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• Clinical Article •
Analysis of the diagnostic efficacy of multi-sequence optimized VBQs and QCT for osteoporosis
BAI Wenqi  QIAN Weijun  JIANG Xinxin  LI Yaqing  LI Li  SHANG Feixiang 

DOI:10.12015/issn.1674-8034.2025.08.016.


[Abstract] Objective To explore the correlation between the vertebral bone quality score based on MRI (VBQ) derived from multi-sequence optimization of non-contrast-enhanced MRI scans of thoracolumbar vertebrae (including T11-L2, L1-2 and individual vertebrae) and the volume bone density (vBMD) measured by quantitative computed tomography (QCT), as well as the diagnostic value for osteoporosis (OP). It also aims to clarify the optimal "single vertebra window" and sequences for screening and diagnosis grouping.Materials and Methods Select healthy individuals aged over 18 years old who underwent both 1.5 T MRI plain scan and CT plain scan of thoracolumbar spine segments simultaneously (with a scan time interval less than 3 days) in the Department of Medical Imaging of Kaifeng Central Hospital (69 cases). Measure the average signal intensity (signal intensity, SI) of the vertebral bodies of thoracolumbar spine segments and the cerebrospinal fluid (CSF) region of interest (ROI) at the posterior side of L3 respectively. Further calculate the multi-sequence and optimized VBQs (including T11, T12, L1, L2, T11-L2 and L1-L2), where the VBQ of T11-L2 and L1-L2 vertebral bodies are averaged (multi-sequence and optimized VBQ, including VBQT1, VBQT2, VBQT2-STIR, VBQFLAIR, VBQT2-STIR optimization, VBQFLAIRoptimization, VBQcommon optimization). Measured the vBMD of T11, T12, L1 and L2, and further calculated the vBMD of T11-L2 and L1-L2 vertebral bodies by averaging. Divide them into two groups twice: (1) screening group, divided into normal bone mass group and non-normal bone mass group (OP + bone mass reduction) with vBMD = 120 mg/cm3 as the boundary value. (2) diagnosis group, divided into OP group and non OP group (normal bone mass + bone mass reduction) with vBMD = 80 mg/cm3 as the boundary value. Explore the correlation between multi-sequence and optimized VBQs of thoracolumbar spine segments and QCT-vBMD. Exploring the diagnostic value of multi-sequence and optimized VBQ for OP using receiver operating characteristic (ROC) curves.Results (1) Correlation analysis revealed that among the individual vertebral body VBQ, the correlation between VBQ(L2) T2-STIR optimization and vBMD was the strongest (r = -0.531, P < 0.001). In the average VBQ of L1-L2 vertebral bodies, the correlation between VBQ(L1-2) T2-STIR optimization was the strongest (r = -0.561, P < 0.001). In the average VBQ of T11-L2 vertebral bodies, the correlation between VBQ(overall) T2-STIR optimization and vBMD was the strongest (r = -0.562, P < 0.001), all of which were fat suppression optimization sequences. It is notable that in the VBQ of the L1 vertebral body, VBQ(L1) FLAIRoptimization had the strongest correlation with vBMD (r = -0.463, P < 0.001), which was a FLAIR optimization sequence. (2) From T11 to L2, the average vBMD values of individual vertebral bodies decreased successively, and the VBQ values optimized by T2-STIR sequence increased successively. (3) ROC curve analysis showed that in a single vertebral body, the diagnostic VBQ(L2) T2-STIR optimization with the highest area under the curve (AUC) was 0.928, the optimal Cut-off value was 8.765, the sensitivity was 88.9%, and the specificity was 80.8%. (4) Screening group: in the VBQ at the T11-L2 level, the VBQ(overall) T2-STIR optimization with the highest AUC (0.791), the optimal Cut-off value was 7.829; in the VBQs of L1-L2, the VBQ(L1-2) T2-STIR optimization with the highest AUC was the highest (0.756), the maximum Youden index was 0.492, the sensitivity was 63.2%, the specificity was 86.0%, and the optimal Cut-off value was 8.406. (5) Diagnostic group: in the VBQ at the T11-L2 level, the VBQ(overall) T2-STIR optimization with the highest AUC (0.791), the optimal Cut-off value was 7.829; in the VBQ of L1-L2, the VBQ(L1-2) T2-STIR optimization with the highest AUC was the highest (0.912), the maximum Youden index was 0.680, the sensitivity was 86.0%, the specificity was 82.0%, and the optimal Cut-off value was 8.406.Conclusions (1) The VBQ of multiple sequences are negatively correlated with vBMD. (2) From T11 to L2, the bone density of individual vertebrae gradually decreases while the fat content gradually increases. A single vertebra can predict the occurrence of OP. In the population undergoing physical examination, the predictive value of a single vertebra VBQ is higher than that of the average values of T11-L2 or L1-L2. The VBQ of a single vertebra can accurately evaluate the bone quality of the vertebra without radiation, with the aim of providing a prompt for clinical practice. (3) Regardless of whether the screening criteria or diagnostic criteria are used for grouping, and regardless of whether it is T11-L2 or L1-L2, the diagnostic efficacy of the optimized VBQ with fat reduction is the highest.
[Keywords] vertebral bone quality score；magnetic resonance imaging；quantitative computed tomography；bone mineral density；osteoporosis；no-radiation screening

