DOI: 10.1177/21925682261462059 ISSN: 2192-5682

Streamlining the MRI-Derived Vertebral Bone Quality Score for Preoperative Osteoporosis and Osteopenia Screening

Paul Köhli, Ali E. Guven, Anna-Maria Mielke, Daniel M. Alschuler, Ranqing Lan, Jan Hambrecht, Erika Chiapparelli, Lukas Schönnagel, Gisberto Evangelisti, Roland Duculan, Jennifer Shue, Koki Tsuchiya, Matthias Pumberger, Marco D. Burkhard, Carol A. Mancuso, Andrew A. Sama, Federico P. Girardi, Frank P. Cammisa, Alexander P. Hughes
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Design

Retrospective study.

Objective

To evaluate the predictive performance of a simplified, MRI-derived vertebral bone quality score (VBQ) using measurements at L1/2 (VBQ L1/2 ) for opportunistic bone quality screening, compared to the established VBQ L1-4.

Methods

In patients undergoing lumbar surgery for degenerative spondylolisthesis, VBQ L1/2 was assessed using circular regions of interest on sagittal T1-weighted sequences in L1 and L2, while VBQ L1-4 included measurements from L1 through L4. Measurements were normalized to cerebrospinal fluid intensity at L2/3. Bone mineral density (BMD) was measured by opportunistic qCT, with osteoporosis defined as BMD < 80 mg/cm 3 and impaired bone quality (osteoporosis or osteopenia) as BMD < 120 mg/cm 3 . Agreement between VBQ L1/2 and VBQ L1-4 was determined using the intraclass correlation coefficient (ICC), and predictive performance was evaluated using receiver operating characteristic analysis with Youden’s index optimization.

Results

Among 144 patients included ((39% male, n = 56) the median age was 69 years (interquartile range 64-67). Osteopenia was present in 47% and osteoporosis in 22%, yielding 69% impaired bone quality. VBQ L1/2 and VBQ L1-4 showed excellent agreement (ICC: 0.988, 95% CI: 0.982–0.991). Predictive performance was comparable for osteoporosis (AUC: VBQ L1/2 0.71 vs. VBQ L1-4 0.69) and impaired bone quality (AUC: 0.68 vs. 0.67). For osteoporosis detection, VBQ L1/2 showed a higher sensitivity (94% vs 71%) but a lower specificity (45% vs 64%), as well as for detecting impaired bone quality (sensitivity 77% vs. 47%, 56%, vs 82%).

Conclusions

VBQ L1/2 offers a simplified alternative to VBQ L1-4 for MRI-based bone quality assessment. Further validation and threshold refinement are warranted.

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