Diagnostic performance of the vertebral bone quality score for osteoporosis is minimally influenced by lipid parameters in lumbar fusion patients: a retrospective study.

Routine MRI for opportunistic osteoporosis screening: diagnostic accuracy of vertebral bone quality and a novel femoral bone quality score compared with DXA.

VBQ can serve as an opportunistic exploratory screening marker of low BMD and FBQcsf may complement VBQ by identifying early marrow-related changes, although further validation is required.

Comparison of the predictive roles of CT- and MRI-based endplate regional osteoporosis status measurements for cage subsidence after posterior lumbar interbody fusion.

OBJECTIVE This study aimed to compare the efficacy of endplate Hounsfield unit (HU) values and endplate bone quality (EBQ) scores in predicting cage subsidence (CS) after posterior lumbar interbody fusion (PLIF) in older patients and identify the most discriminative bone mineral density (BMD) assessment indicator. METHODS This retrospective analysis included consecutive patients who underwent PLIF at the authors' institution between January 2016 and February 2024. Clinical data were collected for all patients. Propensity scores were used to match patients with and without CS, and the matched cohort was subjected to conditional logistic regression to investigate the association between radiographic factors and CS. L1 and endplate HU values were derived from CT scans, whereas vertebral bone quality (VBQ) and EBQ scores were derived from MR images. Receiver operating characteristic curve analysis was conducted to assess the predictive value of endplate HU values and EBQ scores for CS and further compare their predictive value with that of L1 HU values and VBQ scores. RESULTS This study included 130 matched patients. The CS group demonstrated lower L1 (p < 0.001) and endplate HU (p < 0.001) values and higher VBQ (p = 0.002) and EBQ (p < 0.001) scores compared with the non-CS group. The conditional logistic regression analysis identified L1 HU value (OR 0.99, 95% CI 0.97-0.99; p = 0.036), endplate HU value (OR 0.99, 95% CI 0.98-0.99; p = 0.044), VBQ score (OR 2.40, 95% CI 1.34-4.32; p = 0.038), and EBQ score (OR 4.46, 95% CI 2.16-9.18; p = 0.003) as independent predictors of CS, demonstrating areas under the curve of 0.722, 0.815, 0.648, and 0.782, respectively. The optimal cutoff for the endplate HU value in predicting CS was 262.11 (sensitivity 83.08%, specificity 73.85%). CONCLUSIONS Endplate HU values indicated a relatively higher predictive performance for CS compared with EBQ scores and served as the most discriminative BMD indicator in patients who underwent PLIF. Measuring the endplate HU value preoperatively helps surgeons select a more appropriate surgical plan and is expected to improve patient outcomes.

Potential physiological determinants of diagnostic discordance between an MRI-derived lumbar vertebral bone quality score and DXA T-scores.

Lumbar VBQ-DXA discordance is associated with a physiological signature characterized by triglyceride-rich lipoproteins, glycation burden, and conjugated bilirubin, which may complement VBQ by identifying metabolically vulnerable, marrow-related bone quality changes that are not fully captured by DXA-derived T-scores.

Thoracolumbar vertebral bone quality (TLVBQ) score as a possible screening tool for osteoporosis in patients with severe degenerative lumbar scoliosis: a retrospective cohort study.

Evaluation of Predictive Performance of CT Hounsfield Units and Modified VBQ Scores in Lumbar Pedicle Screw Loosening.

