In all the analysed cases electron-density (ED) reconstructions consented to a certain diagnosis of bone edema, thus suggesting spectral CT as a reliable method for its detection. [1,2,3]

Dual-layer spectral CT-based evaluation of bone fractures with ED reconstruction could improve the accuracy in both detection and classification of vertebral bone fractures, providing a tool to distinguish acute and chronic events without the need for MRI. [4,5]

This study has underlined that most of the limiting factors of MRI application in acute settings such as long acquisition time, high costs and non-compatible devices would be easily overcome by the wider use of dual layer technology, a high potential instrument for daily clinical practice. [6,7,8]

However, studies with larger sample sizes and greater statistical robustness will be necessary to confirm these preliminary findings. [9]

Fig 1: Female, 61 years old, sprain injury. a) Axial CT image, baseline acquisition of the knee, does not show cortical alterations. b) Axial MRI acquisition (1.5 T) demonstrates edema of the fibular head in DP T2 FAT-SAT, indicating acute post-traumatic interstitial hemorrhage (white arrow). c) Axial IQon CT image, post-processed with IntelliSpace system, shows the presence of edema through an increase in electronic density visible with orange coloring (white arrow).

Fig 2: Female, 67 years old, oncologic, spontaneous pain. a) Sagittal CT image, baseline acquisition of the lumbar spine, does not show cortical alterations. b) Sagittal MRI acquisition (1.5 T) demonstrates edema of the superior endplate of L5 in DP T2 FAT-SAT, indicating acute interstitial hemorrhage (white arrow). c) Sagittal IQon CT image, post-processed with IntelliSpace system, shows the presence of edema through an increase in electronic density visible with orange coloring (white arrow).

Fig 3: 61-year-old woman, distortion trauma. a) Sagittal baseline CT image of the knee shows no cortical alterations. b) Sagittal MRI acquisition (1.5 T) shows edema of the fibular head in DP T2 FAT-SAT, indicating acute post-traumatic interstitial hemorrhage (WHITE ARROW). c) Sagittal CT scan image, post-processed with IntelliSpace system, shows the presence of edema by an increase in electronic density visible with orange coloring (white arrow).

Fig 4: a) Sagittal image of the thoracic spine acquired with IQon CT, "conventional CT" 70 kV visualization, showing only the osteodense aspect of the vertebral body of D8 (black arrow). b) Sagittal acquisition with 1.5 T MRI, STIR sequence, clearly showing the hyperintensity of the D8 vertebral body (indicative of interstitial edema and an acute process) (white arrow). c) Acquisition with Philips IQon, Dual Layer, post-processed with IntelliSpace software, showing with "Electron Density" map an increased electronic density at the level of the D8 vertebral body (orange color, black arrow), indicative of spongy edema.