Yan Shi, Liu Yinhao, Yuan Lei, Du Guohong, Li Weishi, Zeng Yan
Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
Eur Spine J. 2025 Feb;34(2):506-512. doi: 10.1007/s00586-024-08522-0. Epub 2024 Dec 7.
To evaluate the modified vertebral bone quality (VBQ) method on the magnetic resonance imaging (MRI) T1-weighted (T1w), T2-weighted (T2w), and fat suppression (FS) series in evaluating bone mineral density (BMD) for patients with degenerative lumbar disease.
We reviewed preoperative data of postmenopausal female patients aged ≥ 50 years hospitalized to undergo lumbar surgery for degenerative lumbar disease with available MRI and dual-energy X-ray absorptiometry (DEXA). Patients were categorized into three groups according to T-score. The VBQ score was calculated as the L1-L4 median signal intensity (SI) divided by the L3 CSF SI. One-way analysis of variance was applied to assess the discrepancy between groups. The diagnostic performance of VBQ scores for distinguishing low BMD was analyzed using receiver operating characteristic (ROC) analysis.
The study included 253 patients. T2 VBQ was significantly different between groups (p < 0.001). The interclass correlation coefficient for inter and intra-rater reliability was 0.767 (95%CI 0.650-0.849) and 0.893 (95%CI 0.834-0.932), respectively. The T2 VBQ showed moderate correlations with DEXA BMD (r = - 0.442, p < 0.001). The area under the ROC curve indicated a predictive accuracy of 76%. A sensitivity of 59.0% with a specificity of 87.5% was achieved for distinguishing low BMD by setting the T2 VBQ cutoff at 0.607.
Compared to the traditional VBQ score, T2 VBQ is a more promising tool for distinguishing poor bone quality in patients with degenerative lumbar disease. A T2 VBQ score > 0.607 can identify patients who require additional diagnostic evaluation.
评估改良的椎体骨质量（VBQ）方法在磁共振成像（MRI）的T1加权（T1w）、T2加权（T2w）和脂肪抑制（FS）序列上对退变性腰椎疾病患者骨密度（BMD）的评估价值。
我们回顾了年龄≥50岁、因退变性腰椎疾病住院接受腰椎手术且有可用MRI和双能X线吸收法（DEXA）检查的绝经后女性患者的术前数据。根据T值将患者分为三组。VBQ评分计算为L1-L4的中位信号强度（SI）除以L3脑脊液SI。采用单因素方差分析评估组间差异。使用受试者操作特征（ROC）分析来分析VBQ评分区分低骨密度的诊断性能。
该研究纳入了253例患者。组间T2 VBQ存在显著差异（p<0.001）。评分者间和评分者内信度的组内相关系数分别为0.767（95%CI 0.650-0.849）和0.893（95%CI 0.834-0.932）。T2 VBQ与DEXA骨密度呈中度相关（r=-0.442，p<0.001）。ROC曲线下面积表明预测准确率为76%。通过将T2 VBQ临界值设定为0.607，区分低骨密度的敏感性为59.0%，特异性为87.5%。
与传统的VBQ评分相比，T2 VBQ是一种更有前景的工具，可用于区分退变性腰椎疾病患者的骨质不良。T2 VBQ评分>0.607可识别需要进一步诊断评估的患者。
