Dual-energy CT Virtual Non-Calcium Image is Beneficial for the Detection of Non-displaced Knee Fractures

Background: Early and accurate diagnosis is vital for avoiding the development of nondisplaced fractures to displaced fractures. Dual-energy CT (Computed Tomography) can detect bone marrow edema (BME), which may help to detect non-displaced fractures. Aim: To evaluate the value of DECT (Dual-Energy Computed Tomography) VNCa (Virtual noncalcium) images for improving diagnostic performance and confidence in acute non-displaced knee fractures. Methods: 125 patients with clinical suspicion of knee fractures underwent both DECT and MR. Conventional linear-blended CT and VNCa images were obtained from DECT. First, five readers with varying levels of experience evaluated the presence of fractures on conventional linear-blended CT and graded their diagnostic confidence on a scale of 1 to 10. Then BME with VNCa images was evaluated and compared with MR. Finally, the VNCa images combined with conventional linear-blended CT images were used to reassess the presence of fractures and diagnostic confidence. Diagnostic performance and matched pair analyses were performed. Results: 20 non-displaced knee fractures were detected. The consistency test of VNCa images and MR by five radiologists showed Kappa values are 0.76, 0.79, 0.81,0.85,and 0.90,respectively. The diagnostic performance of all readers was improved when using VNCa images combined with conventional linear-blended CT compared with that with conventional linear-blended CT alone. Diagnostic confidence was improved with combined conventional linear-blended CT and VNCa images (median score:8,8,9,9, and 10, respectively) compared with conventional linear-blended CT alone (median score:7,7,8,9, and 9). Conclusion: DECT VNCa images could improve the radiologists' diagnostic performance and confidence with varying levels of experience in the detection of non-displaced knee fractures.