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

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.