A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Vertebral compression fractures (VCFs) in patients with spinal metastasis can lead to destabilization and often carry a high risk profile. It is therefore important to have tools that enable providers to predict the occurrence of new VCFs. The most widely used tool for bone quality assessment, dual-energy x-ray absorptiometry (DXA), is not often available at a patient’s initial presentation and has limited sensitivity. While the Spinal Instability Neoplastic Score (SINS) has been associated with VCFs, it does not take patients’ baseline bone quality into consideration. To address this, the authors sought to develop an MRI-based scoring system to estimate trabecular vertebral bone quality (VBQ) and to assess this system’s ability to predict the occurrence of new VCFs in patients with spinal metastasis.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Cases of adult patients with a diagnosis of spinal metastasis, who had undergone stereotactic body radiation therapy (SBRT) to the spine or neurosurgical intervention at a single institution between 2012 and 2019, were retrospectively reviewed. The novel VBQ score was calculated for each patient by dividing the median signal intensity of the L1–4 vertebral bodies by the signal intensity of cerebrospinal fluid (CSF). Multivariable logistic regression analysis was used to identify associations of demographic, clinical, and radiological data with new VCFs.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Among the 105 patients included in this study, 56 patients received a diagnosis of a new VCF and 49 did not. On univariable analysis, the factors associated with new VCFs were smoking status, steroid use longer than 3 months, the SINS, and the novel scoring system—the VBQ score. On multivariable analysis, only the SINS and VBQ score were significant predictors of new VCFs and, when combined, had a predictive accuracy of 89%.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>As a measure of bone quality, the novel VBQ score significantly predicted the occurrence of new VCFs in patients with spinal metastases independent of the SINS. This suggests that baseline bone quality is a crucial factor that requires assessment when evaluating these patients’ conditions and that the VBQ score is a novel and simple MRI-based measure to accomplish this.</jats:p></jats:sec>

Vertebral bone quality score predicts fragility fractures independently of bone mineral density

“…Using this technique, it has been shown that VBQ score correlates with BMD scores from DXA scans [8] and is an independent predictor of the occurrence of pathologic vertebral compression fracture in patients with spine metastasis. [9] This study expands these earlier findings by showing that VBQ score can predict fracture risk in patients without neoplastic disease. Although DXA remains the gold standard for osteoporosis screening due to its low cost and widespread ability, this study demonstrated that the predictive power of the VBQ score is independent of and greater than that of DXA BMD values.…”

“…One recently described, novel technique for assessing bone quality is the vertebral bone quality (VBQ) score, which uses noncontrast, T1-weighted lumbar spine magnetic resonance imaging (MRI) [8]. The VBQ has been shown to both correlate with DXA-measured BMD scores [8] and predict vertebral compression fracture risk in patients with spine metastases [9]. By measuring T1-signal, VBQ estimates detrimental fat infiltration within the vertebral body, which is correlated with decreases in trabecular bone quality.…”

Predicting Pedicle Screw Pullout and Fatigue Performance: Comparing Lateral Dual-Energy X-Ray Absorptiometry, Anterior to Posterior Dual-Energy X-Ray Absorptiometry, and Computed Tomography Hounsfield Units

“…A new method of measuring bone quality (vertebral bone quality score) using magnetic resonance imaging has more recently been described since the initiation of this study and so was not able to be included. 29,30 Magnetic resonance imaging on cadavers in the biomechanics lab is also not likely to provide clinically accurate results, limiting future possibilities of investigating vertebral bone quality score in this type of study. 31…”

Biomechanical Properties of Metastatically Involved Osteolytic Bone

“…Radiation therapy is commonly used for treatment of metastatic bone tumours, however in the movement towards localized control with stereotactic body radiotherapy (SBRT), the incidence of post treatment fractures has increased with post SBRT vertebral compression fractures occurring in approximately 11% of patients [3,[115][116][117][118]. As such, the focal impact of SBRT on bone quality [119][120][121] must be considered in the context of treatment planning and patient selection.…”