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Pu X, Liu B, Wang D, Xiao W, Liu C, Gu S, Geng C, Li H. Opportunistic use of lumbar computed tomography and magnetic resonance imaging for osteoporosis screening. Osteoporos Int 2024; 35:1625-1631. [PMID: 38942897 DOI: 10.1007/s00198-024-07164-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 06/20/2024] [Indexed: 06/30/2024]
Abstract
Compared with the healthy patients, patients with osteoporosis had a lower Hounsfield unit (HU) value and a higher vertebral bone quality (VBQ) score. Both the HU value and VBQ score can simply distinguish patients with osteoporosis (OP), with a cutoff value of HU value < 97.06 and VBQ score > 3.08. INTRODUCTION The purpose of this study is to determine whether the opportunistic use of computed tomography (CT) or magnetic resonance imaging (MRI) is effective for identifying spine surgical patients with OP. METHODS We retrospectively evaluated 109 lumbar spine surgery patients who received lumbar quantitative CT (QCT) and MRI. Using the area under the curve, the CT-based HU value and MRI-based VBQ score were calculated. Then, based on the QCT results, receiver operating characteristic (ROC) curves were constructed to determine the diagnostic performance of the HU value and VBQ score. RESULTS The HU value was significantly lower in the OP group, and the VBQ score was significantly higher in the OP group. Using the area under the curve, the diagnostic performance of the HU value and VBQ score for OP were 0.959 and 0.880, respectively. The diagnostic threshold values determined with optimal sensitivity and specificity were an HU value of 97.06 and a VBQ score of 3.08. CONCLUSION Opportunistic use of CT and MRI can simply distinguish patients with OP, which are expected to be potential alternatives to T-score for the osteoporosis screening.
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Affiliation(s)
- Xingxiao Pu
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China
| | - Bailian Liu
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China
| | - Daxing Wang
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China
| | - Weiping Xiao
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China
| | - Chengwei Liu
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China
| | - Shao Gu
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China
| | - Chengkui Geng
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China.
| | - Haifeng Li
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China.
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Feng N, Li W, Yu X, Zhao H, Qiu Z, Guan J, Jiang G, Yang K. Cervical Vertebra Bone Quality Score Predicts Zero-Profile Anchored Spacer Interbody Fusion Cage Subsidence after Anterior Cervical Diskectomy and Fusion: A Retrospective Study. Global Spine J 2024:21925682241280258. [PMID: 39216843 DOI: 10.1177/21925682241280258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE This retrospective study primary focus is to investigate the relationship between the C-VBQ score and the occurrence of postoperative zero-profile anchored spacer (ROI-C) interbody fusion cage subsidence. Additionally, we aim to evaluate the predictive efficacy of the C-VBQ scoring system for subsidence in the context of ACDF with the ROI-C. METHODS Patients who underwent ACDF with the ROI-C cage at our hospital between January 2016 and December 2022 were included in this study. Univariate analysis and multivariate logistic regression were employed to identify independent risk factors associated with ROI-C cage subsidence after ACDF. Pearson correlation analysis was utilized to assess the correlation between the C-VBQ score and the height of ROI-C cage subsidence. RESULTS A total of 102 patients underwent ACDF with ROI-C in our hospital were included in this study. Univariate analysis showed that age (P = 0.021) and C-VBQ score (P < 0.001) were the influencing factors of cage subsidence. Pearson correlation analysis showed that there was a significant positive correlation between the subsidence height of ROI-C cage and C-VBQ (r = 0.55, P < 0.01). Multivariate binary logistic regression analysis showed that C-VBQ score was the only variable that could significantly predict the subsidence of ROI-C cage after ACDF. Higher C-VBQ score was significantly associated with cage subsidence (P < 0.001).The AUC was 0.89, and the cutoff value for C-VBQ was 2.70. CONCLUSION The findings indicate a significant correlation between a higher C-VBQ score before surgery and ROI-C cage subsidence after ACDF. The preoperative assessment of C-VBQ proves valuable for clinicians, enabling them to identify patients with low bone mineral density and predict the risk of zero-profile anchored spacer interbody fusion cage subsidence following ACDF.
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Affiliation(s)
- Ningning Feng
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Wenhao Li
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xing Yu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - He Zhao
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Ziye Qiu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Jianbin Guan
- Honghui Hospital Affiliated to Xi 'an Jiaotong University, Shannxi, China
| | - Guozheng Jiang
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Kaitan Yang
- Honghui Hospital Affiliated to Xi 'an Jiaotong University, Shannxi, China
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Hu F, Li X, Zhao D, Chen C, Liu G, Yang Q. The diagnostic value of MRI-based vertebral bone quality score for osteoporosis or osteopenia in patients undergoing lumbar surgery: a meta-analysis. Osteoporos Int 2024:10.1007/s00198-024-07190-6. [PMID: 39085499 DOI: 10.1007/s00198-024-07190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024]
Abstract
The importance of osteoporosis assessment before lumbar surgery is well recognized. The MRI-based Vertebral Bone Quality (VBQ) score is introduced to evaluate bone quality; however, its diagnostic value has not been well documented. The purpose of this meta-analysis was to summarize the diagnostic value of the VBQ score for osteoporosis or osteopenia in patients undergoing lumbar surgery. We comprehensively searched electronic databases for studies exploring the diagnostic accuracy of the VBQ score for osteoporosis/osteopenia in patients with lumbar disease following the PRISMA guidelines. The quality of the included studies was assessed. The VBQ scores were compared between the groups, and the pooled sensitivity, specificity, and summary receiver operating characteristic (ROC) were calculated. Publication bias was assessed, and meta-regression was conducted. We included 17 studies with a total of 2815 patients, with a mean age of 66.4 years and a percentage of females of 72.5%. According to the QUADAS-2 tool, the quality of the included studies was relatively high. The results showed a significantly higher VBQ score in the osteoporosis/osteopenia group compared with the control group. According to the mean VBQ cutoff value of 3.02 ± 0.38 for the diagnosis of osteoporosis, the pooled sensitivity and specificity were 0.76 and 0.74, respectively, and the AUC was 0.81. According to the mean VBQ cutoff value of 2.31 ± 0.18 for the diagnosis of osteopenia, the pooled sensitivity and specificity were 0.78 and 0.58, respectively, and the AUC was 0.76. The MRI-based VBQ score could provide useful information for identifying patients with low bone mass who need further evaluation. Future prospective studies are still needed to evaluate the complementary role of the VBQ score.
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Affiliation(s)
- Fangke Hu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xiaopeng Li
- Department of Spine Surgery, Weifang People's Hospital, Weifang, Shandong, China
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Dong Zhao
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Chao Chen
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Gang Liu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China.
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Wang Y, Song N, Zhang J, Li J, Li R, Wang L. Systematic evaluation of vertebral bone quality score as an opportunistic screening method for BMD in spine surgery patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3261-3267. [PMID: 38671248 DOI: 10.1007/s00586-024-08284-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE This study aimed to evaluate and compare the predictive value of vertebral bone quality (VBQ) score for low BMD and osteoporosis. Furthermore, we sought to enhance diagnostic effectiveness by integrating VBQ with easily accessible patient-specific factors. METHODS We retrospectively analyzed data from 180 patients. VBQ was obtained by preoperative MRI. Low BMD was classified as meeting the standards for either osteopenia or osteoporosis. The receiver operating characteristic curve analysis and multivariate logistic regression were used to detect the ability of variables to assess BMD. The z-test was used to compare the area under the curves of different variables. RESULTS VBQ was more effective in identifying low BMD than osteoporosis (AUC, 0.768 vs. 0.613, p = 0.02). Elevated VBQ (OR 6.912, 95% CI 2.72-17.6) and low BMI (0.858, 0.76-0.97) were risk factors for low BMD, while the risk factor for osteoporosis was age (1.067, 1.02-1.12), not VBQ. ROC analysis showed that AUCs were 0.613 for VBQ and 0.665 for age when screening for osteoporosis. The combined variable of VBQ, sex, age, and BMI obtained by logistic regression significantly improved the efficacy of BMD screening, with an AUC of 0.824 for low BMD and 0.733 for osteoporosis. CONCLUSION VBQ is better at detecting low BMD than identifying osteoporosis. The ability of VBQ to predict osteoporosis is limited, and a similar diagnostic efficacy can be achieved with age. Incorporating VBQ alongside demographic data enhances the efficiency of BMD assessment. With the development of artificial intelligence in medicine, this simple method is promising.