BAI Wenqi   QIAN Weijun*   JIANG Xinxin   LI Yaqing   LI Li   SHANG Feixiang  

Department of Medical Imaging, Kaifeng Central Hospital, Kaifeng 475000, China

Corresponding author: QIAN W J, E-mail: qwj1120714@126.com

Conflicts of interest   None.

Received  2025-03-05
Accepted  2025-08-07
DOI: 10.12015/issn.1674-8034.2025.08.016
DOI:10.12015/issn.1674-8034.2025.08.016.

[1]
DAVIDSON S, VECELLIO A, FLAGSTAD I, et al. Discrepancy between DXA and CT-based assessment of spine bone mineral density[J]. Spine Deform, 2023, 11(3): 677-683. DOI: 10.1007/s43390-023-00646-5.
[2]
Chinese Medical Association Osteoporosis and Bone Mineral Diseases Branch. Epidemiological investigation of osteoporosis in China and the release of the results of the special action of “healthy bones”[J]. Chin J Osteoporos Bone Miner Res, 2019, 12(4): 317-318.
[3]
Bone and Joint Group of Chinese Society of Radiology of Chinese Medical Association, Musculoskeletal Group of Radiology Society of Chinese Medical Doctors Association, Osteoporosis Group of Chinese Society of Orthopedic of Chinese Medical Association, et al. Consensus on the diagnosis of osteoporosis by imaging and bone mineral density measurement[J]. Chin J Bone and Joint, 2020, 9(9): 666-673.
[4]
COSMAN F, LANGDAHL B, LEDER B Z. Treatment sequence for osteoporosis[J]. Endocr Pract, 2024, 30(5): 490-496. DOI: 10.1016/j.eprac.2024.01.014.
[5]
BOS D, GUBERINA N, ZENSEN S, et al. Radiation exposure in computed tomography[J]. Dtsch Arztebl Int, 2023, 120(9): 135-141. DOI: 10.3238/arztebl.m2022.0395.
[6]
DAMILAKIS J, MARIS T G, KARANTANAS A H. An update on the assessment of osteoporosis using radiologic techniques[J]. Eur Radiol, 2007, 17(6): 1591-1602. DOI: 10.1007/s00330-006-0511-z.
[7]
SIMONELLI C, ADLER R A, BLAKE G M, et al. Dual-energy X-ray absorptiometry technical issues: the 2007 ISCD official positions[J]. J Clin Densitom, 2008, 11(1): 109-122. DOI: 10.1016/j.jocd.2007.12.009.
[8]
YIN H J, LIN W T, XIE F Q, et al. MRI-based vertebral bone quality score for osteoporosis screening based on different osteoporotic diagnostic criteria using DXA and QCT[J]. Calcif Tissue Int, 2023, 113(4): 383-392. DOI: 10.1007/s00223-023-01115-x.
[9]
EHRESMAN J, PENNINGTON Z, SCHILLING A, et al. Novel MRI-based score for assessment of bone density in operative spine patients[J]. Spine J, 2020, 20(4): 556-562. DOI: 10.1016/j.spinee.2019.10.018.
[10]
EHRESMAN J, SCHILLING A, YANG X H, et al. Vertebral bone quality score predicts fragility fractures independently of bone mineral density[J]. Spine J, 2021, 21(1): 20-27. DOI: 10.1016/j.spinee.2020.05.540.
[11]
SCHILLING A T, EHRESMAN J, PENNINGTON Z, et al. Interrater and intrarater reliability of the vertebral bone quality score[J/OL]. World Neurosurg, 2021, 154: e277-e282 [2025-03-04]. https://pubmed.ncbi.nlm.nih.gov/34252629/. DOI: 10.1016/j.wneu.2021.07.020.
[12]
PU M Y, ZHONG W T, HENG H Q, et al. Vertebral bone quality score provides preoperative bone density assessment for patients undergoing lumbar spine surgery: a retrospective study[J]. J Neurosurg Spine, 2023: 1-10. DOI: 10.3171/2023.1.SPINE221187.
[13]
LI W S, ZHU H Z, HUA Z J, et al. Vertebral bone quality score as a predictor of pedicle screw loosening following surgery for degenerative lumbar disease[J]. Spine (Phila Pa 1976), 2023, 48(23): 1635-1641. DOI: 10.1097/BRS.0000000000004577.
