Role of lumbar spine signal intensity measurement by MRI in the diagnosis of osteoporosis in post-menopausal women

Abstract

Background: Osteoporosis is a worldwide health problem and a common cause of bone fractures; the most common type of osteoporosis is post-menopausal type. MRI has a role in the diagnosis of osteoporosis and can be used as a screening tool, so the purpose of our study was to define a quantitative MRI-based score (M-score) for the detection of lumbar spine osteoporosis and to evaluate the correlation between lumbar spine signal intensity measured by MRI and BMD (bone mineral density) in post-menopausal women. Our case-control study involved 100 cases (50 old post-menopausal females as a case group and 50 healthy females as a control group of matched age). Both groups were subjected to history taking, dual-energy X-ray absorptiometry (DEXA), and conventional lumbar MRI. DEXA was performed for the lumbar spine and all scores (T-score, Z-score, BMD) were calculated. Lumbar MRI was performed (sagittal T1WI and T2WI) from L1-L4 levels. SNR L1-L4 and M-score were calculated from T1W images. Results: All DEXA scores were significantly lower in post-menopausal females compared to the control group (P < 0.0001). Meanwhile, SNR L1-L4 and M-score were significantly higher among cases than controls (P < 0.0001). The diagnostic threshold of SNR L1-L4 and M-score for distinguishing osteoporotic from non-osteoporotic females was 104.5 for SNR L1-L4 with a sensitivity of 94%, specificity 60%, positive predictive values (PPV) 31%, and negative predictive values (NPV) 98%, and 3.5 for M-score with a sensitivity of 93.

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

“…More recently, opportunistic bone quality screening has been explored using lumbar MRIs, which are obtained at increasing rates due to the high prevalence of low back pain amongst the aging population [13,14,15]. The first such investigation, published by Bandirali et al in 2015, described the M-score, a SI measurement of the lumbar trabecular bone on T1-weighted MRI [13].…”

“…Using this logic, the authors evaluated a cohort of 226 women who underwent MRI and DXA scans and found that the M-score better correlated with fracture risk than did DXA scores [13]. Subsequent studies by other groups have validated this methodology, giving credence to the use of MRI for assessing bone quality [14,15]. Despite this, the M-score is limited in its utility as it requires all scores be acquired using the same MRI machine, as the score is standardized to the signal-to-noise ratio (SNR), which is specific to each individual MRI scanner.…”

Osteopenia and Sarcopenia as Potential Risk Factors for Surgical Site Infection after Posterior Lumbar Fusion: A Retrospective Study

“…Through magnetic resonance images (MRI), central sarcopenia and osteopenia were evaluated for every patient, measuring the psoas to lumbar vertebral index (PLVI) [ 27 ] and the M score [ 28 ], respectively.…”

Detection of osteoporosis in lumbar spine [L1-L4] trabecular bone: a review article

“…The statistical quantitative method significantly improves distinguishing osteoporotic from non-osteoporotic bones. 36 Muehlematter et al utilized texture analysis attributes of vertebral bone from CT images to detect risk of bone fracture using open-source software (MaZda). 37 The study cases and the matched controls were classified utilizing ROC portion of the image texture features analyzed using Hounsfield unit (HU) and supervised ML techniques.…”