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Affiliation(s)
- Yunsheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Ning Song
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
- Department of Operating Room, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiali Zhang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jia Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Ruoyu Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China.
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China.
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Agaronnik ND, Giberson-Chen C, Bono CM. Using advanced imaging to measure bone density, compression fracture risk, and risk for construct failure after spine surgery. Spine J 2024; 24:1135-1152. [PMID: 38437918 DOI: 10.1016/j.spinee.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/22/2024] [Accepted: 02/23/2024] [Indexed: 03/06/2024]
Abstract
Low bone mineral density (BMD) can predispose to vertebral body compression fractures and postoperative instrumentation failure. DEXA is considered the gold standard for measurement of BMD, however it is not obtained for all spine surgery patients preoperatively. There is a growing body of evidence suggesting that more routinely acquired spine imaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI) can be opportunistically used to measure BMD. Here we review available studies that assess the validity of opportunistic screening with CT-derived Hounsfield Units (HU) and MRI-derived vertebral vone quality (VBQ) to measure BMD of the spine as well the utility of these measures in predicting postoperative outcomes. Additionally, we provide screening thresholds based on HU and VBQ for prediction of osteopenia/ osteoporosis and postoperative outcomes such as cage subsidence, screw loosening, proximal junctional kyphosis, and implant failure.
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Affiliation(s)
| | - Carew Giberson-Chen
- Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Yawkey Building, Suite 3A, Boston, MA 02114
| | - Christopher M Bono
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115; Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Yawkey Building, Suite 3A, Boston, MA 02114; Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey Building, Suite 3A, Boston, MA 02114.
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Pennington Z, Mikula AL, Lakomkin N, Martini M, Pinter ZW, Shafi M, Hamouda A, Bydon M, Clarke MJ, Freedman BA, Krauss WE, Nassr AN, Sebastian AS, Fogelson JL, Elder BD. Bone Quality as Measured by Hounsfield Units More Accurately Predicts Proximal Junctional Kyphosis than Vertebral Bone Quality Following Long-Segment Thoracolumbar Fusion. World Neurosurg 2024; 186:e584-e592. [PMID: 38588791 DOI: 10.1016/j.wneu.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To compare the prognostic power of Hounsfield units (HU) and Vertebral Bone Quality (VBQ) score for predicting proximal junctional kyphosis (PJK) following long-segment thoracolumbar fusion to the upper thoracic spine (T1-T6). METHODS Vertebral bone quality around the upper instrumented vertebrae (UIV) was measured using HU on preoperative CT and VBQ on preoperative MRI. Spinopelvic parameters were also categorized according to the Scoliosis Research Society-Schwab classification. Univariable analysis to identify predictors of the occurrence of PJK and survival analyses with Kaplan-Meier method and Cox regression were performed to identify predictors of time to PJK (defined as ≥10° change in Cobb angle of UIV+2 and UIV). Sensitivity analyses showed thresholds of HU < 164 and VBQ > 2.7 to be most predictive for PJK. RESULTS Seventy-six patients (mean age 66.0 ± 7.0 years; 27.6% male) were identified, of whom 15 suffered PJK. Significant predictors of PJK were high postoperative pelvic tilt (P = 0.038), high postoperative T1-pelvic angle (P = 0.041), and high postoperative PI-LL mismatch (P = 0.028). On survival analyses, bone quality, as assessed by the average HU of the UIV and UIV+1 was the only significant predictor of time to PJK (odds ratio [OR] 3.053; 95% CI 1.032-9.032; P = 0.044). VBQ measured using the UIV, UIV+1, UIV+2, and UIV-1 vertebrae approached, but did not reach significance (OR 2.913; 95% CI 0.797-10.646; P = 0.106). CONCLUSIONS In larger cohorts, VBQ may prove to be a significant predictor of PJK following long-segment thoracolumbar fusion. However, Hounsfield units on CT have greater predictive power, suggesting preoperative workup for long-segment thoracolumbar fusion benefits from computed tomography versus magnetic resonance imaging alone to identify those at increased risk of PJK.
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Affiliation(s)
- Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Anthony L Mikula
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nikita Lakomkin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Martini
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Zachariah W Pinter
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mahnoor Shafi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle J Clarke
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William E Krauss
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmad N Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arjun S Sebastian
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy L Fogelson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Ran L, Xie T, Zhao L, Wang C, Luo C, Wu D, You X, Huang S, Zeng J. MRI-based endplate bone quality score predicts cage subsidence following oblique lumbar interbody fusion. Spine J 2024:S1529-9430(24)00237-7. [PMID: 38754736 DOI: 10.1016/j.spinee.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND CONTEXT Cage subsidence is a common complication after lumbar interbody fusion surgery, with low bone mineral density (BMD) being a significant risk factor. Endplate bone quality (EBQ) obtained from clinical MRI scans has been deemed reliable in determining regional BMD. However, the association between EBQ score and cage subsidence following oblique lumbar interbody fusion (OLIF) has not been clearly established. PURPOSE This study aims to assess the relationship between EBQ score and cage subsidence in patients who underwent single-level OLIF. STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE The study included adults with degenerative spinal conditions who underwent single-level OLIF at our institution. OUTCOME MEASURES Cage subsidence, disc height, EBQ score, fusion rate. METHODS This retrospective study analyzed data from patients who underwent single-level OLIF surgery at our institution between October 2017 and August 2022. Postoperative CT scans were used to measure cage subsidence, while the EBQ score was calculated using preoperative non-contrast T1-weighted MRI. To determine the predictive ability of the EBQ score, receiver operating characteristic (ROC) curve analysis was conducted. Additionally, univariable and multivariable logistic regression analyses were performed. RESULTS In this study, a total of 88 patients were included and followed up for an average of 15.8 months. It was observed that 32.9% (n=29/88) of the patients experienced cage subsidence. The post-surgery disc height was significantly higher in patients who experienced subsidence compared to those who did not. The mean EBQ scores for patients with non-subsidence and subsidence were 2.31±0.6 and 3.48±1.2, respectively, and this difference was statistically significant. The ROC curve analysis showed that the AUC for the EBQ score was 0.811 (95% CI: 0.717-0.905). The most suitable threshold for the EBQ score was determined to be 2.318 (sensitivity: 93.1%, specificity: 55.9%). Additionally, the multivariate logistic regression analysis revealed a significant association between a higher EBQ score and an increased risk of subsidence (odds ratio [OR]=6.204, 95% CI=2.520-15.272, p<.001). CONCLUSIONS Our findings indicate that higher preoperative EBQ scores are significantly linked to cage subsidence following single-level OLIF. Preoperative measurement of MRI can serve as a valuable tool in predicting cage subsidence.
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Affiliation(s)
- Liyu Ran
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tianhang Xie
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Long Zhao
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Changyi Wang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Diwei Wu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuanhe You
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shishu Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jiancheng Zeng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Wang J, Xue M, Hu Y, Li J, Li Z, Wang Y. Proteomic Insights into Osteoporosis: Unraveling Diagnostic Markers of and Therapeutic Targets for the Metabolic Bone Disease. Biomolecules 2024; 14:554. [PMID: 38785961 PMCID: PMC11118602 DOI: 10.3390/biom14050554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Osteoporosis (OP), a prevalent skeletal disorder characterized by compromised bone strength and increased susceptibility to fractures, poses a significant public health concern. This review aims to provide a comprehensive analysis of the current state of research in the field, focusing on the application of proteomic techniques to elucidate diagnostic markers and therapeutic targets for OP. The integration of cutting-edge proteomic technologies has enabled the identification and quantification of proteins associated with bone metabolism, leading to a deeper understanding of the molecular mechanisms underlying OP. In this review, we systematically examine recent advancements in proteomic studies related to OP, emphasizing the identification of potential biomarkers for OP diagnosis and the discovery of novel therapeutic targets. Additionally, we discuss the challenges and future directions in the field, highlighting the potential impact of proteomic research in transforming the landscape of OP diagnosis and treatment.
