ArticleEuropean radiology2012
Quantitative assessment of bone marrow attenuation values at MDCT: an objective tool for the detection of bone bruise related to occult sacral insufficiency fractures.
Article in European radiology, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 25 citations in OpenAlex.
- CT Hounsfield Unit Measurements Around the Hip and Their Utility for Opportunistic Screening: A Systematic Review.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2026Pooled it
- Imaging of pelvic ring fractures in older adults and its clinical implications-a systematic review.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023Pooled it
- Opportunistic bone density measurement on fragility fracture of the pelvis II and III: Hounsfield units might help to reveal dormant fractures in native computed tomography scan.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Diagnostic Value of Opportunistic CT-Based Bone Density Assessment in Patients with and Without Sacral Insufficiency Fractures.Diagnostics (Basel, Switzerland) · 2025Article
- Dual-energy CT: Impact of detecting bone marrow oedema in occult trauma in the Emergency.BJR open · 2024Review
- A comparison of smooth and sharp kernel CT reconstructions in the detection of unilateral sacral fractures.Skeletal radiology · 2023Article
- Efficacy and confounding factors of CT attenuation value differences in distinguishing acute and old vertebral compression fractures: a retrospective study.BMC musculoskeletal disorders · 2023Article
- Dual-energy CT in sacral fragility fractures: defining a cut-off Hounsfield unit value for the presence of traumatic bone marrow edema in patients with osteoporosis.BMC musculoskeletal disorders · 2022Article
- Agreement on grading of normal clivus using magnetic resonance imaging among radiologists.European journal of radiology open · 2022Article
- Clinical utility of virtual noncalcium dual-energy CT in imaging of the pelvis and hip.Skeletal radiology · 2019Review
- Clinical applications of a computed tomography color "marrow mapping" algorithm to increase conspicuity of nondisplaced trabecular fractures.Emergency radiology · 2019Article
- Fragility fractures of the sacrum: how to identify and when to treat surgically?European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2015Review
- Comparison of characteristic CT findings of lymphedema, cellulitis, and generalized edema in lower leg swelling.The international journal of cardiovascular imaging · 2013Article
- CT of Sacral Fractures: Classification Systems and Management.Radiographics : a review publication of the Radiological Society of North America, IncArticle
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo prove the feasibility of using Hounsfield attenuation values at MDCT to detect bone bruises related to sacral insufficiency fractures.
methodsTwenty-two patients with acute sacrum trauma and no fracture findings at MDCT were included in our prospective study. Two observers independently reviewed CTs regarding visual signs of bone bruises in 132 defined regions of the sacral alae. Interobserver agreement was tested by κ statistics. Subsequently, HU values were obtained in the same regions, and attenuation differences between the two sides were calculated. Validity and reliability were assessed by intraclass correlation coefficient and Bland-Altman analysis. HU differences were subjected to ROC curve analysis to determine sensitivity, specificity, PPV and NPV. MRI served as standard reference.
resultsMRI revealed 19 regions with bone bruises and associated sacral insufficiency fractures. HU measurements demonstrated good validity and reliability (r = 0.989). ROC curve analysis exhibited an ideal cutoff value of 35.7 HU density difference between affected and non-affected regions. Visual evaluation revealed moderate agreement (κ = 0.48); diagnostic accuracy was inferior to objective evaluation.
conclusionsAssessment of differences in bone marrow density by HU measurements is an objective and reliable tool for detection of bone bruises associated with occult sacral insufficiency fractures. KEY POINTS : • Bone bruising is associated with occult sacral insufficiency fractures. • Assessment of differences in bone marrow CT attenuation appears valid and reliable. • Comparative HU measurements of bone marrow allow detection of bone bruises. • Comparative HU measurements have high specificity and negative predictive values. • Comparative HU measurements may make further diagnostic workup with MRI unnecessary.
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