Dual-Layer Spectral CT with Electron Density in Bone Marrow Edema Diagnosis: A Valid Alternative to MRI?

Background/Objectives: Although MRI with fat-suppression sequences is the gold standard for diagnosis of bone marrow edema (BME), Dual-Layer Spectral CT (DL-SCT) with electron density (ED) provides a viable alternative, particularly in situations where an MRI is not accessible. Using MRI as the reference standard, this study analyzed how DL-SCT with ED reconstructions may be a valid alternative in the detection of BME. Methods: This retrospective study included 28 patients with a suspected diagnosis of BME via MRI conducted between March and September 2024. Patients underwent DL-SCT using ED reconstructions obtained through IntelliSpace software v. 12.1. Images were evaluated by two experienced radiologists and one young radiologist in a blinded way, giving a grade from 0 to 3 to classify BME (0 absence; 1 mild; 2 moderate; 3 severe). To reduce the recall bias effect, the order of image evaluations was set differently for each reader. p-Values were considered significant when <0.05. Fleiss' Kappa was used to assess inter-rater reliability: agreement was considered poor for k < 0; slight for k 0.01-0.20; fair for 0.21-0.40; moderate for 0.41-0.60; substantial for 0.61-0.80; and almost perfect for 0.81-1.00. Results: All the readers detected the presence or absence of BME using DL-SCT. Inter-rater reliability for grade 0 resulted in 1 (p-value < 0.001); for grade 1: 0.21 (p-value < 0.001); for grade 2: 0.197 (p-value < 0.001); and for grade 3: 0.515 (p-value < 0.001). Conclusions: ED reconstructions allowed the identification of BME presence or absence in all analyzed cases, thus suggesting DL-SCT as a potentially effective method for its detection.