Visual assessment and quantitative analysis of bone marrow edema in young and middle-aged versus elderly patients with vertebral compression fracture by spectral CT

For the diagnosis of bone marrow edema (BME), spectral computed tomography (CT) has emerged as a promising technique.

To study the different performances of spectral CT in the diagnosis of vertebral BME in young and middle-aged versus elderly patients.

Magnetic resonance imaging (MRI) was used as the gold standard. To determine the existence of BME, spectral CT color-coded images of the vertebral bodies of 82 patients with vertebral compression fractures (VCFs) were visually inspected. A quantitative analysis of the spectral CT vertebral water concentration in the diagnosis of BME was performed using a receiver operating characteristic (ROC) curve. Patients were divided into two groups for comparison: the young and middle-aged group; and the elderly group.

The sensitivity and specificity for visual assessment were 83.7% and 98.3%, respectively, in the young and middle-aged group and 96.8% and 98.2%, respectively, in the elderly group. The elderly group had a higher sensitivity than the young and middle-aged group (P < 0.05). With a threshold of 1046.2 mg/cm³, the ROC curve for the young and middle-aged group displayed an area under the curve (AUC) of 0.870, sensitivity of 86.0%, and specificity of 81.4%. The threshold of 1031.4 mg/cm³ yielded a sensitivity of 95.2% and a specificity of 98.4%, and the AUC of the elderly group was 0.997. The elderly group had a higher level of specificity than the young and middle-aged group (P < 0.05).

Spectral CT can reliably diagnose BME in VCFs, and it performs better in elderly people than in young and middle-aged people.