Diagnostic value of a magnetic resonance imaging (MRI)-based vertebral bone quality score for bone mineral density assessment: an updated systematic review and meta-analysis.

Background: Many studies have explored the application of the magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score as a tool for opportunistic osteoporosis screening before spine surgery. We aimed to conduct a systematic review and meta-analysis of studies to determine the diagnostic value of the VBQ score for bone mineral density (BMD) assessment.

Methods: The PubMed, EBSCO, Ovid, Web of Science, Cochrane Library, Wanfang, China National Knowledge Infrastructure, Chinese Science and Technology Periodical databases were searched to retrieve original studies on VBQ and BMD published from inception to 31 December 2023 with no restrictions on language and the reference standard of BMD. The quality of the included articles was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Summary accuracy metrics were obtained by bivariate random-effects meta-analysis. The area under the curve (AUC) of the summary receiver operating characteristic (SROC) analysis was used to evaluate the performance of the VBQ score. Meta-regression and subgroup analyses were performed to examine the source of heterogeneity.

Results: In total, 23 studies, comprising 2981 patients, from 2022 to 2023, of high- or medium-to-high scientific quality were included in the meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of the VBQ score in the assessment of BMD were 0.77 [95% confidence interval (CI), 0.73-0.81; P<0.001], 0.65 (95% CI, 0.59-0.71; P<0.001), and 6.49 (95% CI, 4.82-8.73; P<0.001), respectively, with an area under the SROC curve of 0.78 (95% CI, 0.74-0.82; P<0.001). The presence of heterogeneity was found to have a significant association with factors such as the reference standard, sex, mean age, region of publication, VBQ method, and magnet field strength.

Conclusions: The MRI-based VBQ score has some diagnostic value in detecting osteoporosis. The VBQ score could be used as a tool for opportunistic osteoporosis screening before spine surgery.