基于 MRI 的椎体骨质量评分用于评估腰椎退行性疾病手术患者的骨质疏松症。

MRI-based vertebral bone quality score for the assessment of osteoporosis in patients undergoing surgery for lumbar degenerative diseases.

机构信息

Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.

出版信息

J Orthop Surg Res. 2023 Mar 29;18(1):257. doi: 10.1186/s13018-023-03746-0.

PURPOSE

To explore the value of vertebral bone quality (VBQ) scores in diagnosing osteoporosis in patients with lumbar degeneration.

METHODS

A retrospective analysis was conducted of 235 patients treated with lumbar fusion surgery at the age of ≥ 50; they were divided into a degenerative group and a control group according to the severity of degenerative changes on three-dimensional computed tomography. The L1-4 vertebral body and L3 cerebrospinal fluid signal intensities in the T1-weighted lumbar magnetic resonance imaging (MRI) image were recorded, and the VBQ score was calculated. Demographics, clinical data, and dual-energy X-ray absorptiometry (DXA) indicators were recorded, and the VBQ value was compared with bone density and T-score using the Pearson correlation coefficient. The VBQ threshold was obtained according to the control group and compared with the efficacy of osteoporosis diagnosis based on DXA.

RESULTS

A total of 235 patients were included in the study, and the age of the degenerative group was older than that of the control group (61.8 vs. 59.4, P = 0.026). The VBQ score of the control group suggested a higher correlation with the bone mineral density (BMD) value and T-score (r = - 0.611 and - 0.62, respectively). The BMD value and T-score in the degenerative group were higher than those in the control group (P < 0.05). Receiver-operating characteristic curve analysis showed that the VBQ score had a good predictive ability for osteoporosis (AUC = 0.818), with a sensitivity of 93% and a specificity of 65.4%. Among the undiagnosed osteoporosis patients with T-score, the VBQ score after adjusting the threshold was higher in the degenerative group (46.9% vs. 30.8%).

CONCLUSIONS

Emerging VBQ scores can reduce the interference caused by degenerative changes compared to traditional DXA measures. Screening for osteoporosis in patients undergoing lumbar spine surgery provides new ideas.

目的

探讨椎体骨质量（VBQ）评分在诊断腰椎退变患者骨质疏松症中的价值。

方法

对 235 例年龄≥50 岁行腰椎融合术的患者进行回顾性分析；根据三维 CT 退变程度将其分为退变组和对照组。记录腰椎 MRI 矢状位 T1 加权像 L1-4 椎体及 L3 脑脊液信号强度，计算 VBQ 评分。记录患者一般资料、临床资料及双能 X 线吸收法（DXA）指标，采用 Pearson 相关系数比较 VBQ 值与骨密度、T 评分的相关性。根据对照组获得 VBQ 截断值，并与 DXA 诊断骨质疏松的效能进行比较。

结果

共纳入 235 例患者，退变组年龄大于对照组（61.8 岁比 59.4 岁，P=0.026）。对照组 VBQ 评分与骨密度值及 T 评分相关性更高（r 值分别为-0.611、-0.62）。退变组骨密度值及 T 评分均高于对照组（P<0.05）。受试者工作特征曲线分析显示，VBQ 评分对骨质疏松症具有良好的预测能力（AUC=0.818），敏感度为 93%，特异度为 65.4%。在 T 评分未诊断为骨质疏松症的患者中，调整阈值后退变组的 VBQ 评分更高（46.9%比 30.8%）。