{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:07:11Z","timestamp":1787166431177,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Lumbar disk herniation is a common cause of low back pain and radiculopathy, significantly impacting patients\u2019 life quality and functional capacity. Magnetic Resonance Imaging (MRI) remains the gold standard for its assessment due to its superior soft tissue contrast and multiplanar imaging capabilities. However, recent advances in spectral computed tomography (CT), particularly dual-energy CT (DECT), have introduced new diagnostic opportunities, offering improved soft tissue characterization. Objective: To evaluate the diagnostic performance of DECT in detecting and grading lumbar disk herniations using dedicated color-coded fat maps. Materials and Methods: A total of 205 intervertebral levels from 41 consecutive patients with lumbar symptoms were prospectively analyzed. All patients underwent both DECT and MRI within 3 days. Three radiologists with varying years of experience independently assessed DECT images using color-coded reconstructions. A five-point grading score was attributed to each lumbar level: 1 = normal disk, 2 = bulging\/protrusion, 3 = focal herniation, 4 = extruded herniation, and 5 = migrated fragment. The statistical analysis included Pearson\u2019s correlation for score consistency, Cohen\u2019s Kappa for interobserver agreement, generalized estimating equations for a cluster-robust analysis, and an ROC curve analysis. The DECT diagnostic accuracy was assessed in a dichotomized model (grades 1\u20132 = no herniation; 3\u20135 = herniation), using MRI as reference. Results: A strong correlation was observed between DECT and MRI scores across all readers (mean Pearson\u2019s r = 0.826, p &lt; 0.001). The average exact agreement between DECT and MRI was 79.4%, with the highest concordance at L1\u2013L2 (86.7%) and L5\u2013S1 (80.4%). The interobserver agreement was substantial (mean Cohen\u2019s \u03ba = 0.765), with a near-perfect agreement between the two most experienced readers (\u03ba = 0.822). The intraclass correlation coefficient was 0.906 (95% CI: 0.893\u20130.918). The ROC analysis showed excellent performance (AUC range: 0.953\u20130.986). In the dichotomous model, DECT demonstrated a markedly higher sensitivity than conventional CT (95.1% vs. 57.2%), with a comparable specificity (DECT: 99.0%; CT: 96.5%) and improved overall accuracy (98.4% vs. 90.0%). Subgroup analyses by age and disk location revealed no statistically significant differences. Conclusions: The use of DECT dedicated color-coded fat map reconstructions showed high diagnostic performance in the assessment of lumbar disk herniations compared to MRI. These findings support the development of dedicated post-processing tools, facilitating the broader clinical adoption of spectral CT, especially in cases where MRI is contraindicated or less accessible.<\/jats:p>","DOI":"10.3390\/jcm14197000","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T11:53:37Z","timestamp":1759492417000},"page":"7000","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Assessment of Intervertebral Lumbar Disk Herniation: Accuracy of Dual-Energy CT Compared to MRI"],"prefix":"10.3390","volume":"14","author":[{"given":"Giuseppe","family":"Ocello","sequence":"first","affiliation":[{"name":"Department of radiology, Messina University Hospital, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Tripodi","sequence":"additional","affiliation":[{"name":"Department of radiology, Messina University Hospital, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9846-8145","authenticated-orcid":false,"given":"Flavio","family":"Spoto","sequence":"additional","affiliation":[{"name":"Department of radiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Monterubbiano","sequence":"additional","affiliation":[{"name":"Department of radiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerardo","family":"Serra","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Analgesic Therapy, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Merci","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Analgesic Therapy, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1426-2402","authenticated-orcid":false,"given":"Giovanni","family":"Foti","sequence":"additional","affiliation":[{"name":"Department of radiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1002\/acr.23710","article-title":"Risk Factors for Low Back Pain: A Population-Based Longitudinal Study","volume":"71","author":"Shiri","year":"2019","journal-title":"Arthritis Care Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3112","DOI":"10.1002\/art.11321","article-title":"Risk factors for progression of lumbar spine disc degeneration: The Chingford Study","volume":"48","author":"Hassett","year":"2003","journal-title":"Arthritis Rheum."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"l6273","DOI":"10.1136\/bmj.l6273","article-title":"Diagnosis and treatment of sciatica","volume":"367","author":"Jensen","year":"2019","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"586","DOI":"10.7326\/0003-4819-137-7-200210010-00010","article-title":"Diagnostic evaluation of low back pain with emphasis on imaging","volume":"137","author":"Jarvik","year":"2002","journal-title":"Ann. 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