[14]
ÖZMEN E, BIÇER O, MERIÇ E, et al. Vertebral bone quality score for opportunistic osteoporosis screening: a correlation and optimal threshold analysis[J]. Eur Spine J, 2023, 32(11): 3906-3911. DOI: 10.1007/s00586-023-07912-0.
[15]
LI W S, ZHU H Z, LIU J C, et al. Characteristics of MRI-based vertebral bone quality scores in elderly patients with vertebral fragility fractures[J]. Eur Spine J, 2023, 32(7): 2588-2593. DOI: 10.1007/s00586-023-07744-y.
[16]
EHRESMAN J, SCHILLING A, PENNINGTON Z, et al. A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis[J]. J Neurosurg Spine, 2019, 32(4): 499-506. DOI: 10.3171/2019.9.SPINE19954.
[17]
LI R Y, YIN Y J, JI W, et al. MRI-based vertebral bone quality score effectively reflects bone quality in patients with osteoporotic vertebral compressive fractures[J]. Eur Spine J, 2022, 31(5): 1131-1137. DOI: 10.1007/s00586-022-07177-z.
[18]
TANIWAKI H, HOSHINO M, KINOSHITA Y, et al. Assessing the impact of preoperative MRI-based vertebral bone quality scores on five-year prognosis in lumbar spine surgery[J]. Spine (Phila Pa 1976), 2025, 50(4): 259-265. DOI: 10.1097/BRS.0000000000005040.
[19]
ROCH P J, ÇELIK B, JÄCKLE K, et al. Combination of vertebral bone quality scores from different magnetic resonance imaging sequences improves prognostic value for the estimation of osteoporosis[J]. Spine J, 2023, 23(2): 305-311. DOI: 10.1016/j.spinee.2022.10.013.
[20]
TACHIBANA Y, NIWA T, KWEE T C, et al. Effective performance of T(1)-weighted FLAIR imaging with BLADE in pediatric brains[J]. Magn Reson Med Sci, 2012, 11(1): 17-26. DOI: 10.2463/mrms.11.17.
[21]
SHAH L M, HANRAHAN C J. MRI of spinal bone marrow: part I, techniques and normal age-related appearances[J]. AJR Am J Roentgenol, 2011, 197(6): 1298-1308. DOI: 10.2214/AJR.11.7005.
[22]
LEE J K, CHOI H Y, LEE S W, et al. Usefulness of T1-weighted image with fast inversion recovery technique in intracranial lesions: comparison with T1-weighted spin echo image[J]. Clin Imaging, 2000, 24(5): 263-269. DOI: 10.1016/s0899-7071(00)00229-1.
[23]
JIANG X X, QIAN W J, LI L. Quantitative CT study of different thoracic and lumbar vertebral bone mineral density in middle-aged and elderly population[J]. Chin J CT MRI, 2022, 20(5): 179-182. DOI: 10.3969/j.issn.1672-5131.2022.05.058.
[24]
WANG R Z, FU S, DONG C, et al. Relationship between bone mineral density and lumbar disc degeneration in middle-aged and elderly men and postmenopausal women[J]. Chin J Tissue Eng Res, 2025, 29(24): 5079-5085. DOI: 10.12307/2025.747.
[25]
FINE N, LIVELY S, SÉGUIN C A, et al. Intervertebral disc degeneration and osteoarthritis: a common molecular disease spectrum[J]. Nat Rev Rheumatol, 2023, 19(3): 136-152. DOI: 10.1038/s41584-022-00888-z.
[26]
ZHANG B R, DU J W, JIN X L, et al. Diagnostic value of quantitative ultrasound and dual energy X-ray absorber in menopausal patients with postmenopausal osteoporosis and chest-costal joint pain[J]. J Hebei Med Univ, 2019, 40(11): 1295-1298. DOI: 10.3969/j.issn.1007-3205.2019.11.012.
[27]
YAGI M, HOSOGANE N, WATANABE K, et al. The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis[J]. Spine J, 2016, 16(4): 451-458. DOI: 10.1016/j.spinee.2015.07.001.
[28]
