A novel T2-weighted series-based modified vertebral bone quality score for evaluating bone mineral density

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_CSF 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_CSF 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_CSF 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_CSF cutoff at 0.607.

Compared to the traditional VBQ score, T2 VBQ_CSF is a more promising tool for distinguishing poor bone quality in patients with degenerative lumbar disease. A T2 VBQ_CSF score > 0.607 can identify patients who require additional diagnostic evaluation.