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However, this imaging task is inherently challenging because of the narrow energy separation between water (edematous fluid) and fat (health yellow marrow), requiring precise artifact correction and dedicated material decomposition approaches.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>We investigate the feasibility of BME assessment using kV\u2010switching DE CBCT with a comprehensive CBCT artifact correction framework and a two\u2010stage projection\u2010 and image\u2010domain three\u2010material decomposition algorithm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>DE CBCT projections of quantitative BME phantoms (water containers 100\u2013165\u00a0mm in size with inserts presenting various degrees of edema) and an animal cadaver model of BME were acquired on a CBCT test bench emulating the standard wrist imaging configuration of a Multitom Rax twin robotic x\u2010ray system. The slow kV\u2010switching scan protocol involved a 60\u00a0kV low energy (LE) beam and a 120\u00a0kV high energy (HE) beam switched every 0.5\u00b0 over a 200\u00b0 angular span. The DE CBCT data preprocessing and artifact correction framework consisted of (i) projection interpolation onto matched LE and HE projections views, (ii) lag and glare deconvolutions, and (iii) efficient Monte Carlo (MC)\u2010based scatter correction. Virtual non\u2010calcium (VNCa) images for BME detection were then generated by projection\u2010domain decomposition into an Aluminium (Al) and polyethylene basis set (to remove beam hardening) followed by three\u2010material image\u2010domain decomposition into water, Ca, and fat. Feasibility of BME detection was quantified in terms of VNCa image contrast and receiver operating characteristic (ROC) curves. Robustness to object size, position in the field of view (FOV) and beam collimation (varied 20\u2013160\u00a0mm) was investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The MC\u2010based scatter correction delivered\u00a0&gt;\u00a069% reduction of cupping artifacts for moderate to wide collimations (&gt;\u00a080\u00a0mm beam width), which was essential to achieve accurate DE material decomposition. In a forearm\u2010sized object, a 20% increase in water concentration (edema) of a trabecular bone\u2010mimicking mixture presented as \u223c15 HU VNCa contrast using 80\u2013160\u00a0mm beam collimations. The variability with respect to object position in the FOV was modest (&lt;\u00a015% coefficient of variation). The areas under the ROC curve were\u00a0&gt;\u00a00.9. A femur\u2010sized object presented a somewhat more challenging task, resulting in increased sensitivity to object positioning at 160\u00a0mm collimation. In animal cadaver specimens, areas of VNCa enhancement consistent with BME were observed in DE CBCT images in regions of MRI\u2010confirmed edema.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our results indicate that the proposed artifact correction and material decomposition pipeline can overcome the challenges of scatter and limited spectral separation to achieve relatively accurate and sensitive BME detection in DE CBCT. This study provides an important baseline for clinical translation of musculoskeletal DE CBCT to quantitative, point\u2010of\u2010care bone health assessment.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.16962","type":"journal-article","created":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T14:25:24Z","timestamp":1707315924000},"page":"1653-1673","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Feasibility of bone marrow edema detection using dual\u2010energy cone\u2010beam computed tomography"],"prefix":"10.1002","volume":"51","author":[{"given":"Stephen Z.","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magdalena","family":"Herbst","sequence":"additional","affiliation":[{"name":"Siemens Healthineers  Forchheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamin","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Siemens Healthineers  Forchheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Weber","sequence":"additional","affiliation":[{"name":"Siemens Healthineers  Forchheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Vogt","sequence":"additional","affiliation":[{"name":"Siemens Healthineers  Forchheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ludwig","family":"Ritschl","sequence":"additional","affiliation":[{"name":"Siemens Healthineers  Forchheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steffen","family":"Kappler","sequence":"additional","affiliation":[{"name":"Siemens Healthineers  Forchheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher E.","family":"Kawcak","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences  Fort Collins Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holly L.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences  Fort Collins Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey H.","family":"Siewerdsen","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins University  Baltimore Maryland USA"},{"name":"Department of Imaging Physics MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wojciech","family":"Zbijewski","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,2,7]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","unstructured":"McQueenFM Bone marrow edema and osteitis in rheumatoid arthritis: the imaging perspective.Arth Res Ther vol. 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