Department of Spine Surgery, Hospital for Special Surgery, New York, NY.
Spine (Phila Pa 1976). 2023 Jan 15;48(2):107-112. doi: 10.1097/BRS.0000000000004509. Epub 2022 Oct 17.
Retrospective comparison.
The aim was to determine whether a previously developed magnetic resonance imaging (MRI)-derived bone mineral density (BMD) scoring system can differentiate between healthy and osteoporotic vertebrae and to validate this scoring system against quantitative computed tomography measurements.
BMD is an important preoperative consideration in spine surgery. Techniques to measure BMD are subject to falsely elevated values in the setting of spondylosis (dual-energy X-ray absorptiometry) or require significant exposure to radiation [quantitative computed tomography (QCT)]. Previous studies have shown that MRI may be utilized to measure bone quality using changes in the bone marrow signal observed on T1-weighted MRIs.
Retrospective study of patients who underwent operative lumbar procedures at a single tertiary institution between 2016 and 2021 (n=61). Vertebral bone quality (VBQ) scores were measured by dividing the median signal intensities of L1-L4 by the signal intensity of cerebrospinal fluid on noncontrast T1W MRI. Demographic data, comorbidities, VBQ scores, and QCT-derived T scores and BMD of the lumbar spine were compared between healthy ( T score ≥-1; n=21), osteopenic (-2.5 < T score < -1; n=21), and osteoporotic ( T score ≤-2.5; n=19) cohorts using analysis of variance with post hoc Tukey test. Linear regression and receiver operating characteristic curve analyses were performed to assess the predictive value of VBQ scores. Pearson correlation test was used to evaluate the association between VBQ scores and QCT-derived measurements.
VBQ differentiated between healthy and osteoporotic groups ( P =0.009). Receiver operating characteristic curve analysis revealed that a greater VBQ score was associated with presence of osteoporosis (area under the curve=0.754, P =0.006). Cutoff VBQ for osteoporosis was 2.6 (Youden index 0.484; sensitivity: 58%; specificity: 90%). VBQ scores weakly correlated with QCT-derived BMD ( P =0.03, r =-0.27) and T scores ( P =0.04, r =-0.26).
This study attempted to further validate a previously developed MRI-based BMD scoring system against QCT-derived measurements. VBQ score was found to be a significant predictor of osteoporosis and could differentiate between healthy and osteoporotic vertebrae.
回顾性比较。
旨在确定先前开发的基于磁共振成像（MRI）的骨密度（BMD）评分系统是否能够区分健康和骨质疏松椎体，并针对定量计算机断层扫描（QCT）测量结果对该评分系统进行验证。
BMD 是脊柱手术的重要术前考虑因素。测量 BMD 的技术在存在脊椎病的情况下会导致假性升高值（双能 X 射线吸收法），或者需要大量辐射暴露[定量计算机断层扫描（QCT）]。先前的研究表明，MRI 可以通过观察 T1 加权 MRI 上骨髓信号的变化来测量骨质量。
对 2016 年至 2021 年间在一家三级医疗机构接受腰椎手术的患者进行回顾性研究（n=61）。通过将 L1-L4 的中位数信号强度除以非对比 T1W MRI 上脑脊液的信号强度来测量椎体骨质量（VBQ）评分。使用方差分析和事后 Tukey 检验比较健康（T 评分≥-1；n=21）、骨量减少（-2.5<T 评分<-1；n=21）和骨质疏松（T 评分≤-2.5；n=19）组之间的人口统计学数据、合并症、VBQ 评分以及腰椎 QCT 衍生的 T 评分和 BMD。进行线性回归和接收者操作特征曲线分析以评估 VBQ 评分的预测价值。使用 Pearson 相关测试评估 VBQ 评分与 QCT 衍生测量值之间的相关性。
VBQ 可区分健康组和骨质疏松组（P=0.009）。接收者操作特征曲线分析显示，VBQ 评分越高，骨质疏松的可能性越大（曲线下面积=0.754，P=0.006）。骨质疏松的 VBQ 截断值为 2.6（约登指数 0.484；敏感性：58%；特异性：90%）。VBQ 评分与 QCT 衍生的 BMD（P=0.03，r=-0.27）和 T 评分（P=0.04，r=-0.26）呈弱相关。
本研究试图进一步验证先前开发的基于 MRI 的 BMD 评分系统与 QCT 衍生测量结果的一致性。VBQ 评分是骨质疏松的重要预测因子，可区分健康和骨质疏松椎体。
