HW
• Juhng SK

Abstract

PURPOSE
To evaluate the diagnostic performance of dual-energy computed tomography (DECT) in detecting traumatic bone marrow lesions in patients with acute knee injury.
MATERIALS AND METHODS
Between August 2011 and June 2012, 22 patients presenting with an acute knee injury, including 4 patients who were referred for bilateral knee trauma, underwent DECT (80 kVp and 140 kVp) and MR imaging. DECT data were postprocessed using a three-dimensional, color-coded, virtual non-calcium technique (VNC). DECT data were graded by 2 blinded independent readers using a four-point system (1 = distinct bone marrow lesion, 2 = less distinct bone marrow lesion, 3 = equivocal, 4 = none) for 6 femoral and tibial regions and 2 patellar regions. Routine MR knee imaging served as the reference standard.
RESULTS
MR images showed bone bruises in 81 of 364 regions. The overall sensitivity, specificity, positive predictive value, and negative predictive value of DECT for bone bruises were 65.4%, 98.2%, 91.4%, and 90.8%, respectively, for Reader 1 and 70.3%, 93.6%, 76.0%, and 91.7%, respectively, for Reader 2. In particular, tibial bone bruises could be found more easily with better sensitivity (80.2%).
CONCLUSION
The color-coded VNC technique with reconstructions from the DECT maybe helpful in detecting traumatic bone bruises with moderate sensitivity and excellent specificity compared to MR imaging.

MeSH Terms

Bone Marrow
Contusions*
Humans
Knee Injuries
Knee Joint*
Knee*
Magnetic Resonance Imaging
Sensitivity and Specificity

Figure

• 

  Fig. 1 Four-point grading system for axial color-coded VNC image (left) and corresponding T2-weighted STIR MR images (right). A. Grade 1: distinct bone marrow lesion, color-coded VNC images depict bone marrow abnormalities (arrow) in the same area as seen on the MR image (arrow). B. Grade 2: less distinct bone marrow lesion, "probable" bone marrow abnormality on color-coded VNC image (arrows). Corresponding MR image shows bone bruise in the same area (arrows). C. Grade 3: equivocal lesion, probably no bone marrow lesion on color-coded VNC image (arrow). MR image shows no bone bruise in medial femoral condyle. D. Grade 4: normal bone marrow, no abnormality on either modality.

• 

  Fig. 2 A 23-year-old man with acute knee trauma. A. Sagittal weighted-average image simulating single-energy CT shows no fracture and normal trabecular structure. B. Color-coded VNC image shows bone bruise in the medial condyle of the femur (arrow). C. T2-weighted STIR MR image shows diffuse bone marrow lesion in the medial femoral condyle (arrow).

• 

  Fig. 3 A 72-year-old woman with acute knee trauma. A. Axial weighted-average image simulating single-energy CT shows no fracture. B. Color-coded VNC image shows no traumatic lesion in the medial femoral condyle. C. T2-weighted STIR MR image shows bone marrow edema in the medial femoral condyle (arrow).

• 

  Fig. 4 A 61-year-old man with acute knee trauma. A. Sagittal weighted-average image simulating single-energy CT shows normal trabecular bone structure without fracture. B. Color-coded VNC image shows dark colored area in medial tibialplateau of knee joint (arrow). C. T2-weighted STIR MR image shows no bone bruise in medial tibial plateau (arrow).

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