Diagnostic Accuracy of Dual-Layer Spectral CT Using Electron Density Images to Detect Post-Traumatic Prevertebral Hematoma of the Cervical Spine

Abstract

Purpose To investigate the diagnostic value of dual-layer spectral detector computed tomography (SDCT) in detecting posttraumatic prevertebral hematoma of the cervical spine by including electron density images.

Methods 38 patients with post-traumatic imaging of the cervical spine were included in this study and received both SDCT and MRI examinations. MRI was set as the reference and combined conventional/electron density (C + ED) images were compared to conventional CT (CCT) images alone.

Results A total of 18 prevertebral hematomas were identified. Reader 1 identified 14 of 18 and reader 2 15 of 18 prevertebral hematomas by using C + ED reconstructions. Readers 1 and 2 detected 6 and 9 of 18 hematomas on CCT, respectively. CCT showed a sensitivity of 33–50 % and a specificity of 75–80 %, while for C + ED reconstructed images the sensitivity was 77–83 % and the specificity was 85–90 %. Accuracy increased from 55–66 % to 84 % by using C + ED images. The minimum thickness for detecting hematoma on C + ED images was 3 mm. The sizes of prevertebral hematoma on CCT/C + ED were not significantly under- or overestimated compared to the MRI reference. There was a significant difference between the two readers for measuring hematoma sizes on CCT (p = 0.04). Readers showed an excellent inter-rater reliability (kappa = 0.82) for C + ED images and a moderative inter-rater reliability (kappa = 0.44) for CCT.

Conclusion With SDCT, the diagnostic accuracy for detecting post-traumatic prevertebral hematoma is improved by using combined conventional and electron density reconstructions compared to conventional images alone.

Key Points: 

• SDCT has a high potential for detecting post-traumatic prevertebral hematomas of the cervical spine by using combined conventional and electron density images.

• Prevertebral hematomas with a thickness of less than 3 mm cannot be reliably identified by SDCT.

• There is no discernible value of conventional SDCT images for diagnosing prevertebral hematoma.

Citation Format

• Sedaghat S, Langguth P, Larsen N et al. Diagnostic Accuracy of Dual-Layer Spectral CT Using Electron Density Images to Detect Post-Traumatic Prevertebral Hematoma of the Cervical Spine. Fortschr Röntgenstr 2021; 193: 1445 – 1450

Zusammenfassung

Zielsetzung Untersuchung der diagnostischen Wertigkeit der Dual-Layer-Spektraldetektor-Computertomografie (SDCT) zur Erkennung von posttraumatischen prävertebralen Hämatomen der Halswirbelsäule unter Verwendung von Elektronendichtebildern.

Methoden 38 Patienten mit posttraumatischer Bildgebung der Halswirbelsäule wurden in diese Studie eingeschlossen und erhielten sowohl SDCT- als auch MRT-Untersuchungen. Die MRT wurde als Referenz festgelegt. Kombinierte konventionelle und Elektronendichtebilder (C + ED) wurden mit konventionellen Bildern (CCT) verglichen.

Ergebnisse Insgesamt wurden 18 prävertebrale Hämatome identifiziert. Reader 1 identifizierte 14 von 18 und Reader 2 15 von 18 prävertebrale Hämatome unter Verwendung von C + ED-Bildern. Reader 1 und 2 entdeckten 6 bzw. 9 von 18 Hämatomen mittels CCT. Bei CCT-Bildern zeigte sich eine Sensitivität von 33–50 % und eine Spezifität von 75–80 %, während für C + ED-Bilder eine Sensitivität von 77–83 % und eine Spezifität von 85–90 % ermittelt wurde. Die Genauigkeit wurde unter Verwendung von C + ED-Bildern von 55–66 % auf 84 % erhöht. Die Mindestdicke zum Nachweis von Hämatomen auf C + ED-Bildern betrug 3 mm. Das Ausmaß der prävertebralen Hämatome wurde weder bei CCT- noch bei C + ED-Bildern im Vergleich zur MRT-Referenz signifikant unter- oder überschätzt. Dagegen gab es einen signifikanten Unterschied zwischen den beiden Readern in Bezug auf die Messung der Hämatomgrößen in CCT-Bildern (p = 0,04). Die Reader zeigten eine exzellente Interrater-Übereinstimmung (kappa = 0,82) für C + ED-Bilder und eine moderate Interrater-Übereinstimmung (kappa = 0,44) für CCT-Bilder.

Schlussfolgerung Durch die Verwendung von kombinierten konventionellen und Elektronendichtebildern lässt sich bei der SDCT die diagnostische Genauigkeit zur Erkennung von posttraumatischen prävertebralen Hämatomen im Vergleich zu konventionellen Bildern steigern.

Kernaussagen: 

• SDCT hat ein hohes Potenzial zur Erkennung von posttraumatischen prävertebralen Hämatomen der Halswirbelsäule unter Verwendung von kombinierten konventionellen und Elektronendichtebildern.

• Prävertebrale Hämatome mit einer Dicke von weniger als 3 mm können durch die SDCT nicht sicher identifiziert werden.

• Konventionelle SDCT-Bilder sind für die Diagnose eines prävertebralen Hämatoms ungeeignet.

Key words

dual-layer spectral CT - diagnostic accuracy - prevertebral hematoma - electron density

Publikationsverlauf

Eingereicht: 17. Februar 2021

Angenommen: 05. Juni 2021

Artikel online veröffentlicht:
05. August 2021

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