Dual-Energy Computed Tomography for the Detection of Bone Edema-Like Lesions in the Equine Foot: Standing Horses and Cadaveric Specimens

Dual-energy computed tomography (DECT) is a promising advancement for detecting bone edema-like lesions (BME). However, its application in horses remains limited. The aim of this study was to evaluate DECT virtual-non-calcium (VNCa) imaging in the equine foot and establish which confounding factors could influence its applicability in clinical practice. The DECT VNCa map of 14 standing and 5 cadaveric (recumbent) cases with foot-related lameness was scored in consensus by two readers in comparison to MRI. Overall, 17/19 cases demonstrated BME on MRI, whereas 2 did not. Agreement between DECT VNCa and MRI was found in 15/19 feet (78.9%). Disagreement in 4/19 cases with BME was due to sclerosis (1/19), mild BME extent on MRI (2/19), or scan artifacts (1/19). The extent of BME was significantly underestimated using DECT VNCa compared to MRI (<i>p</i> = 0.016). No significant correlation was found between sclerosis score and the BME extent underestimation on DECT (<i>p</i> = 0.056). Between standing and post-mortem cases, there was no significant difference in the agreement between DECT and MRI (<i>p</i> = 0.53) or DECT VNCa image quality (<i>p</i> = 0.22). In conclusion, DECT VNCa effectively identified moderate and severe BME, and its use was feasible in standing positioning. In case of sclerosis, a case-by-case assessment is recommended.