# Diagnostic performance of dual-energy CT for opportunistic detection of rotator cuff disease: a retrospective multireader study

## TL;DR

Dual-energy CT with multi-material decomposition improves detection of rotator cuff diseases compared to standard CT and matches MRI accuracy, offering a viable alternative for MRI-ineligible patients.

## Contribution

DECT-based MMD shows superior diagnostic performance for rotator cuff disease detection compared to standard CT and comparable accuracy to MRI.

## Key findings

- MMD demonstrated higher average AUC for diagnosing rotator cuff tears (88%) compared to standard CT (65%).
- MMD's diagnostic performance for supraspinatus tendon disease was comparable to MRI (91% vs. 90%).
- Experienced radiologists using MMD achieved MRI-level diagnostic performance for rotator cuff diseases.

## Abstract

Multi-material decomposition (MMD), a key application of dual-energy computed tomography (DECT), has shown potential in musculoskeletal research. This study aimed to compare the diagnostic performance of DECT-based MMD with standard CT and MRI in detecting rotator cuff disease.

This retrospective study evaluated patients diagnosed with rotator cuff disease who underwent third-generation dual-source DECT and 3.0-T MRI within a 2-week interval between December 2023 and November 2024. Shoulder arthroscopy served as the reference standard. Six readers independently assessed rotator cuff tears and determined the degree of supraspinatus tendon diseases using standard CT, DECT-based MMD and MRI. Area under the curve (AUC), sensitivity, specificity, positive/negative predictive values and accuracy were calculated for the diagnosis of rotator cuff disease. Friedman test was used to analyze the radiologists’ diagnostic confidence across the three image types.

In total of 103 patients (mean age: 50.0 ± 15.6 years) underwent shoulder arthroscopy. MMD demonstrated a higher average AUC for diagnosing rotator cuff tears (88% vs. 65%, p < 0.001) and supraspinatus tendon disease (86% vs. 63%, p < 0.001) compared to standard CT. Its diagnostic performance for supraspinatus tendon disease (91% vs. 90%, p = 0.35) and full-thickness tears (95% vs. 93%, p = 0.11) was comparable to that of MRI.

DECT-based MMD demonstrated superior diagnostic performance and reliability for detecting rotator cuff diseases compared to standard CT, with accuracy comparable to that of MRI in detecting supraspinatus tendon tears. DECT-based MMD offers a promising approach for the opportunistic detection of rotator cuff diseases.

Dual energy CT-based multi-material decomposition demonstrated accuracy comparable to that of MRI in detecting supraspinatus tendon tears, and may provide an alternative for patients with contraindications to MRI, facilitating early detection of injuries and accurate diagnosis of rotator cuff diseases.

Dual energy (DE) CT multi-material decomposition (MMD) improves diagnostic performance for rotator cuff tears and supraspinatus tendon injuries.Radiologists with varying experience levels benefited from MMD, with experienced readers achieving MRI-level diagnostic performance.DECT MMD offers a promising alternative for patients with contraindications for MRI.

Dual energy (DE) CT multi-material decomposition (MMD) improves diagnostic performance for rotator cuff tears and supraspinatus tendon injuries.

Radiologists with varying experience levels benefited from MMD, with experienced readers achieving MRI-level diagnostic performance.

DECT MMD offers a promising alternative for patients with contraindications for MRI.