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Affiliation(s)
- Jihan Wang
- Xi’an Key Laboratory of Stem Cell and Regenerative Medicine, Institute of Medical Research, Northwestern Polytechnical University, Xi’an 710072, China; (J.W.)
| | - Mengju Xue
- School of Medicine, Xi’an International University, Xi’an 710077, China
| | - Ya Hu
- Department of Medical College, Hunan Polytechnic of Environment and Biology, Hengyang 421000, China
| | - Jingwen Li
- Xi’an Key Laboratory of Stem Cell and Regenerative Medicine, Institute of Medical Research, Northwestern Polytechnical University, Xi’an 710072, China; (J.W.)
- Research and Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen 518057, China
| | - Zhenzhen Li
- Xi’an Key Laboratory of Stem Cell and Regenerative Medicine, Institute of Medical Research, Northwestern Polytechnical University, Xi’an 710072, China; (J.W.)
- Research and Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen 518057, China
| | - Yangyang Wang
- School of Electronics and Information, Northwestern Polytechnical University, Xi’an 710129, China
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9
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Ai Y, Chen Q, Zhu C, Liu L. Response to letter to the editor regarding, "MRI-based endplate Bone Quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion". Spine J 2024; 24:911-912. [PMID: 38670783 DOI: 10.1016/j.spinee.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/27/2024] [Accepted: 02/01/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Youwei Ai
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, 610041, Sichuan, China
| | - Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, 610041, Sichuan, China; Department of Orthopaedics and Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Rd, Nanchong, Sichuan, China
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, 610041, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, 610041, Sichuan, China.
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Özmen E, Biçer O, Bariş A, Circi E, Yüksel S, Beytemür O, Kesiktaş FN. Improving Osteoporosis Prediction Using Vertebral Bone Quality Score and Paravertebral Muscle Measurements From Lumbar MRI Scans. Clin Spine Surg 2024:01933606-990000000-00298. [PMID: 38637928 DOI: 10.1097/bsd.0000000000001584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/22/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE This study aims to use a novel method of combining vertebral bone quality score with paravertebral cross-sectional area measurements to improve the accuracy of predicting individuals with total hip T-scores <-2.5. SUMMARY OF BACKGROUND DATA Osteoporosis is a prevalent skeletal condition associated with decreased bone density and increased fracture risk. Dual-energy x-ray absorptiometry (DXA) is the conventional method for diagnosing osteoporosis, but it has limitations. Opportunistic osteoporosis screening techniques using lumbar magnetic resonance imaging (MRI), particularly the vertebral bone quality (VBQ) score, have shown promise. This study aims to improve the accuracy of predicting individuals with low total hip T-scores using a novel method that combines VBQ scores with paravertebral cross-sectional area (CSA) measurements. METHODS A retrospective cohort of 98 patients with DXA and lumbar MRI scans was analyzed. VBQ scores were calculated based on lumbar MRI images, and CSA measurements of paravertebral and psoas muscles were obtained. Threshold-based logistic regression was used to identify optimal thresholds for predicting total hip T-scores <-2.5. RESULTS The combined model incorporating the VBQ score and paravertebral muscle percent achieved an accuracy of 96.9% for predicting total hip T-scores <-2.5, compared to 81.6% when using the VBQ score alone. Incorporating paravertebral muscle measurements significantly improved the accuracy of identifying osteoporotic individuals. CONCLUSIONS The combination of VBQ score and paravertebral muscle measurements enhances the accuracy of predicting individuals with low total hip T-scores. Lumbar MRI scans provide valuable information beyond opportunistic osteoporosis screening, and the inclusion of paravertebral muscle measurements could aid in identifying at-risk individuals more accurately.
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Affiliation(s)
- Emre Özmen
- Department of Orthopedics and Traumatology, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital
| | - Ozancan Biçer
- Department of Orthopedics and Traumatology, SBU Bagcilar Training and Research Hospital
| | - Alican Bariş
- Department of Orthopedics and Traumatology, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital
| | - Esra Circi
- Department of Orthopedics and Traumatology, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital
| | - Serdar Yüksel
- Department of Orthopedics and Traumatology, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital
| | - Ozan Beytemür
- Department of Orthopedics and Traumatology, SBU Bagcilar Training and Research Hospital
| | - Fatma Nur Kesiktaş
- Department of Physical Therapy and Rehabilitation, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Istanbul, Turkey
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11
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Chen H, Zhu X, Zhou Q, Pu X, Wang B, Lin H, Zhu Z, Qiu Y, Sun X. Utility of MRI-based vertebral bone quality scores and CT-based Hounsfield unit values in vertebral bone mineral density assessment for patients with diffuse idiopathic skeletal hyperostosis. Osteoporos Int 2024; 35:705-715. [PMID: 38148381 DOI: 10.1007/s00198-023-06999-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
This study investigated bone mineral density assessment for patients with DISH. DXA-based T-scores overestimated bone quality, while MRI-based VBQ scores and CT-based HU values provided accurate assessments, particularly for advanced degenerative cases. This enhances accurate evaluation of BMD, crucial for clinical decision-making. PURPOSE To investigate the diagnostic effectiveness of DXA, MRI, and CT in assessing bone mineral density (BMD) for diffuse idiopathic skeletal hyperostosis (DISH) patients. METHODS Retrospective analysis of 105 DISH patients and 116 age-matched controls with lumbar spinal stenosis was conducted. BMD was evaluated using DXA-based T-scores, MRI-based vertebral bone quality (VBQ) scores, and CT-based Hounsfield unit (HU) values. Patients were categorized into three BMD subgroups. Lumbar osteophyte categories were determined by Mata score. Demographics, clinical data, T-scores, VBQ scores, and HU values were collected. Receiver operating characteristic (ROC) analysis identified VBQ and HU thresholds for diagnosing normal BMD using DXA in controls. Correlations between VBQ, HU, and lumbar T-score were analyzed. RESULTS Age, gender, and BMI showed no significant differences between DISH and control groups. DISH patients had higher T-score (L1-4), the lowest T-score, and Mata scores. VBQ and HU did not significantly differ between groups. In controls, VBQ and HU effectively diagnosed normal BMD (AUC = 0.857 and 0.910, respectively) with cutoffs of 3.0 for VBQ and 104.3 for HU. DISH had higher normal BMD prevalence using T-scores (69.5% vs. 58.6%, P < 0.05), but no significant differences using VBQ (57.1% vs. 56.2%, P > 0.05) and HU (58.1% vs. 57.8%, P > 0.05). Correlations revealed moderate correlations between HU and T-scores (L1-4) in DISH (r = 0.642, P < 0.001) and strong in controls (r = 0.846, P < 0.001). Moderate negative correlations were observed between VBQ and T-scores (L1-4) in DISH (r = - 0.450, P < 0.001) and strong in controls (r = - 0.813, P < 0.001). CONCLUSION DXA-based T-scores may overestimate BMD in DISH. VBQ scores and HU values could effectively complement BMD assessment, particularly in DISH patients or those with advanced lumbar degeneration.
