Texas Back Institute, Plano, TX, USA.
Texas Back Institute Research Foundation, 6020 W Parker Rd #200, Plano, TX, 75093, USA.
Eur Spine J. 2023 Sep;32(9):3176-3182. doi: 10.1007/s00586-023-07855-6. Epub 2023 Jul 13.
The purpose of this study was to investigate the impact of various methods on the assessment of vertebral bone quality.
A consecutive series of 427 candidates for lumbar disc replacement with lumbar DEXA and MRI and/or CT scans were included. Two measurement techniques were used on CTs-a sagittal and axial. From axial images, the upper, mid, and lower portions of each vertebral body were measured. Four MRI vertebral bone quality (VBQ) calculations were generated using separate equations.
All CT measures were highly correlated with each other, regardless of measurement or calculation method (range 0.925-0.995). Sagittal measurements were highly correlated with axial (r = 0.928, p < 0.001). CT values were correlated with DEXA (range 0.446-0.534). There was no benefit to measuring multiple axial images of each vertebral body vs. just midbody (r = 0.441 and 0.455, respectively). No MRI VBQ values were highly correlated with DEXA (r = - 0.103, p = 0.045). In receiver operating curve analysis, the area under the curve ranged from 0.539 to 0.558, indicating poor ability of VBQ to identify osteoporosis/osteopenia.
CT produced values more closely related to DEXA, while MRI was less reliable for osteoporosis/osteopenia screening. On CT, there was no benefit to making multiple measurements for each vertebral body to calculate a composite. Measuring sagittal CT images produced values similar to axial and required less time. While assessing bone quality from existing images rather than getting an additional DEXA scan is appealing, the methods of measuring these images needs standardization to maximize their utility.
本研究旨在探讨各种方法对评估椎体骨质量的影响。
本研究纳入了 427 例接受腰椎间盘置换术的患者，对其进行腰椎 DEXA 和 MRI 及/或 CT 扫描。在 CT 上使用了两种测量技术——矢状位和轴位。从轴位图像上，对每个椎体的上、中、下部分进行了测量。使用 4 个不同的 MRI 椎体骨质量（VBQ）计算公式生成了 4 个 VBQ 测量值。
无论测量方法或计算方法如何，所有 CT 测量值之间均高度相关（范围为 0.925-0.995）。矢状位测量值与轴位高度相关（r=0.928，p<0.001）。CT 值与 DEXA 相关（范围为 0.446-0.534）。与仅测量中体相比，测量每个椎体的多个轴位图像并无益处（r 分别为 0.441 和 0.455）。没有任何一个 MRI VBQ 值与 DEXA 高度相关（r=-0.103，p=0.045）。在接受者操作特征曲线分析中，曲线下面积范围为 0.539 至 0.558，表明 VBQ 对识别骨质疏松/低骨量的能力较差。
CT 产生的数值与 DEXA 更相关，而 MRI 对骨质疏松/低骨量筛查的可靠性较低。在 CT 上，为计算综合值而对每个椎体进行多次测量并无益处。测量矢状 CT 图像产生的值与轴位相似，但所需时间更少。虽然从现有图像评估骨质量而不是进行额外的 DEXA 扫描具有吸引力，但需要对这些图像的测量方法进行标准化，以最大程度地发挥其效用。
