Assessment of osteoporosis and vertebral fractures with T1- and T2-weighted MRI scans

Abstract

Summary

Osteoporosis is related to changes in vertebral bone marrow tissues, which can be detected by MRI. A novel MRI scoring method based on routine T1 and T2 sequences has been developed and demonstrated capabilities in detecting osteoporosis and discriminating vertebral fractures. The scoring method may provide an alternative tool other than BMD measurement for broad, opportunistic use in clinics.

Purpose

As a routinely used radiation-free modality at the spine, magnetic resonance imaging (MRI) is promising to assess osteoporosis because it can detect age- or osteoporosis-related changes in bone marrow tissues. Here, we proposed a new MRI scoring method using the patient’s low-back subcutaneous fat and cerebrospinal fluid as reference controls on routine T1 and T2 sequences, respectively, to indicate proton-rich changes in vertebrae for assessing osteoporosis and vertebral fractures.

Methods

The study included 60 female patients (64.1 ± 15.9 years) who underwent both MRI and quantitative computed tomography (QCT) at spine. T1-based F-score_sc.fat and T2-based W-score_cs.fluid were defined as the median signal intensity (SI) from L1 to L5 over their reference controls. QCT-measured vertebral BMD was used for defining osteoporosis. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performances of the new scores for osteoporosis and vertebral fractures, which were also compared with L1–L5 signal-to-noise ratio (SNR_L1−L5) or SNR-based vertebral bone quality (VBQ) score.

Results

The F-score_sc.fat and W-score_cs.fluid increased significantly by 25.3% and 22%, respectively, in patients with osteoporosis compared to non-osteoporosis. Age was also found to be significantly different between non-osteoporosis and osteoporosis (49.92 and 74.03 years, p < .001). ROC analysis indicated that F-score_sc.fat had a greater AUC value (0.85, p < .001) than VBQ score (0.77) and SNR_L1−L5 (0.71) when being used to detect osteoporosis. For separating vertebral fractures from non-fractures, F-score_sc.fat resulted in the largest AUC value of 0.81 (p < .001), compared to W-score_cs.fluid (0.74), VBQ (0.72), and SNR_L1−L5 (0.75).

Conclusion

A new MRI scoring method based on routine T1 and T2 sequences has been developed and demonstrated improved abilities in detecting osteoporosis and discriminating vertebral fractures over VBQ and SNR.