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Affiliation(s)
- Haojie Chen
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiufen Zhu
- Department of Orthopedic Surgery, Osteoporosis and Metabolic Bone Disease Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qingshuang Zhou
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, China
| | - Xiaojiang Pu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hua Lin
- Department of Orthopedics, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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12
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Wang L, Deng Q, Wang B, Li XB, Sha ZJ, Wang ZR, Huang AB. Comparison of the predictive values of MRI-based vertebral bone quality scores for the determination of osteoporosis in different diseases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1504-1510. [PMID: 38355769 DOI: 10.1007/s00586-024-08151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/26/2023] [Accepted: 01/20/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE The study aimed to examine the consistency of vertebral bone quality (VBQ) scores for assessing osteoporosis across different etiologies and explore the predictive value of various VBQ scores for fragility vertebral fractures. METHODS Patients with fragility fractures were matched by age and sex to patients with lumbar degeneration. VBQ scores were calculated in T1- and T2-weighted magnetic resonance imaging. Differential analysis of bone quality was performed based on etiology. RESULTS A total of 96 inpatients were retrospectively enrolled. VBQT1 scores were only sensitive to osteoporotic bone in degenerative group (p < 0.01), failing to identify osteoporosis in fractured group (p > 0.05). For the degenerative group, the area under the curve (AUC) using the VBQT1 scores to differentiate osteoporosis was 0.72. After controlling the confounding variables, only VBQT2 scores were significantly higher in fractured group than degenerative group, with a greater AUC of 0.82 predicting fragility fractures. VBQT1 scores moderately correlated with femoral neck T-scores in degenerative group (r = -0.45, p < 0.01) but not in fractured group (r = -0.24, p > 0.05). VBQT2 scores were not associated with femoral neck T-scores (p > 0.05). CONCLUSION This study is the first to evaluate the effectiveness of VBQs scores in assessing osteoporosis post-fracture. Only non-fractured patients' bone quality is fully susceptible to VBQT1 scores. While VBQT1 scores may not correlate with fragility fractures, VBQT2 scores present a viable alternative.
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Affiliation(s)
- Lu Wang
- Postgraduate School, Dalian Medical University, Dalian, 116000, Liaoning, China
- Department of Rehabilitation, Taizhou People's Hospital Affiliated to Nanjing Medical University, Taizhou, 225300, Jiangsu, China
| | - Qian Deng
- Department of Orthopedics, Taizhou People's Hospital Affiliated to Nanjing Medical University, Taizhou, 225300, Jiangsu, China
- Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Bang Wang
- Postgraduate School, Dalian Medical University, Dalian, 116000, Liaoning, China
- Department of Orthopedics, Taizhou People's Hospital Affiliated to Nanjing Medical University, Taizhou, 225300, Jiangsu, China
| | - Xing-Bin Li
- Postgraduate School, Dalian Medical University, Dalian, 116000, Liaoning, China
- Department of Orthopedics, Taizhou People's Hospital Affiliated to Nanjing Medical University, Taizhou, 225300, Jiangsu, China
| | - Zhi-Jun Sha
- Department of Orthopedics, Taizhou People's Hospital Affiliated to Nanjing Medical University, Taizhou, 225300, Jiangsu, China
| | - Zhao-Rui Wang
- Postgraduate School, Dalian Medical University, Dalian, 116000, Liaoning, China
- Department of Orthopedics, Taizhou People's Hospital Affiliated to Nanjing Medical University, Taizhou, 225300, Jiangsu, China
| | - Ai-Bing Huang
- Department of Orthopedics, Taizhou People's Hospital Affiliated to Nanjing Medical University, Taizhou, 225300, Jiangsu, China.
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Li W, Wang F, Chen J, Zhu H, Tian H, Wang L. MRI‑based vertebral bone quality score is a comprehensive index reflecting the quality of bone and paravertebral muscle. Spine J 2024; 24:472-478. [PMID: 37980959 DOI: 10.1016/j.spinee.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/09/2023] [Accepted: 11/12/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Recently, vertebral bone quality (VBQ) score has been shown to predict bone mineral density (BMD) and spine-related postoperative complications. However, in clinical work, we found that patients with higher VBQ scores also had more severe paravertebral muscle degeneration. PURPOSE To explore the ability of the VBQ score to evaluate BMD and paravertebral muscle quality. STUDY DESIGN/SETTING Retrospective single-center cohort. PATIENT SAMPLE Patients in the spinal surgery department of our hospital. OUTCOME MEASURES Bone mineral density and T-score were measured by dual-energy X-ray absorptiometry (DXA). The Picture Archiving and Communication Systems (PACS) measured the cross-sectional area (CSA) of the paravertebral muscles. Image J software was used to measure the degree of fat infiltration (DFF) of the paraspinal muscle. METHODS Patients who underwent lumbar MRI and DXA simultaneously within two weeks were enrolled. The VBQ score was calculated using T1-weighted lumbar MRI images. Firstly, BMD-related and muscle-related parameters of patients with different VBQ scores were compared. Then, the correlation coefficients between the VBQ score and the parameters of BMD and paravertebral muscle were calculated. Finally, multivariate linear analysis was used to compare the contribution of each variable to the VBQ score. RESULTS A total of 101 patients were eventually included in this study for analysis. When the VBQ score was greater than 3.0, the patients were mostly female, older, less likely to smoke, and had lower BMD. Interestingly, we found that patients with VBQ scores greater than 3.0 had smaller CSA of the paravertebral muscles (ES: 17.53±3.36 vs 19.13±3.97, p=.032; total: 29.59±5.27 vs 34.12±7.02, p<.001) and higher DFF (MF: 22.47±5.93 vs 19.64±5.28, p=.015; ES: 17.71±4.67 vs 15.74±4.62, p=.038; PM: 13.70±3.32 vs 11.33±3.02, p<.001; average: 17.96±3.78 vs 15.57±3.42, p=.001). The VBQ score was negatively correlated with the CSA (MF: r=-0.316, p=.001; ES: r =-0.388, p=.001; PM: r=0.388, p=.001) and positively correlated with the DFF (MF: r=0.344, p<.001; ES: r=0.439, p<.001; PM: =0.416, p<.001). In multivariate linear analysis, BMD, total CSA, and average DFF determined the value of the VBQ score, and the contribution of paravertebral muscle was higher than that of BMD (BMD: r=-0.203, p=.024; total CSA: r=-0.294, p=.003; average DFF: r=0.261, p=.011). CONCLUSIONS This study is the first to find a positive association between the VBQ score and paravertebral muscle degeneration, and this association may be independent of BMD. VBQ can reflect the quality of bone and paravertebral muscle, which is its special advantage in clinical application.
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Affiliation(s)
- Wenshuai Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University,139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China
| | - Feng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University,139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China
| | - Junyi Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University,139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China
| | - Houze Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University,139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China
| | - Hongsen Tian
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University,139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University,139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China.
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Yen TY, Ho CS, Chen YP, Pei YC. Diagnostic Accuracy of Deep Learning for the Prediction of Osteoporosis Using Plain X-rays: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:207. [PMID: 38248083 PMCID: PMC10814351 DOI: 10.3390/diagnostics14020207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
(1) Background: This meta-analysis assessed the diagnostic accuracy of deep learning model-based osteoporosis prediction using plain X-ray images. (2) Methods: We searched PubMed, Web of Science, SCOPUS, and Google Scholar from no set beginning date to 28 February 2023, for eligible studies that applied deep learning methods for diagnosing osteoporosis using X-ray images. The quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. The area under the receiver operating characteristic curve (AUROC) was used to quantify the predictive performance. Subgroup, meta-regression, and sensitivity analyses were performed to identify the potential sources of study heterogeneity. (3) Results: Six studies were included; the pooled AUROC, sensitivity, and specificity were 0.88 (95% confidence interval [CI] 0.85-0.91), 0.81 (95% CI 0.78-0.84), and 0.87 (95% CI 0.81-0.92), respectively, indicating good performance. Moderate heterogeneity was observed. Mega-regression and subgroup analyses were not performed due to the limited number of studies included. (4) Conclusion: Deep learning methods effectively extract bone density information from plain radiographs, highlighting their potential for opportunistic screening. Nevertheless, additional prospective multicenter studies involving diverse patient populations are required to confirm the applicability of this novel technique.
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Affiliation(s)
- Tzu-Yun Yen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou No. 5, Fuxing Street, Guishan District, Taoyuan City 333, Taiwan; (T.-Y.Y.); (C.-S.H.)
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City 333, Taiwan
| | - Chan-Shien Ho
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou No. 5, Fuxing Street, Guishan District, Taoyuan City 333, Taiwan; (T.-Y.Y.); (C.-S.H.)
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City 333, Taiwan
| | - Yueh-Peng Chen
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou No. 5, Fuxing Street, Guishan District, Taoyuan City 333, Taiwan;
- Master of Science Degree Program in Innovation for Smart Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City 333, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou No. 5, Fuxing Street, Guishan District, Taoyuan City 333, Taiwan; (T.-Y.Y.); (C.-S.H.)
