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Tomografia computorizada de dupla energia: avaliação de fraturas - revisão sistemática/metanálise: fraturas da coluna toracolombar
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Contexto: As fraturas da coluna toracolombar são frequentes em contexto de trauma e podem estar associadas a morbilidade significativa. A distinção entre fraturas recentes e antigas é clinicamente relevante, sendo o edema da medula óssea um marcador típico de fratura aguda. A Ressonância Magnética (RM) é o método de referência para a sua deteção, mas a sua aplicação em contexto de urgência pode ser limitada por questões logísticas, duração do exame e contraindicações. A Tomografia Computorizada de Dupla Energia (TCDE) tem emergido como alternativa promissora, permitindo a identificação de edema ósseo e, consequentemente, a avaliação de fraturas recentes.
Objetivo: Avaliar o desempenho diagnóstico da TCDE na deteção de fraturas toracolombares através da identificação de edema da medula óssea associado a fraturas recentes, utilizando a RM como padrão de referência, e sintetizar quantitativamente a evidência disponível através de uma revisão sistemática e metanálise.
Metodologia: Realizou-se uma revisão sistemática de estudos publicados entre 2014 e 2025, de acordo com as diretrizes PRISMA, com pesquisa nas bases de dados: PubMed®, B-On, Web of Science™ e Google Scholar®. Foram incluídos estudos em português ou inglês, com texto integral, que comparassem TCDE com
RM na avaliação de fraturas toracolombares. A metanálise bivariada foi conduzida com modelo de efeitos aleatórios, estimando-se sensibilidade, especificidade, razões de verosimilhança (RV+ e RV−), diagnostic odds ratio (DOR) e curva ROC sumária (SROC).
Discussão: Foram incluídos 19 estudos. A TCDE demonstrou sensibilidade combinada de 89,2% e especificidade combinada de 94,5%, sugerindo elevado desempenho na identificação e exclusão de fraturas, respetivamente. A RV+ elevada, de 16,29, reforçou a utilidade clínica de um resultado positivo, enquanto a RV− de 0,114, indicou redução relevante da probabilidade de fratura perante um resultado negativo, embora sem exclusão absoluta. Observou-se heterogeneidade elevada, refletida pelos valores de 𝜏2 e pela região preditiva alargada na SROC, plausivelmente relacionada com diferenças entre populações, prevalência de fratura, modalidades de TCDE, parâmetros técnicos e experiência dos leitores.
Conclusão: A TCDE apresenta bom desempenho diagnóstico na avaliação de fraturas toracolombares quando comparada com a RM, constituindo uma ferramenta útil, particularmente em contextos em que a RM não é imediatamente exequível. Contudo, a variabilidade entre estudos sugere necessidade de padronização técnica e investigação adicional para clarificar os fatores que influenciam o desempenho diagnóstico.
Context: Thoracolumbar spine fractures are common in trauma settings and may be associated with significant morbidity. Distinguishing acute from chronic fractures is clinically relevant, with bone marrow edema being a typical marker of acute injury. Magnetic Resonance Imaging (MRI) is considered the reference standard for its detection; however, its use in emergency settings may be limited by logistical constraints, examination duration, and contraindications. Dual-Energy Computed Tomography (DECT) has emerged as a promising alternative, allowing the identification of bone marrow edema and, consequently, the assessment of recent fractures. Objective: To evaluate the diagnostic performance of Dual-Energy Computed Tomography (DECT) in the detection of thoracolumbar fractures through the identification of bone marrow edema associated with recent fractures, using Magnetic Resonance Imaging (MRI) as the reference standard, and to quantitatively synthesize the available evidence through a systematic review and meta-analysis. Methodology: A systematic review of studies published between 2014 and 2025 was conducted, in accordance with the PRISMA guidelines, using the following databases: PubMed®, B-On, Web of Science™ and Google Scholar®. Studies published in Portuguese or English, with full-text availability, that compared DECT with MRI in the evaluation of thoracolumbar fractures were included. A bivariate meta-analysis using a random-effects model was performed, estimating sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−), diagnostic odds ratio (DOR), and the summary receiver operating characteristic (SROC) curve. Discussion: Nineteen studies were included. DECT demonstrated a pooled sensitivity of 89.2% and a pooled specificity of 94.5%, indicating high performance in identifying and excluding fractures, respectively. The high positive likelihood ratio (16.29) supported the clinical usefulness of a positive DECT result, while the negative likelihood ratio (0.114) indicated a substantial reduction in the probability of fracture following a negative result, although without absolute exclusion. Considerable heterogeneity was observed, reflected by elevated 𝜏2 values and a wide predictive region in the SROC curve, plausibly related to differences in study populations, fracture prevalence, DECT acquisition techniques, technical parameters, and reader experience. Conclusion: DECT demonstrates good diagnostic performance in the evaluation of thoracolumbar fractures when compared with MRI and represents a valuable imaging tool, particularly in clinical contexts where MRI is not immediately available. However, the observed inter-study variability highlights the need for technical standardization and further research to clarify the factors influencing diagnostic performance.
Context: Thoracolumbar spine fractures are common in trauma settings and may be associated with significant morbidity. Distinguishing acute from chronic fractures is clinically relevant, with bone marrow edema being a typical marker of acute injury. Magnetic Resonance Imaging (MRI) is considered the reference standard for its detection; however, its use in emergency settings may be limited by logistical constraints, examination duration, and contraindications. Dual-Energy Computed Tomography (DECT) has emerged as a promising alternative, allowing the identification of bone marrow edema and, consequently, the assessment of recent fractures. Objective: To evaluate the diagnostic performance of Dual-Energy Computed Tomography (DECT) in the detection of thoracolumbar fractures through the identification of bone marrow edema associated with recent fractures, using Magnetic Resonance Imaging (MRI) as the reference standard, and to quantitatively synthesize the available evidence through a systematic review and meta-analysis. Methodology: A systematic review of studies published between 2014 and 2025 was conducted, in accordance with the PRISMA guidelines, using the following databases: PubMed®, B-On, Web of Science™ and Google Scholar®. Studies published in Portuguese or English, with full-text availability, that compared DECT with MRI in the evaluation of thoracolumbar fractures were included. A bivariate meta-analysis using a random-effects model was performed, estimating sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−), diagnostic odds ratio (DOR), and the summary receiver operating characteristic (SROC) curve. Discussion: Nineteen studies were included. DECT demonstrated a pooled sensitivity of 89.2% and a pooled specificity of 94.5%, indicating high performance in identifying and excluding fractures, respectively. The high positive likelihood ratio (16.29) supported the clinical usefulness of a positive DECT result, while the negative likelihood ratio (0.114) indicated a substantial reduction in the probability of fracture following a negative result, although without absolute exclusion. Considerable heterogeneity was observed, reflected by elevated 𝜏2 values and a wide predictive region in the SROC curve, plausibly related to differences in study populations, fracture prevalence, DECT acquisition techniques, technical parameters, and reader experience. Conclusion: DECT demonstrates good diagnostic performance in the evaluation of thoracolumbar fractures when compared with MRI and represents a valuable imaging tool, particularly in clinical contexts where MRI is not immediately available. However, the observed inter-study variability highlights the need for technical standardization and further research to clarify the factors influencing diagnostic performance.
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Tomografia Computorizada de Dupla Energia Fraturas Toracolombares Edema da Medula Óssea Precisão Diagnóstica Metanálise Dual-Energy Computed Tomography Thoracolumbar Fractures Bone Marrow Edema Diagnostic Accuracy Meta-analysis