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Diagnostic accuracy of dual-energy CT for detecting bone marrow edema in patients with acute knee injuries: a systematic review and meta-analysis

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Abstract

Purpose

This systematic review and meta-analysis evaluated the diagnostic accuracy of dual-energy CT (DECT) for detecting bone marrow edema (BME) in adult patients with acute knee injuries.

Methods

A systematic review of MEDLINE, EMBASE, Scopus, the Cochrane Library, and gray literature was performed from inception to January 31, 2020, using PRISMA-DTA guidelines. The review included studies assessing the diagnostic accuracy of DECT for detecting BME in at least 10 adult patients with acute knee injuries and with an MRI reference standard. Study details were independently extracted by two reviewers. Meta-analysis was performed using a bivariate mixed-effects regression model with subgroup analysis performed to evaluate for sources of variability. Risk of bias (ROB) was evaluated using the QUADAS-2 tool.

Results

Eight studies evaluating 267 patients between the ages of 25–54 with acute knee injuries undergoing DECT and MRI were included in analysis. Summary sensitivity, specificity, and AUROC values for BME were 84% (95% confidence interval (CI) 74–91%), 96% (95% CI 93–98%), and 0.97 (95% CI 0.95–0.98), respectively. Bone-based characterization was found to have lower specificity than region-based characterization (83% (57–95%) versus 97 (96–98%), p < 0.05), but no difference in sensitivity. No other statistical differences were identified amongst study subgroups to account for presumed variability amongst studies. Most studies were rated low risk for bias and applicability concerns.

Conclusion

DECT is specific and accurate for detecting BME in adult patients with acute knee injuries and can be used as an alternative to MRI, particularly when MRI is contraindicated or unavailable.

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Abbreviations

BME:

Bone marrow edema

DECT:

Dual-energy computed tomography

MRI:

Magnetic resonance imaging

TP:

True positive

FN:

False negative

TN:

True negative

FN:

False positive

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies-2

AUROC:

Area under the receiver operator characteristic curve

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analysis

ROB:

Risk of bias

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Funding

Studentship funding for this systematic review was provided through an Office of the Provost and VP (Academic) Summer Student Award from University of Alberta Faculty of Medicine and Dentistry and through the Radiology Endowment Fund from the University of Alberta Department of Radiology and Diagnostic Imaging.

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Authors and Affiliations

  1. Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada

    Mitchell P. Wilson, Kevin Lui, Dorian Nobbee, Prayash Katlariwala & Gavin Low

  2. Evidence-based Practice Center, Mayo Clinic, Room 2-54, 205 3rd Ave SW, Rochester, MN, 55905, USA

    Mohammad H. Murad

Authors
  1. Mitchell P. Wilson
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  2. Kevin Lui
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  3. Dorian Nobbee
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  4. Mohammad H. Murad
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  5. Prayash Katlariwala
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  6. Gavin Low
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Corresponding author

Correspondence to Mitchell P. Wilson.

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The authors declare that they have no conflict of interest.

Ethical approval and informed consent

The study is exempt from ethical approval at our institution as all reviewed publications included anonymized data and have acquired appropriate institutional ethical approval where necessary.

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Appendices

Appendix 1

Table 5 Search strategy by database
Full size table

Appendix 2

Table 6 Dual-energy CT characteristics of individual studies included in analysis
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Wilson, M.P., Lui, K., Nobbee, D. et al. Diagnostic accuracy of dual-energy CT for detecting bone marrow edema in patients with acute knee injuries: a systematic review and meta-analysis. Skeletal Radiol 50, 871–879 (2021). https://doi.org/10.1007/s00256-020-03646-y

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  • DOI: https://doi.org/10.1007/s00256-020-03646-y

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