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City 333, Taiwan
- Master of Science Degree Program in Innovation for Smart Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City 333, Taiwan
- Center of Vascularized Tissue Allograft, Gung Memorial Hospital, Linkou No. 5, Fuxing Street, Guishan District, Taoyuan City 333, Taiwan
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15
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Gao Y, Ye W, Ge X, Wang H, Xiong J, Zhu Y, Wang Z, Wang J, Tang P, Liu W, Cai W. Assessing the utility of MRI-based vertebral bone quality (VBQ) for predicting lumbar pedicle screw loosening. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:289-297. [PMID: 37981599 DOI: 10.1007/s00586-023-08034-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 10/18/2023] [Accepted: 10/28/2023] [Indexed: 11/21/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The purpose of this study is to assess the potential of utilizing the MRI-based vertebral bone quality (VBQ) score as a predictive tool for pedicle screw loosening (PSL) in patients who have undergone pedicle screw fixation and to identify risk factors associated with VBQ scores. METHODS One hundred and sixteen patients who had undergone pedicle screw fixation between December 2019 and January 2021 and had more than a year of follow-up were divided into two groups of PSL and non-PSL. The radiological and clinical parameters investigated were age, gender, body mass index, the VBQ score, length of fusion and the DXA T-score. RESULTS Of the 116 patients included in the study, 22 patients developed pedicle screw loosening after surgery (18.97%). VBQ score of PSL group was higher than the non-PSL group (3.61 ± 0.63 vs. 2. 86 ± 0.43, p < 0.001). According to logistic regression, PSL was independently linked with a higher VBQ score (OR = 3.555, 95% confidence interval [1.620-7.802], p < 0.005). The AUC of predicting screw loosening was 0.774 (p < 0.001) for VBQ score, and the best threshold was 3.055 (sensitivity, 81.8%; specificity, 71.3%). High VBQ score was associated with age (r (114) = 0.29, p = 0.002), while it was not negatively correlated with T-scores of each part. CONCLUSION VBQ score is an independent predictor of pedicle screw loosening, with higher scores indicating a greater risk. Our results showed that older patients and women had higher VBQ scores.
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Affiliation(s)
- Yu Gao
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Wu Ye
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Xuhui Ge
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Haofan Wang
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Junjun Xiong
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Yufeng Zhu
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Zhuanghui Wang
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Jiaxing Wang
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Pengyu Tang
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Wei Liu
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
| | - Weihua Cai
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
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Zhang B, Zhou LP, Zhang XL, Li D, Wang JQ, Jia CY, Zhang HQ, Kang L, Zhang RJ, Shen CL. Which Indicator Among Lumbar Vertebral Hounsfield Unit, Vertebral Bone Quality, or Dual-Energy X-Ray Absorptiometry-Measured Bone Mineral Density Is More Efficacious in Predicting Thoracolumbar Fragility Fractures? Neurospine 2023; 20:1193-1204. [PMID: 38171288 PMCID: PMC10762399 DOI: 10.14245/ns.2346998.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/12/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Hounsfield units (HU), vertebral bone quality (VBQ), and bone mineral density (BMD) can all serve as predictive indicators for thoracolumbar fragility fractures. This study aims to explore which indicator provides better risk prediction for thoracolumbar fragility fractures. METHODS Patients who have received medical attention from The First Affiliated Hospital of Anhui Medical University for thoracolumbar fragility fractures were selected. A total of 78 patients with thoracolumbar fragility fractures were included in the study. To establish a control group, 78 patients with degenerative spinal diseases were matched to the fracture group on the basis of gender, age, and body mass index. The lumbar vertebral HU, the VBQ, and the BMD were obtained for all the 156 patients through computed tomography, magnetic resonance imaging, and dual-energy x-ray absorptiometry (DEXA). The correlations among these parameters were analyzed. The area under curve (AUC) analysis was employed to assess the predictive efficacy and thresholds of lumbar vertebral HU, VBQ, and BMD in relation to the risk of thoracolumbar fragility fractures. RESULTS Among the cohort of 156 patients, lumbar vertebral HU exhibited a positive correlation with BMD (p < 0.01). Conversely, VBQ showed a negative correlation with HU, BMD (p < 0.05). HU and BMD displayed a favorable predictive efficacy for thoracolumbar fragility fractures (p < 0.01), with HU (AUC = 0.863) showcasing the highest predictive efficacy, followed by the DEXA-measured BMD (AUC = 0.813). VBQ (AUC = 0.602) ranked lowest among the 3 indicators. The thresholds for predicting thoracolumbar fragility fractures were as follows: HU (88),VBQ (3.37), and BMD (0.81). CONCLUSION All 3 of these indicators, HU, VBQ, and BMD, can predict thoracolumbar fragility fractures. Notably, lumbar vertebral HU exhibits the highest predictive efficacy, followed by the BMD obtained through DEXA scanning, with VBQ demonstrating the lowest predictive efficacy.
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Affiliation(s)
- Bo Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lu-Ping Zhou
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xian-Liang Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dui Li
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jia-Qi Wang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chong-Yu Jia
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hua-Qing Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liang Kang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ren-Jie Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cai-Liang Shen
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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Liu D, Kadri A, Hernando D, Binkley N, Anderson PA. MRI-based vertebral bone quality score: relationship with age and reproducibility. Osteoporos Int 2023; 34:2077-2086. [PMID: 37640844 DOI: 10.1007/s00198-023-06893-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
Vertebral bone quality (VBQ) score is an opportunistic measure of bone mineral density using routine preoperative MRI in spine surgery. VBQ score positively correlates with age and is reproducible across serial scans. However, extrinsic factors, including MRI machine and protocol, affect the VBQ score and must be standardized. PURPOSE The purposes of this study were to determine whether VBQ score increased with age and whether VBQ remained consistent across serial MRI studies obtained within 3 months. METHODS This retrospective study evaluated 136 patients, age 20-69, who received two T1-weighted lumbar MRI within 3 months of each other between January 2011 and December 2021. VBQ(L1-4) score was calculated as the quotient of L1-L4 signal intensity (SI) and L3 cerebral spinal fluid (CSF) SI. VBQ(L1) score was calculated as the quotient of L1 SI and L1 CSF SI. Regression analysis was performed to determine correlation of VBQ(L1-4) score with age. Coefficient of variation (CV) was used to determine reproducibility between VBQ(L1-4) scores from serial MRI scans. RESULTS One hundred thirty-six patients (mean ± SD age 44.9 ± 12.5 years; 53.7% female) were included in this study. Extrinsic factors affecting the VBQ score included patient age, MRI relaxation time, and specific MRI machine. When controlling for MRI relaxation/echo time, the VBQ(L1-4) score was positively correlated with age and had excellent reproducibility in serial MRI with CV of 0.169. There was excellent agreement (ICC > 0.9) of VBQ scores derived from the two formulas, VBQ(L1) and VBQ(L1-4). CONCLUSION Extrinsic factors, including MRI technical factors and age, can impact the VBQ(L1-4) score and must be considered when using this tool to estimate bone mineral density (BMD). VBQ(L1-4) score was positively correlated with age. Reproducibility of the VBQ(L1-4) score across serial MRI is excellent especially when controlling for technical factors, supporting use of the VBQ score in estimating BMD. The VBQ(L1) score was a reliable alternative to the VBQ(L1-4) score.