MCPHEE S, KERSHAW L E, DANIEL C R, et al. QCT-based computational bone strength assessment updated with MRI-derived 'hidden' microporosity[J/OL]. J Mech Behav Biomed Mater, 2023, 147: 106094 [2025-03-04]. https://pubmed.ncbi.nlm.nih.gov/37741181/. DOI: 10.1016/j.jmbbm.2023.106094.
[29]
LU H, ZHANG Q C, DING F, et al. Establishment and validation of a T12-L2 3D finite element model for thoracolumbar segments[J]. Am J Transl Res, 2022, 14(3): 1606-1615.
[30]
LIU Y J, YANG H T, YAO M M, et al. Quantifying lumbar vertebral perfusion by a Tofts model on DCE-MRI using segmental versus aortic arterial input function[J/OL]. Sci Rep, 2021, 11(1): 2920 [2025-03-04]. https://pubmed.ncbi.nlm.nih.gov/33536471/. DOI: 10.1038/s41598-021-82300-6.
[31]
BERNATZ J T, GOH B C, SKJAERLUND J D, et al. Intraoperative surgeon assessment of bone: correlation to bone mineral density, CT Hounsfield units, and vertebral bone quality[J]. Spine (Phila Pa 1976), 2024, 49(16): 1125-1129. DOI: 10.1097/BRS.0000000000004854.
[32]
ÖZMEN E, BIÇER O, BARIŞ A, et al. Improving osteoporosis prediction using vertebral bone quality score and paravertebral muscle measurements from lumbar MRI scans[J]. Clin Spine Surg, 2024, 37(8): 357-363. DOI: 10.1097/BSD.0000000000001584.
[33]
HABIBI H, TAKAHASHI S, HOSHINO M, et al. Impact of paravertebral muscle in thoracolumbar and lower lumbar regions on outcomes following osteoporotic vertebral fracture: a multicenter cohort study[J/OL]. Arch Osteoporos, 2021, 16(1): 2 [2025-03-04]. https://pubmed.ncbi.nlm.nih.gov/33389230/. DOI: 10.1007/s11657-020-00866-6.
[34]
GE X Y, CHEN H, ZHANG S B, et al. Advances in MRI-based vertebral bone quality scoring and its clinical application[J]. Chin J Spine Spinal Cord, 2024, 34(6): 636-640. DOI: 10.3969/j.issn.1004-406X.2024.06.10.
[35]
PU X X, LIU B L, WANG D X, et al. Opportunistic use of lumbar computed tomography and magnetic resonance imaging for osteoporosis screening[J]. Osteoporos Int, 2024, 35(9): 1625-1631. DOI: 10.1007/s00198-024-07164-8.
[36]
WANG S, LIU L, LIU H, et al. Comprehensive diagnostic value of vertebral bone quality scores and paravertebral muscle quality parameters in osteoporotic vertebral fractures[J/OL]. World Neurosurg, 2025, 194: 123503 [2025-03-04]. https://pubmed.ncbi.nlm.nih.gov/39603452/. DOI: 10.1016/j.wneu.2024.11.086.
[37]
WANG Y S, SONG N, ZHANG J L, et al. Systematic evaluation of vertebral bone quality score as an opportunistic screening method for BMD in spine surgery patients[J]. Eur Spine J, 2024, 33(8): 3261-3267. DOI: 10.1007/s00586-024-08284-9.
[38]
LI D C, LU X, GONG Z Y, et al. Evaluation of the modified MRI vertebral bone quality score for bone quality in lumbar degenerative disorders[J]. Eur Spine J, 2024, 33(8): 3230-3241. DOI: 10.1007/s00586-024-08228-3.
[39]
PU X X, GENG C K, XIAO W P, et al. Simultaneous comparison of three methods for bone quality assessment[J]. Eur Spine J, 2025, 34(1): 17-26. DOI: 10.1007/s00586-024-08532-y.
[40]
YAN S, LIU Y H, YUAN L, et al. A novel T2-weighted series-based modified vertebral bone quality score for evaluating bone mineral density[J]. Eur Spine J, 2025, 34(2): 506-512. DOI: 10.1007/s00586-024-08522-0.
[41]
KADRI A, BINKLEY N, HERNANDO D, et al. Opportunistic use of lumbar magnetic resonance imaging for osteoporosis screening[J]. Osteoporos Int, 2022, 33(4): 861-869. DOI: 10.1007/s00198-021-06129-5.

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