Rationale and Objectives
We investigated the diagnostic performance of dual-energy CT (DECT) virtual non-calcium
(VNCa) and Rho/Z images for bone marrow infiltration of primary malignant bone tumors
(PMBTs).
Materials and Methods
We retrospectively analyzed 65 patients with PMBT who underwent DECT and MRI within
2 weeks. DECT was used to evaluate the presence and extent of marrow involvement surrounding
PMBTs using the SCT, VNCa, and Rho/Z images. MRI was used as the reference standard
for measurements. CT values of normal and involved bone marrow areas were measured
on VNCa images, and Zeff values were measured on Rho/Z images. The statistical methods
used were the 2*C chi-square test, ANOVA test, paired samples t test, and diagnostic performance of the different variables were evaluated using
receiver operating characteristic curves.
Results
VNCa and Rho/Z images showed higher accuracy (91%, 92% vs. 67%) and sensitivity (90%,
92% vs. 69%) than SCT images for diagnosing bone marrow infiltration in patients with
PMBT. The maximum longitudinal diameter of tumor involvement measurements was statistically
different between VNCa and SCT, Rho/Z and SCT, MRI, and SCT (all p < 0.05, p = 0.047, p = 0.049, and p = 0.023, respectively). The maximum transverse diameter was statistically significant
between SCT and MRI, VNCa and MRI, Rho/Z and MRI (all p < 0.05, and p = 0.015, and p = 0.044, and p = 0.047, respectively). The HU or Zeff values based on the area of interest of VNCa
and Rho/Z images differed significantly between the normal and infiltrated bone marrow
area (p < 0.001). Receiver operating characteristic curve analysis revealed area under the
curves of 0.995 and 0.988, respectively, with cut-off values of −31.57 HU and 7.8,
and the sensitivity of both was 96.9%.
Conclusion
DECT-VNCa and Rho/Z images have good diagnostic value when evaluating bone marrow
infiltration in PMBTs.
Key Words
Abbreviations:
DECT (dual-energy CT), VNCa (virtual non-calcium), PMBTs (primary malignant bone tumors), SCT (standard computed tomography), ICC (intraclass correlation coefficient), ROC (receiver operating characteristic), AUC (area under the curve)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 10, 2022
Accepted:
October 15,
2022
Received in revised form:
October 12,
2022
Received:
August 24,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