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Affiliation(s)
- Daniel Liu
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792-3252, USA.
| | - Aamir Kadri
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Diego Hernando
- Department of Radiology and Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Neil Binkley
- Osteoporosis Clinical Research Program, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792-3252, USA
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Chen A, Feng S, Lai L, Yan C. A meta-analysis of the value of MRI-based VBQ scores for evaluating osteoporosis. Bone Rep 2023; 19:101711. [PMID: 37681002 PMCID: PMC10480551 DOI: 10.1016/j.bonr.2023.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
Objective Osteoporosis is the most common skeletal disease in humans. Early onset of osteoporosis is usually asymptomatic, so early diagnosis is critical. The purpose of this study was to analyze the value of MRI-based VBQ scores for evaluating osteoporosis. Methods We searched PubMed, Embase, the Cochrane Library databases, Web of Science, and some Chinese electronic databases for published articles and the ClinicalTrials.gov site for completed but unpublished studies on evaluating the value of MRI-based VBQ scores for evaluating osteoporosis. We calculated the summarized sensitivity, specificity, the ROC curve (AUC) values and their 95% confidence intervals (CIs) using MetaDiSc 1.4 software and STATA. Results Our study included 8 studies involving 999 patients of which 660 patients were diagnosed with osteopenia/osteoporosis, and 339 patients were identified as having normal BMD. The pooled sensitivity was 0.809 (95% CI, 0.777-0.838, I 2 = 78.8%), the pooled specificity was 0.640 (95% CI, 0.587-0.691, I 2 = 85.9%), and the pooled AUC was 0.8375. Conclusion MRI-based VBQ scores provided high sensitivity and moderate specificity in detecting osteoporosis. Opportunistic use of VBQ scores could be considered, e.g. before lumbar spine surgery. Prospero registration number CRD42022377024.
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Affiliation(s)
- Ang Chen
- Department of Endocrinology, Northern Jiangsu People's Hospital, The First Clinical College of Dalian Medical University, Yangzhou 225001, Jiangsu, China
| | - Shangyong Feng
- Department of Endocrinology, Northern Jiangsu People's Hospital, The First Clinical College of Dalian Medical University, Yangzhou 225001, Jiangsu, China
| | - Lijuan Lai
- Department of Endocrinology, Northern Jiangsu People's Hospital, The First Clinical College of Dalian Medical University, Yangzhou 225001, Jiangsu, China
| | - Caifeng Yan
- Department of Endocrinology, Northern Jiangsu People's Hospital, The First Clinical College of Dalian Medical University, Yangzhou 225001, Jiangsu, China
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Sim JZT, Bhanu Prakash KN, Huang WM, Tan CH. Harnessing artificial intelligence in radiology to augment population health. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1281500. [PMID: 38021439 PMCID: PMC10663302 DOI: 10.3389/fmedt.2023.1281500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
This review article serves to highlight radiological services as a major cost driver for the healthcare sector, and the potential improvements in productivity and cost savings that can be generated by incorporating artificial intelligence (AI) into the radiology workflow, referencing Singapore healthcare as an example. More specifically, we will discuss the opportunities for AI in lowering healthcare costs and supporting transformational shifts in our care model in the following domains: predictive analytics for optimising throughput and appropriate referrals, computer vision for image enhancement (to increase scanner efficiency and decrease radiation exposure) and pattern recognition (to aid human interpretation and worklist prioritisation), natural language processing and large language models for optimising reports and text data-mining. In the context of preventive health, we will discuss how AI can support population level screening for major disease burdens through opportunistic screening and democratise expertise to increase access to radiological services in primary and community care.
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Affiliation(s)
- Jordan Z. T. Sim
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - K. N. Bhanu Prakash
- Clinical Data Analytics & Radiomics, Cellular Image Informatics, Bioinformatics Institute, Singapore, Singapore
| | - Wei Min Huang
- Healthcare-MedTech Division & Visual Intelligence Department, Institute for Infocomm Research, Singapore, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Chen Q, Ai Y, Huang Y, Li Q, Wang J, Ding H, Zhu C, Feng G, Liu L. MRI-based Endplate Bone Quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion. Spine J 2023; 23:1652-1658. [PMID: 37442209 DOI: 10.1016/j.spinee.2023.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/16/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND CONTEXT Cage subsidence following transforaminal lumbar interbody fusion (TLIF) has closely correlated with poor vertebral bone quality. Studies have shown better predictive value for cage subsidence by measuring bone density at specific site. However, few studies have been performed to examine the relationship between site-specific MRI bone assessment and cage subsidence in patients who have undergone lumbar interbody fusion. The association between MRI-based assessment of endplate bone quality and cage subsidence after TLIF remains unclear. PURPOSE To study the predictive value of MRI-based endplate bone quality (EBQ) score for cage subsidence following TLIF, using QCT bone densitometry as a reference standard. STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE A total of 280 adult patients undergoing single-segment TLIF for degenerative lumbar spine disease from 2010 to 2020 at our institution who had preoperative T1-weighted MRIs. OUTCOME MEASURES Cage subsidence, disc height, endplate bone quality (EBQ) score, bone mineral density, fusion rate. METHODS The retrospective study reviewed patients who underwent TLIF at one institution between March 2010 and October 2020. Cage subsidence was measured with postoperative lumbar X-rays based on the cage protrusion through into the superior or inferior end plate or both by more than 2 mm. The EBQ score was measured from preoperative T1-weighted MRI in accordance with the previously reported method. RESULTS Cage subsidence was observed in 42 of the 280 patients. Bone densitometry with quantitative computed tomography was visibly reduced in the subsidence group. The mean EBQ scores of the lumbar endplate bone was 4.3±0.9 in nonsubsidence and 5.0±0.6 in subsidence. On multivariate logistic regression, the difference between the two groups was remarkable. Risk of cage subsidence increases significantly with higher EBQ scores (odds ratio [OR]=2.063, 95% confidence interval [CI] 1.365-3.120, p=.001) and was an independent factor in predicting subsidence after TLIF. On receiver operating characteristic curve, the AUC for the EBQ score was 0.820 (95% confidence interval [CI]: 0.755-0.844) and the most suitable threshold for the EBQ score was 4.730 (sensitivity: 76.2%, specificity: 83.2%). CONCLUSIONS Higher EBQ scores measured on preoperative MRI correlated significantly with cage subsidence following TLIF. Performing EBQ assessment prior to TLIF may be a valid method of predicting the risk of postoperative subsidence.
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Affiliation(s)
- Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37 Guoxue alley, Chengdu 610041, Sichuan, China; Department of Orthopaedics and Laboratory of Biological Tissue, Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, No. 1 South Maoyuan Road, Nanchong 637000, Sichuan, China
| | - Youwei Ai
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37 Guoxue alley, Chengdu 610041, Sichuan, China
| | - Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37 Guoxue alley, Chengdu 610041, Sichuan, China
| | - Qiujiang Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37 Guoxue alley, Chengdu 610041, Sichuan, China
| | - Juehan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37 Guoxue alley, Chengdu 610041, Sichuan, China
| | - Hong Ding
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37 Guoxue alley, Chengdu 610041, Sichuan, China
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37 Guoxue alley, Chengdu 610041, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37 Guoxue alley, Chengdu 610041, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37 Guoxue alley, Chengdu 610041, Sichuan, China.
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Yin H, Lin W, Xie F, He C, Chen T, Zheng G, Wang Z. MRI-based Vertebral Bone Quality Score for Osteoporosis Screening Based on Different Osteoporotic Diagnostic Criteria Using DXA and QCT. Calcif Tissue Int 2023; 113:383-392. [PMID: 37493798 DOI: 10.1007/s00223-023-01115-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023]
Abstract
In this study, we aim to evaluate the correlation between T score measured by dual X-ray absorptiometry (DXA), volumetric bone mineral density (vBMD) derived from quantitative computed tomography (QCT) and MRI-based vertebral bone quality (VBQ), explore the diagnostic performance of VBQ in osteoporosis and determine the recognition value of VBQ in osteoporotic fracture in a relatively large cohort of elderly patients scheduled to undergo spinal surgery. A total of 260 patients were enrolled in the study. DXA and QCT were used to evaluate osteoporotic status. We calculated the lumbar VBQ score, analyzed the correlation between T score, vBMD and VBQ, and explored whether VBQ was an influential factor of bone quality and fracture by binary logistic regression as well as the diagnostic performance of VBQ in osteoporosis and fracture by ROC curve. VBQ was negatively correlated with vBMD and T score. (r = - 0.487 vs. r = - 0.220). The VBQ score was a risk factor for osteoporosis under the QCT diagnostic criteria (OR = 2.245, 95% CI 1.456-3.460) and osteoporotic fractures (OR = 1.496, 95% CI 1.097-2.040). It exhibited superior discriminant performance for osteoporosis diagnosed by QCT, with a cutoff value of 3.70 and an AUC of 0.7354. Its cutoff value for osteoporotic fractures was 3.72, and its AUC was 0.6717. In a cohort of elderly patients scheduled to undergo spinal surgery, the VBQ score was more strongly associated with vBMD than the T score and could identify patients with osteoporosis and corresponding vertebral compression fracture (VCF).