RATIONALE AND OBJECTIVES Evaluating and Comparing the Predictive Ability of computed tomography (CT)-based Hounsfield units (HU), Magnetic resonance imaging (MRI)-based vertebral bone quality score (VBQ) and modified VBQ scores for pedicle screw loosening (PSL) in patients with lumbar degenerative diseases. MATERIALS AND METHODS Retrospective study of patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative diseases (Dec 2019 - Jan 2021). Screw loosening was assessed using 12-month postoperative lumbar radiographs and defined by a ≥1 mm radiolucent halo surrounding the screw. Various VBQ scores and HU value were measured using preoperative MRI and CT, respectively. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS Among all patients (n = 185), several modified VBQ scores showed higher areas under the curve (AUCs) than the VBQ score (0.776, 95% CI: 0.701-0.851) and CT HU value (0.770, 95% CI: 0.684-0.857), without statistical significance (PAUC>0.05). No significant differences were observed in lumbar disc herniation (LDH) or spondylolisthesis (LS) subgroups. In lumbar spinal stenosis (LSS) patients, the AUC of T1-VBQFAT (0.876, 95% CI: 0.788-0.965) was significantly higher than that of CT HU value (0.718, 95% CI: 0.583-0.852) (PAUC=0.040). CONCLUSION In the overall cohort and other subgroups, HU values and several modified VBQ scores showed numerically higher AUCs without statistical significance (PAUC>0.05). In the LSS subgroup, T1-VBQFAT demonstrated superior predictive performance compared with HU values (PAUC=0.040); notably, this finding did not remain statistically significant after correction for multiple comparisons (PAUC>0.0026). These exploratory results suggest that T1-VBQFAT may serve as a potential adjunct for predicting PSL in patients with LSS.

MRI-Based Vertebral Bone Quality Score and Paravertebral Muscle Parameters for Identifying Osteoporotic Vertebral Compression Fractures.

BACKGROUND Osteoporotic vertebral compression fractures (OVCFs) are prevalent but frequently remain unrecognized. While bone mineral density (BMD) is the primary assessment tool, MRI-based parameters associated with bone and muscle quality may offer additional value, yet sex-specific analyses are limited, despite sex differences in incidence and hormones. PURPOSE To explore the associations between MRI-based vertebral bone quality (VBQ) score, psoas muscle index (PMI), and paravertebral muscle fat infiltration (FI) fraction with OVCFs, and to assess the potential diagnostic performance of MRI parameters across sexes. STUDY TYPE Retrospective. POPULATION 260 subjects (≥ 50 years); 130 OVCF patients (73.0 years (67.0-80.0), 89 females) and 130 non-fracture (NF) patients (64.5 years (58.0-73.0), 76 females). FIELD STRENGTH AND SEQUENCES 3 T and 1.5 T. T1-weighted TSE and T2-weighted TSE (Siemens) and T1-weighted FSE and T2-weighted FSE (United Imaging). ASSESSMENT VBQ was calculated on sagittal T1-weighted MRI; PMI and FI were quantified on axial T2-weighted MRI at the L3 endplate by ImageJ. BMD was derived from CT using QCT PRO software. Two trained observers, blinded to clinical data, performed all MRI measurements. STATISTICAL TESTS Significance level was set at p < 0.05. t-test/Mann-Whitney U test, chi-squared test (χ2), Spearman's rank correlation coefficient, multivariate logistic regression, receiver operating characteristic (ROC) curve analysis with area under the curve (AUC). Bootstrap resampling (1000 iterations) for internal validation. RESULTS The OVCF group exhibited significantly elevated VBQ (3.71 ± 0.55 vs. 3.25 ± 0.58) and FI (24.11% (21.66-28.92) vs. 20.31% (18.90-22.14)), while PMI (3.42 ± 1.02 vs. 4.08 ± 1.14) and BMD (55.82 mg/cm3 (38.75-70.90) vs. 89.24 mg/cm3 (67.80-110.00)) were reduced. FI was independently associated with OVCFs exclusively in females (OR = 1.566). The combined MRI model (VBQ + FI + PMI) yielded a significantly higher AUC in females (AUC = 0.896) than in males (AUC = 0.720). DATA CONCLUSION VBQ, PMI, and FI reveal significant sex-specific correlations with OVCFs. The multi-parametric MRI model shows considerable potential as a diagnostic aid for OVCFs in individuals aged over 50, particularly in females. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE 2 (Diagnostic Accuracy).