Abstract: Objective To investigate the accuracy of virtual non-calcium technique based on dual energy CT for the diagnosis of fresh osteoporotic vertebral compression fractures(OVCF) in the elderly, and to evaluate the possibility of an alternative examination for magnetic resonance imaging (MRI). Methods The imaging data from the patients who met the inclusion criteria were retrospectively collected from January 2022 to March 2024. A total of 133 elderly patients with a mean age of 75.3±7.2 years were enrolled in this study,with 48 males and 85 females. All patients underwent virtual non-calcium technique based on dual energy CT examination and MRI. The diagnosis was performed by senior imaging physicians. Spearman correlation analysis was used to evaluate the consistency of diagnosis among MRI, dual energy CT and virtual non-calcium technique based on dual energy CT, and then chi-square test was adopted to evaluate the differences in diagnostic accuracy.Finally,the reasons for misdiagnosis of dual energy CT and virtual non-calcium technique based on dual energy CT was analyzed. Results The sensitivity, specificity and accuracry of dual energy CT in diagnosing fresh OVCF were 89.0%, 62.7% and 77.4%, compared with 97.3%, 74.7% and 89.5% of virtual non-calcium technique. The virtual non-calcium technique group had significantly less misdiagnosis cases due to old vertebral fractures and osteophytes than dual energy CT group(P<0.05). Conclusions Virtual non-calcium technique based on dual energy CT is a novel imaging technique that can replace MRI in diagnosing fresh osteoporotic vertebral compression thoracolumbar fractures, especially for the patients with MRI-related contraindications. However, this examination should be carefully prescribed for the patients with bone cement injection and metal fixation history.

Key words: dual energy CT, virtual non-calcium technique, fresh osteoporotic vertebral compression fractures, diagnostic accuracy