Comparison of Spectral CT and MRI in Pelvic Ring Fragility Fractures: A Prospective Diagnostic Accuracy Study.

J Clin Med

Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany.

Published: September 2024

AI Article Synopsis

  • Fragility fractures of the pelvis (FFP) primarily affect patients with osteoporosis and are often difficult to diagnose using conventional CT, with MRI being the gold standard for accurate detection.* -
  • This study compares the diagnostic accuracy of Spectral CT to MRI by examining patients with suspected FFP, finding that while Spectral CT has slightly lower sensitivity than MRI, it can still identify additional fractures effectively.* -
  • The results show that Spectral CT maintained good specificity and inter-rater reliability, suggesting it could be a valuable tool in uncertain cases of FFP diagnosis.*

Article Abstract

Fragility fractures of the pelvis (FFP) are characterized by inadequate trauma to a structurally compromised bone, primarily in osteoporosis. Conventional CT studies can be inadequate in identifying FFPs. An MRI of the pelvis is considered the gold standard in diagnosing FFPs. Spectral CT or Dual-Energy CT may have comparable diagnostic accuracy. It provides additional insights into associated bone marrow edema. The aim of this prospective monocentric study is to evaluate the diagnostic accuracy of Spectral CT compared to the gold standard MRI in diagnosing FFP. Over a 2-year period, patients presenting in the emergency department with clinical suspicion of an FFP were consecutively included. They underwent Spectral CT (GE Revolution 16 cm GSI) upon admission, followed by an MRI. The gold standard for diagnosing FFP is pelvic MRI, showing sensitivity and specificity ranging from 97% to 100%. The acquired images were evaluated and classified using the osteoporotic fractures of the pelvis (OFP) classification. Compared to the reference test, which was the MRI pelvis, the sensitivity of the CT pelvis was determined to be 86.8 (95% confidence interval (CI) 71.9-95.6%) with a specificity of 84.6% (95% CI: 54.6-98.1%, = 0.453). Spectral CT could identify an additional FFP correctly, exhibiting a sensitivity of 89.5% (95% CI: 75.2-97.1%, = 0.688), while maintaining the same specificity as the conventional CT. The inter-rater reliability assessment for Spectral CT, conducted by four independent raters, resulted in a Fleiss' Kappa value of 0.516 (95% CI: 0.450-0.582, < 0.001). The sensitivity of Spectral CT in the detection of pelvic ring fragility fractures shows a slightly lower sensitivity compared to MRI. There were no statistically significant differences observed when compared to conventional CT or MRI. In conclusion, Spectral CT may be beneficial in distinguishing FFP, particularly in cases where a definitive diagnosis is uncertain. Level of Evidence: II.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11432043PMC
http://dx.doi.org/10.3390/jcm13185446DOI Listing

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