Virtual non-calcium imaging to detect bone marrow edema in patients with arthritis: a feasibility study with MRI as...

To evaluate the diagnostic performance of virtual non-calcium (VNCa) imaging derived from dual-energy CT (DECT) for the detection of bone marrow edema (BME) in patients with suspected hand arthritis using magnetic resonance imaging (MRI) as standard of reference.

In this post-hoc analysis, 68 patients ((50 women) with a mean age of 55 (SD 13.1)) were included. All patients underwent DECT and MRI of the hand. VNCa images were reconstructed using three-material decomposition. Two radiologists scored the VNCa images and MRI datasets in consensus for BME. Specificity, sensitivity, and diagnostic accuracy of VNCa were calculated. The sum score was calculated by adding all region-based BME scores per patient, providing an aggregated measure for correlation with MRI findings.

MRI was positive in 21 patients and VNCa in 15 patients. VNCa achieved a high specificity (96.7 %), moderate sensitivity (61.9 %), and an overall accuracy of 85.3 %. The sum score in VNCa was strongly correlated with MRI (r = 0.77; p < 0.001).

VNCa imaging showed excellent specificity, albeit only moderate sensitivity for detecting BME in patients with suspected hand arthritis. These results underscore the clinical utility of DECT for arthritis imaging, adding to known strengths such as sensitivity for structural damage and ease of acquisition.