The accuracy of dual energy CT on evaluation of bone invasion caused by oral squamous cell carcinoma – a comparison to MRI

Bone marrow edema (BME) is a key sign of bone invasion by malignancies, alongside cortical involvement. Dual-energy CT virtual non-calcium (VNCa) reconstructions can visualize BME in the head and neck, but its role in evaluating bone invasion by oral squamous cell carcinoma (OSCC) remains underexplored. This study aimed to evaluate the accuracy of Dual energy CT (DECT) and additional virtual non-calcium (VNCa) reconstructions in detecting OSCC- related bone invasion in comparison to MRI using histology as reference standard. This retrospective study included 59 consecutive participants (mean age 68 years ± 12, 33 male) with primary OSCC who underwent both contrast-enhanced DECT and MRI. DECT weighted average (DECT WA) and DECT VNCa reconstructions were assessed for bone invasion based on the presence of cortical erosion, cortical disruption and cortical erosion combined with BME. DECT WA(erosion) showed a sensitivity and specificity of 95 % and 86 % comparable to MRI (92 % and 86 % respectively). Addition of VNCa-reconstructions to DECT WA did not improve sensitivity or specificity (84 % and 86 % respectively). Overall, accuracy of DECT is excellent and comparable to MRI for detecting bone invasion caused by OSCC. However, additional diagnostic benefits of VNCa reconstructions could not be shown in this study.