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Diagnostic Value of Dual-Energy CT Virtual Non-Calcium and Rho/Z Images for Bone Marrow Infiltration in Primary Malignant Bone Tumors

  • Author Footnotes
    # Suwei Liu, Haojie Pan and Shijie Wu contributed equally to the writing of this article.
    Suwei Liu
    Footnotes
    # Suwei Liu, Haojie Pan and Shijie Wu contributed equally to the writing of this article.
    Affiliations
    Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China

    Second clinical school, Lanzhou University, Lanzhou, China

    Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China

    Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
    Search for articles by this author
  • Author Footnotes
    # Suwei Liu, Haojie Pan and Shijie Wu contributed equally to the writing of this article.
    Haojie Pan
    Footnotes
    # Suwei Liu, Haojie Pan and Shijie Wu contributed equally to the writing of this article.
    Affiliations
    Second clinical school, Lanzhou University, Lanzhou, China
    Search for articles by this author
  • Author Footnotes
    # Suwei Liu, Haojie Pan and Shijie Wu contributed equally to the writing of this article.
    Shijie Wu
    Footnotes
    # Suwei Liu, Haojie Pan and Shijie Wu contributed equally to the writing of this article.
    Affiliations
    Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China
    Search for articles by this author
  • Shenglin Li
    Affiliations
    Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China

    Second clinical school, Lanzhou University, Lanzhou, China

    Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China

    Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
    Search for articles by this author
  • Jiachen Sun
    Affiliations
    Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China

    Second clinical school, Lanzhou University, Lanzhou, China

    Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China

    Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
    Search for articles by this author
  • Tiezhu Ren
    Affiliations
    Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China

    Second clinical school, Lanzhou University, Lanzhou, China

    Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China

    Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
    Search for articles by this author
  • Zhengxiao Li
    Affiliations
    Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China

    Second clinical school, Lanzhou University, Lanzhou, China

    Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China

    Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
    Search for articles by this author
  • Junlin Zhou
    Correspondence
    Address correspondence to: J.Z.
    Affiliations
    Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China

    Second clinical school, Lanzhou University, Lanzhou, China

    Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China

    Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
    Search for articles by this author
  • Author Footnotes
    # Suwei Liu, Haojie Pan and Shijie Wu contributed equally to the writing of this article.
Published:November 10, 2022DOI:https://doi.org/10.1016/j.acra.2022.10.016

      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)
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      References