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Affiliation(s)
- Houjie Yin
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
- The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Wentao Lin
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Faqin Xie
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Chaoqin He
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
- The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Tao Chen
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
- The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Guanghao Zheng
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
- The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhiyun Wang
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China.
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Choo PZQ, Lim TCC, Tan CH. Transforming radiology to support population health. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:476-480. [PMID: 38920194 DOI: 10.47102/annals-acadmedsg.202360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
This commentary highlights key areas in which diagnostic radiological services in Singapore will need to evolve in order to address the needs of Healthier SG and population health. Policymakers should focus on “doing the right thing” by improving access to radiological expertise and services to support community and primary care and “doing the thing right” by establishing robust frameworks to support value-based care.
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Affiliation(s)
| | | | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
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Li W, Zhu H, Tian H, Tong T, Hua Z, Zhao X, Shen Y, Wang L. Combinations of two imaging parameters to improve bone mineral density (BMD) assessment in patients with lumbar degenerative diseases. BMC Musculoskelet Disord 2023; 24:747. [PMID: 37735402 PMCID: PMC10512586 DOI: 10.1186/s12891-023-06888-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE To explore whether combining the Hounsfield unit (HU) values and vertebral bone quality (VBQ) scores can improve the BMD assessment in patients with lumbar degenerative diseases. METHODS The HU values were measured by CT image, and VBQ scores were calculated by lumbar MRI image. The correlations of the opportunistic imaging parameters to the lowest T-scores were analyzed. Receiver-operating characteristic curve (ROC) analysis was used to evaluate the accuracy in detecting osteoporosis. Finally, the specificity and sensitivity of different combined methods of the HU values and VBQ scores in the diagnosis of osteoporosis were compared. RESULTS Patients with osteoporosis had the lowest HU values and the highest VBQ scores. The correlation coefficients between the VBQ scores and the T-scores were smaller than HU values (L1 HU value: 0.702; average HU value:0.700; L1 VBQ score: -0.413; VBQ score: -0.386). The areas under the curve (AUCs) of the HU values were greater than those of the VBQ scores, and the AUCs of the L1 VBQ score were similar to the VBQ score (L1 HU value: 0.850; average HU value:0.857; L1 VBQ score: 0.704; VBQ score: 0.673). When combining the two imaging parameters in series, the specificity of the detection of osteoporosis was improved (L1 HU value and L1 VBQ score: 87.3%; Average HU value and VBQ score: 85.9%). When combining the two imaging parameters in parallel, the sensitivity of the detection of osteoporosis was improved (L1 HU value or L1 VBQ score: 88.1%; Average HU value or VBQ score: 91.5%). CONCLUSIONS Combinations of the HU values and VBQ scores could improve the diagnostic performance of osteoporosis. In addition, considering the same diagnostic performance but easier measurement, parameters at the single-segment level were recommended to assist in the diagnosis of osteoporosis.
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Affiliation(s)
- Wenshuai Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Houze Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Hongsen Tian
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Tong Tong
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Zijian Hua
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Xuan Zhao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Yong Shen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China.
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
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Courtois EC, Ohnmeiss DD, Guyer RD. Assessing lumbar vertebral bone quality: a methodological evaluation of CT and MRI as alternatives to traditional DEXA. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3176-3182. [PMID: 37439864 DOI: 10.1007/s00586-023-07855-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 04/20/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE The purpose of this study was to investigate the impact of various methods on the assessment of vertebral bone quality. METHODS A consecutive series of 427 candidates for lumbar disc replacement with lumbar DEXA and MRI and/or CT scans were included. Two measurement techniques were used on CTs-a sagittal and axial. From axial images, the upper, mid, and lower portions of each vertebral body were measured. Four MRI vertebral bone quality (VBQ) calculations were generated using separate equations. RESULTS All CT measures were highly correlated with each other, regardless of measurement or calculation method (range 0.925-0.995). Sagittal measurements were highly correlated with axial (r = 0.928, p < 0.001). CT values were correlated with DEXA (range 0.446-0.534). There was no benefit to measuring multiple axial images of each vertebral body vs. just midbody (r = 0.441 and 0.455, respectively). No MRI VBQ values were highly correlated with DEXA (r = - 0.103, p = 0.045). In receiver operating curve analysis, the area under the curve ranged from 0.539 to 0.558, indicating poor ability of VBQ to identify osteoporosis/osteopenia. CONCLUSION CT produced values more closely related to DEXA, while MRI was less reliable for osteoporosis/osteopenia screening. On CT, there was no benefit to making multiple measurements for each vertebral body to calculate a composite. Measuring sagittal CT images produced values similar to axial and required less time. While assessing bone quality from existing images rather than getting an additional DEXA scan is appealing, the methods of measuring these images needs standardization to maximize their utility.
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Affiliation(s)
| | - Donna D Ohnmeiss
- Texas Back Institute Research Foundation, 6020 W Parker Rd #200, Plano, TX, 75093, USA.
| | - Richard D Guyer
- Center for Disc Replacement at Texas Back Institute, Plano, TX, USA
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Kaya HE, Akay T, Gökalp G. Can the greater trochanter/femoral neck signal intensity ratio on coronal T1 weighted images of the hip differentiate normal-abnormal bone mineral density? Arch Osteoporos 2023; 18:102. [PMID: 37468694 DOI: 10.1007/s11657-023-01313-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
A simple index calculated by dividing the greater trochanter signal intensity by that of the femoral neck on coronal T1-weighted magnetic resonance images of the hip may be useful as an opportunistic screening tool to differentiate normal vs. abnormal bone mineral density. PURPOSE The aim of this study is to evaluate the efficacy of the greater trochanter/femoral neck (T/N) signal intensity (SI) ratio on T1 weighted images of the hip in differentiating patients with normal vs. abnormal bone mineral density (BMD) using hip dual-energy x-ray absorptiometry (DXA) as the reference. METHODS Three BMD groups according to the T score of the femoral neck (i.e., normal, osteopenia, and osteoporosis) were created, and 20 patients were included for each group. The T/N ratio was calculated by dividing the greater trochanter SI by that of the femoral neck on coronal T1-weighted images. Receiver-operator characteristic (ROC) analysis was performed to determine diagnostic efficacy. RESULTS The mean age was 59.2±9.4; there were 57 women and 3 men. The mean BMD was 0.67±0.14 g/cm2. The mean T/N ratio for the normal, osteopenia, and osteoporosis groups were 1.37 (±0.12), 1.19 (±0.10), and 1.18 (±0.13), respectively. When the osteopenia and osteoporosis groups were combined into one group, i.e., low BMD group, the mean T/N ratio was 1.18 (±0.11), and it was significantly different from that of the normal BMD group (p<0.00001). In ROC analysis, the area under curve (AUC) for the T/N ratio in the diagnosis of low BMD was 0.870. An optimal cutoff value of 1.28 was found for the differentiation of normal vs. abnormal BMD with 80% sensitivity and 80% specificity. CONCLUSIONS The T/N ratio seems to be effective at differentiating patients with normal vs. abnormal BMD and may help triage patients for additional evaluation.
