Improved diagnostic confidence in evaluating bone non-union using virtual monochromatic dual-energy CT

Area of Science:

• Radiology
• Orthopedic Surgery
• Medical Imaging

Background:

• Non-union of appendicular skeleton fractures is a challenging complication.
• Metallic intramedullary nails and plates used for fixation can cause artifacts in CT imaging.
• Accurate diagnosis of non-union is crucial for timely surgical intervention.

Purpose of the Study:

• To evaluate the efficacy of virtual monochromatic dual-energy CT (DECT) imaging in assessing non-union.
• To compare DECT imaging at different keV levels for evaluating fractures with titanium or stainless steel hardware.
• To determine if DECT improves diagnostic confidence and image quality in suspected non-union cases.

Main Methods:

• Forty-one patients with suspected non-union and existing hardware underwent dual-source CT scanning.
• Images were reconstructed at various keV levels (70, 130, and 150 keV) to simulate virtual monochromatic imaging.
• Musculoskeletal radiologists and orthopedic surgeons assessed image quality, consolidation, non-union type, and diagnostic confidence.

Main Results:

• Image quality significantly improved with higher keV virtual monochromatic images (130/150 keV) compared to standard 70 keV images (p < 0.001).
• Diagnostic confidence was significantly higher with high keV images (p < 0.001).
• Higher keV images showed a trend towards reducing false-negative non-unions but did not significantly improve inter-observer agreement on consolidation or non-union type.

Conclusions:

• Virtual monochromatic 130 and 150 keV DECT imaging improves image quality and diagnostic confidence for evaluating suspected non-union in appendicular skeleton fractures with metallic hardware.
• This advanced imaging technique offers a valuable tool for orthopedic surgeons and radiologists in managing non-union cases.
• Further research may explore optimizing DECT parameters for even greater diagnostic accuracy.