Meta-analysis of dual-energy computed tomography virtual non-calcium imaging to detect bone marrow edema

Objective: This meta-analysis aimed to evaluate the accuracy of dual-energy CT (DECT) virtual non-calcium (VNC) imaging for the detection of bone marrow edema (BME).

Methods: A systematic literature search up to March 2017 was performed to find relevant original studies. Two reviewers independently selected studies, assessed literature quality, and extracted data. Pooled sensitivity, specificity, area under receiver operating characteristic (AUROC) curve, and other measures of DECT accuracy for detecting BME were calculated using random effects models. Risk of heterogeneity was assessed for the appropriateness of meta-analysis.

Results: Fourteen studies involving 2205 regions of vertebrae, hips, knees, and ankles were included. To evaluate the accuracy of BME detection using DECT, calculations were performed to obtain a pooled sensitivity of 0.812 (95% confidence interval [CI], 0.780-0.841) and specificity of 0.951 (95% CI, 0.940-0.960). The AUROC value was 0.9635. The major potential cause of heterogeneity was bone position. No significant publication bias was present.

Conclusion: DECT VNC imaging gives very good diagnostic performance for BME detection and will likely be an important and common modality for acute assessment in the future.