        • Folkert I.W.
        • Devalaraja S.
        • Linette G.P.
        • et al.
        Primary bone tumors: challenges and opportunities for CAR-T Therapies.
        J Bone Miner Res. 2019; 34: 1780-1788
        • Rainusso N.
        • Wang L.L.
        • Yustein J.T.
        The adolescent and young adult with cancer: state of the art – bone tumors.
        Curr Oncol Rep. 2013; 15: 296-307
        • Matsuoka K.
        • Bakiri L.
        • Wolff L.I.
        • et al.
        Wnt signaling and Loxl2 promote aggressive osteosarcoma.
        Cell Res. 2020; 30: 885-901
        • Murphey M.D.
        • Kransdorf M.J.
        Staging and classification of primary musculoskeletal bone and soft-tissue tumors according to the 2020 WHO update, from the AJR Special Series on Cancer Staging.
        AJR Am J Roentgenol. 2021; 217: 1038-1052
        • Jeys L.M.
        • Thorne C.J.
        • Parry M.
        • et al.
        A novel system for the surgical staging of primary high-grade osteosarcoma: the Birmingham classification.
        Clin Orthop Relat Res. 2017; 475: 842-850
        • Bertrand T.E.
        • Cruz A.
        • Binitie O.
        • et al.
        Do surgical margins affect local recurrence and survival in extremity, nonmetastatic, high-grade osteosarcoma?.
        Clin Orthop Relat Res. 2016; 474: 677-683
        • Steinbach L.S.
        MRI in the detection of malignant infiltration of bone marrow"–a commentary.
        AJR Am J Roentgenol. 2007; 188: 1443-1445
        • Yin F.
        • Wang Z.
        • Jiang Y.
        • et al.
        Reduction-responsive polypeptide nanomedicines significantly inhibit progression of orthotopic osteosarcoma.
        Nanomedicine. 2020; 23102085
        • Bruckmann N.M.
        • Kirchner J.
        • Umutlu L.
        • et al.
        Prospective comparison of the diagnostic accuracy of 18F-FDG PET/MRI, MRI, CT, and bone scintigraphy for the detection of bone metastases in the initial staging of primary breast cancer patients.
        Eur Radiol. 2021; 31: 8714-8724
        • Mallinson P.I.
        • Coupal T.M.
        • McLaughlin P.D.
        • et al.
        Dual-energy CT for the musculoskeletal system.
        Radiology. 2016; 281: 690-707
        • Kosmala A.
        • Weng A.M.
        • Heidemeier A.
        • et al.
        Multiple myeloma and dual-energy CT: diagnostic accuracy of virtual noncalcium technique for detection of bone marrow infiltration of the spine and pelvis.
        Radiology. 2018; 286: 205-213
        • Guggenberger R.
        Dual-energy CT in the detection of bone marrow edema in the sacroiliac joints: is there a case for axial spondyloarthritis?.
        Radiology. 2019; 290: 165-166
        • Wu H.
        • Zhang G.
        • Shi L.
        • et al.
        Axial spondyloarthritis: dual-energy virtual noncalcium CT in the detection of bone marrow edema in the sacroiliac joints.
        Radiology. 2019; 290: 157-164
        • Booz C.
        • Nöske J.
        • Lenga L.
        • et al.
        Color-coded virtual non-calcium dual-energy CT for the depiction of bone marrow edema in patients with acute knee trauma: a multireader diagnostic accuracy study.
        Eur Radiol. 2020; 30: 141-150
        • Shim E.
        • Kim B.H.
        • Kang W.Y.
        • et al.
        Diagnostic performance of electron-density dual-energy CT in detection of cervical disc herniation in comparison with standard gray-scale CT and virtual non-calcium images.
        Eur Radiol. 2022; 32: 2209-2220
        • Ghazi Sherbaf F.
        • Sair H.I.
        • Shakoor D.
        • et al.
        DECT in detection of vertebral fracture-associated bone marrow edema: a systematic review and meta-analysis with emphasis on technical and imaging interpretation parameters.
        Radiology. 2021; 300: 110-119
        • Jans L.
        • De Kock I.
        • Herregods N.
        • et al.
        Dual-energy CT: a new imaging modality for bone marrow oedema in rheumatoid arthritis.
        Ann Rheum Dis. 2018; 77: 958-960
        • Foti G.
        • Faccioli N.
        • Silva R.
        • et al.
        Bone marrow edema around the hip in non-traumatic pain: dual-energy CT vs MRI.
        Eur Radiol. 2020; 30: 4098-4106
        • Benchoufi M.
        • Matzner-Lober E.
        • Molinari N.
        • et al.
        Interobserver agreement issues in radiology.
        Diagn Interv Imaging. 2020; 101: 639-641
        • Johnson T.R.
        • Krauss B.
        • Sedlmair M.
        • et al.
        Material differentiation by dual energy CT: initial experience.
        Eur Radiol. 2007; 17: 1510-1517
        • Pache G.
        • Krauss B.
        • Strohm P.
        • et al.
        Dual-energy CT virtual noncalcium technique: detecting posttraumatic bone marrow lesions–feasibility study.
        Radiology. 2010; 256: 617-624
        • Guggenberger R.
        • Gnannt R.
        • Hodler J.
        • et al.
        Diagnostic performance of dual-energy CT for the detection of traumatic bone marrow lesions in the ankle: comparison with MR imaging.
        Radiology. 2012; 264: 164-173
        • Fervers P.
        • Fervers F.
        • Kottlors J.
        • et al.
        Feasibility of artificial intelligence-supported assessment of bone marrow infiltration using dual-energy computed tomography in patients with evidence of monoclonal protein - a retrospective observational study.
        Eur Radiol. 2022; 32: 2901-2911
        • Hua C.H.
        • Shapira N.
        • Merchant T.E.
        • et al.
        Accuracy of electron density, effective atomic number, and iodine concentration determination with a dual-layer dual-energy computed tomography system.
        Med Phys. 2018; 45: 2486-2497