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Affiliation(s)
- Hasan Emin Kaya
- School of Medicine, Department of Radiology, Görükle Campus, Bursa Uludağ University, 16059, Bursa, Turkey.
| | - Tayfun Akay
- School of Medicine, Department of Radiology, Görükle Campus, Bursa Uludağ University, 16059, Bursa, Turkey
| | - Gökhan Gökalp
- School of Medicine, Department of Radiology, Görükle Campus, Bursa Uludağ University, 16059, Bursa, Turkey
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Li W, Zhu H, Liu J, Tian H, Li J, Wang L. Characteristics of MRI‑based vertebral bone quality scores in elderly patients with vertebral fragility fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2588-2593. [PMID: 37133764 DOI: 10.1007/s00586-023-07744-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/17/2023] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To explore the characteristics of vertebral bone quality (VBQ) scores in patients with vertebral fragility fractures, including VBQ score and single-level VBQ score, and evaluate their effectiveness as predictors. METHODS The VBQ scores were measured using T1-weighted MRI images. VBQ scores were compared in patients with different times of previous fragility fractures. In addition, patients with fractures were matched for age and sex with patients without fractures, and VBQ scores were compared between the two groups. Finally, the predictive efficiency of VBQ scores for vertebral fragility fractures was analyzed by the receiver-operator curve (ROC). RESULTS The average VBQ score and single-level VBQ score in patients with fractures were 3.48 ± 0.56 and 3.60 ± 0.60 and no difference among patients with different times of previous fractures. As for the age- and sex-matched patients, fracture patients had higher VBQ scores (VBQ score: 3.48 ± 0.56 vs. 2.88 ± 0.40, p < 0.001; single-level VBQ score: 3.60 ± 0.60 vs. 2.95 ± 0.44, p < 0.001). The AUCs using the VBQ score and single-level VBQ score to predict fragility fractures were 0.815 and 0.817, respectively. The optimal thresholds of the VBQ score and single-level VBQ score for predicting fragility fractures were 3.22 and 3.16, respectively. CONCLUSION MRI‑based VBQ scores are important predictors of vertebral fragility fracture but have no predictive value for the recurrence of fractures in patients with a history of fragility fractures. The VBQ score of 3.22 and single-level VBQ score of 3.16 are optimal thresholds that can be used when using lumbar MRI scans to identify individuals at high risk for fragility fractures.
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Affiliation(s)
- Wenshuai Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Houze Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Junchuan Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Hongsen Tian
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Jia Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China.
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
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Pu X, Li H. Letter to the editor regarding "Opportunistic Use of Lumbar Magnetic Resonance Imaging for Osteoporosis Screening". Osteoporos Int 2023:10.1007/s00198-023-06801-y. [PMID: 37341730 DOI: 10.1007/s00198-023-06801-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Xingxiao Pu
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, People's Republic of China
| | - Haifeng Li
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, People's Republic of China.
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, 245# Panlong, Renmingdonglu, Kunming, Yunnan, 650051, People's Republic of China.
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Jain M, Naik S, Mishra NP, Tripathy SK, Neha A, Sahu DP, KP L. Correlation of bone mineral density using the dual energy x-ray absorptiometry and the magnetic resonance imaging of the lumbar spine in Indian patients. J Orthop 2023; 40:65-69. [PMID: 37188144 PMCID: PMC10172620 DOI: 10.1016/j.jor.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Background Dual-energy x-ray absorptiometry (DEXA) scan is extensively used to diagnose osteoporosis. But surprisingly, osteoporosis remains an underdiagnosed condition with many fragility fracture patients who have failed to undergo DEXA or received concomitant treatment for osteoporosis. Magnetic resonance imaging (MRI) of the lumbar spine is a routine radiological investigation bring done for low back pain. MRI can detect changes in the bone marrow signal intensity on the standard T1-weighted images. This correlation can be explored to measure osteoporosis in elderly and post-menopausal patients. The present study aims to find any correlation of bone mineral density using the DEXA and MRI of the lumbar spine in Indian patients. Methods Five regions of interest (ROI) of size 130-180 mm2 were placed in the vertebral body in the mid-sagittal section and parasagittal sections on either side (four in L1-L4 and one outside body) of elderly patients who underwent MRI for back pain. They also underwent a DEXA scan for osteoporosis. Signal to Noise Ratio (SNR) was calculated by dividing the mean signal intensity obtained for each vertebra by the standard deviation of the noise. Similarly, SNR was measured for 24 controls. An MRI-based "M score" was calculated by getting the difference in SNR patients to SNR controls and then dividing it by the control's standard deviation (SD). Correlation between the T score on DEXA and M scores on MRI was found out. Results With the M score greater than or equal to 2.82, the sensitivity was 87.5%, and the specificity was 76.5%. M scores negatively correlated with the T score. With the increase in the T score, the M score decreased. The Spearman correlation coefficient for the spine T score was -0.651, with a p-value of <0.001, and the hip T score was -0.428, with a p-value of 0.013. Conclusion Our study indicates that MRI investigations are helpful in Osteoporosis assessments. Even though MRI may not replace DEXA, it can give insight into elderly patients who get an MRI routinely for back pain. It may also have a prognostic value.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Suprava Naik
- Department of Radiodiagnosis, AIIMS Bhubaneswar, Odisha, 751019, India
| | | | | | - Aishwarya Neha
- Department of Radiodiagnosis, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Dinesh Prasad Sahu
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Lubaib KP
- Department of Orthopedics, AIIMS Bhubaneswar, Odisha, 751019, India
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Lin W, He C, Xie F, Chen T, Zheng G, Yin H, Chen H, Wang Z. Assessment of bone density using the 1.5 T or 3.0 T MRI-based vertebral bone quality score in older patients undergoing spine surgery: Does field strength matter? Spine J 2023:S1529-9430(23)00152-3. [PMID: 37031891 DOI: 10.1016/j.spinee.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/25/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND CONTEXT Recently published studies have revealed a correlation between MRI-based vertebral bone quality (VBQ) score and bone mineral density (BMD) measured using dual X-ray absorptiometry (DXA) or quantitative computed tomography (QCT). However, no studies have determined if differences in field strength (1.5 vs. 3.0 T) could affect the comparability of the VBQ score among different individuals. PURPOSE To compare the VBQ score obtained from 1.5 T and 3.0 T MRI (VBQ1.5T versus VBQ3.0T) in patients undergoing spine surgery and assess the predictive performance of VBQ for osteoporosis and osteoporotic vertebral fracture (VCF). DESIGN A nested case‒control study based on an ongoing prospective cohort study of patients undergoing spine surgery. PATIENT SAMPLE All older patients (men aged > 60 years and postmenopausal women) with available DXA, QCT and MR images within one month were included. OUTCOME MEASURES VBQ score, DXA T-score, and QCT derived vBMD. METHODS The osteoporotic classifications recommended by the World Health Organization and American College of Radiology were used to categorize the DXA T-score and QCT-derived BMD, respectively. For each patient, the VBQ score was calculated using T1-weighted MR images. Correlation analysis between VBQ and DXA/QCT was performed. Receiver operating characteristic (ROC) curve analysis, including determination of the area under the curve (AUC), was performed to assess the predictive performance of VBQ for osteoporosis. RESULTS A total of 452 patients (98 men aged > 60 years and 354 postmenopausal women) were included in the analysis. Across different BMD categories, the correlation coefficients between the VBQ score and BMD ranged from -0.211 to -0.511, and the VBQ1.5T score and QCT BMD demonstrated the strongest correlation. The VBQ score was a significant classifier of osteoporosis detected by either DXA or QCT, with VBQ1.5T showing the highest discriminative power for QCT-osteoporosis (AUC = 0.744, 95% CI = 0.685-0.803). In ROC analysis, the VBQ1.5T threshold values ranged from 3.705 to 3.835 with a sensitivity between 48% and 55.6% and a specificity between 70.8% and 74.8%, while the VBQ3.0T threshold values ranged from 2.59 to 2.605 with a sensitivity between 57.6% and 67.1% and a specificity between 67.8% and 69.7%. CONCLUSIONS VBQ1.5T exhibited better discriminability between patients with and without osteoporosis than VBQ3.0T. Considering the nonnegligible difference in osteoporosis diagnosis threshold values between the VBQ1.5T and VBQ3.0T scores, it is essential to clearly distinguish the magnetic field strength when assessing the VBQ score.
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Affiliation(s)
- Wentao Lin
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Chaoqin He
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Faqin Xie
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Tao Chen
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Guanghao Zheng
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Houjie Yin
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Haixiong Chen
- Department of Radiology and Image, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Zhiyun Wang
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China.
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