Bone Marrow Edema on Dual-energy Computed Tomography: Spectrum of Causes and Pitfalls

Bone marrow edema (BME) is a frequent but nonspecific imaging finding encountered in a wide range of musculoskeletal disorders, including fractures, infection, inflammatory arthritis, and neoplasia. While MR imaging is considered the reference standard for detection of BME, dual-energy computed tomography (DECT) offers a valuable alternative, particularly in emergent settings or when MR imaging is contraindicated. This article outlines the principles and acquisition strategies of DECT, including dual-source, rapid kilovoltage peak switching, and dual-layer spectral detector techniques. Integration of DECT into clinical workflows can enhance diagnostic accuracy, especially in acute care and resource-limited settings.