Zero Echo Time MRI and Dual-Energy CT Virtual Non-Calcium Imaging in Skeletal Oncology: A Critical Evidence-Based Review.

Authors

Luca Marinelli, Maria Chiara Brunese, Fiammetta Cappabianca, Nicola Maria Tarantino, Anna Russo, Alfonso Reginelli, Salvatore Cappabianca

Published in

The British journal of radiology. Jul 29, 2026. Epub Jul 29, 2026.

Abstract

To provide a structured and critical overview of the technical foundations, diagnostic performance, and clinical applicability of Zero Echo Time/Black-Bone MRI (ZTE/BB) and Dual-Energy CT Virtual Non-Calcium imaging (DECT-VNCa) in skeletal oncology, with the aim of clarifying their respective roles and potential complementarity within contemporary imaging workflows.
A structured narrative review of peer-reviewed literature published between 2010 and 2025 was conducted, focusing on technical principles, methodological quality, lesion-level diagnostic performance, and clinical applications of ZTE/BB MRI and DECT-VNCa in oncologic bone disease. Evidence was synthesised according to anatomical region and diagnostic task, including staging, assessment of cortical integrity, marrow infiltration, and treatment response. ZTE/BB MRI demonstrates high-fidelity depiction of cortical bone, utility in PET/MR attenuation correction, and growing relevance in radiotherapy planning and skeletal tumour assessment. DECT-VNCa enables sensitive and reproducible evaluation of bone marrow involvement, improving detection of CT-occult disease and providing quantitative biomarkers correlated with cellularity and therapy-related changes. Direct head-to-head comparisons remain limited, and variability in acquisition protocols and quantitative thresholds persists across platforms.
ZTE/BB MRI and DECT-VNCa should be considered complementary rather than competing techniques in skeletal oncology imaging. ZTE/BB MRI is particularly suited for radiation-free assessment of cortical integrity and structurally relevant disease, whereas DECT-VNCa offers rapid, quantitative characterisation of marrow involvement. An integrated, task-oriented use of these modalities may improve diagnostic coherence across different anatomical sites and phases of the oncologic pathway. Further prospective and standardised studies are required to harmonise protocols and define their optimal clinical integration.

PMID:
42525387
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.

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