Spinal Bone Bruise: Can Computed Tomography (CT) Enable Accurate Diagnosis?

Rationale and Objectives The study aimed to evaluate the usefulness of dual-energy computed tomography (DECT) before and after calcium subtraction in the diagnosis of spinal bone bruise. Materials and Methods Among the patients who visited our emergency department between January 2013 and July 2014 who underwent both spinal DECT and magnetic resonance imaging, 38 patients (men:women = 25:13; mean age: 55.6 years, range: 28–82) were included. The patients were divided into two groups, those with and without acute spinal compression fracture, based on magnetic resonance imaging findings. In the fracture group (n = 22), the ratio of Hounsfield unit (HU) values was calculated between the fracture level and the next normal inferior vertebra in the DECT before and after calcium subtraction. In the non-fracture group (n = 16), the ratios of HU values were calculated between two normal adjacent vertebrae. The mean HU ratios were compared between the two groups. Results The mean HU ratio was higher in the fracture group (calcium subtraction: before: 1.57 and 1.59; after: 1.74 and 1.76) than the non-fracture group (before: 1.07 and 1.08; after: 1.07 and 1.07) (P < 0.001). The mean HU ratio between before and after calcium subtraction images was different only in the fracture group (P < 0.05). There was no significant difference in the area under the curve, sensitivity, specificity, positive and negative predictive values, and accuracy (before: 0.846, 87.5%, 81.2%, 87.5%, 81.2%, 85%; after: 0.865, 91.7%, 81.2%, 88%, 86.7%, 87.5% in high energy) between the images before and after calcium subtraction. Conclusion The HU ratio between the fractured and next normal vertebra was diagnostic for spinal bone bruise on DECT images both before and after calcium subtraction.