Patient physiology influences the MRI-based vertebral bone quality score |
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| Institution: | 1. Geisinger Commonwealth School of Medicine, 525 Pine St., Scranton, PA 18510, USA;2. Department of Spine Surgery, Geisinger Musculoskeletal Institute, 3 W. Olive St., Scranton, PA 18508, USA;1. Consultant Spine surgeon, Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu. India;2. Fellow in spine surgery, Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu. India;3. Senior Consultant and Academic Director, Department of Anaesthesia, Ganga Hospital, Coimbatore, Tamil Nadu. India;4. Consultant Spine surgeon, Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu. India;5. Chairman and Director, Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu. India;1. Department of Orthopedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110 USA;2. Department of Neurosurgery, Northwell Health Chair of Neurosurgery at North Shore University Hospital and Long Island Jewish Medical Center, NY, USA;3. Institute for Neurology and Neurosurgery, Northwell Health and Chair of Neurosciences, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, NY, USA;1. École de réadaptation, Université de Montréal, 7077 Av du Parc, Montreal, Quebec, Canada, H3N1×7;2. Sainte-Justine University Hospital Center, 3175 Chem. de la Côte-Sainte-Catherine, Montreal, Quebec, Canada, H3T1C5;3. Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta, Canada, T6G2G4;5. University La Statale, Via Festa del Perdono 7, 20121 Milan, Italy;6. IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy;1. Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA;2. Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave Ste 1100, Nashville, TN 37203, USA;3. Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA;4. Department of Neurosurgery, Mayo Clinic, 200 First St SW Floor 8. Rochester, MN 55905, USA;5. Neuroscience Institute, Atrium Health and Department of Neurosurgery, Carolinas Medical Center, Charlotte, North Carolina; Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, 1021 Morehead Medical Dr, Charlotte, NC 28204, USA;6. Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, 3401 West End Ave Suite 380, Nashville, TN 37203, USA;7. Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN 37212, USA;1. Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, 3204, New Zealand;2. Department of Surgery, University of Auckland, Auckland, New Zealand |
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| Abstract: | BACKGROUND CONTEXTOsteoporosis is a critical issue affecting postmenopausal women and the aging population. A novel magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score has been proposed as a method to identify poor bone quality and predict fragility fractures. The diagnostic accuracy of this tool is not well understood.PURPOSETo examine the ability of VBQ to predict osteoporosis and osteopenia, its correlation with dual-energy x-ray absorptiometry (DEXA), and the influence of patient-specific factors upon the score.STUDY DESIGNRetrospective cohort study.PATIENT SAMPLEPatients over the age of 18 with a DEXA scan and noncontrast, T1-weighted MRI of the lumbar spine completed within a 2-year period.OUTCOME MEASURESArea-under-curve (AUC) values of the VBQ score predicting osteopenia and osteoporosis when controlling for patient characteristics.METHODSPatients with noncontrast, T1-weighted MRIs of the lumbar spine and DEXA scans completed within a 2-year time frame were retrospectively reviewed. Patient demographics and medical risk factors for osteoporosis were identified and compared. VBQ scores were measured by two trained researchers and interrater reliability was calculated. Patients were separated into three groups defined by lowest DEXA T-score: Healthy Bone, Osteopenia, and Osteoporosis. analysis of variance, Kruskal-Wallis test, chi-square, t tests, Mann-Whitney U tests, and multivariate linear regression were performed to examine the relationship between patient characteristics, DEXA t-scores, and VBQ scores. Receiver operating characteristic analysis and AUC values were generated for the prediction of osteopenia and osteoporosis.RESULTSA total of 156 patients were included for analysis. Sufficient inter-rater reliability was determined for VBQ measures (intraclass correlation coefficient: 0.81). Most patients were female (83%), postmenopausal (81%), and had hyperlipidemia (64%). Patients with hyperlipidemia and healthy bone density by DEXA had elevated baseline VBQ scores (p<.001) reflective of values seen in osteopenia and osteoporosis. The AUC of the VBQ score predicting osteopenia and osteoporosis changed to be more concordant with DEXA results after controlling for hyperlipidemia (AUC=0.72, 0.70 vs. AUC=0.88, 0.89; p<.001). Sub-analysis of hyperlipidemia subtypes revealed that elevated high-density lipoprotein is associated with elevated VBQ scores.CONCLUSIONSHyperlipidemia increased the MRI-based VBQ score in our healthy bone population. The high signal intensities resembled values seen in osteopenia and osteoporosis, suggesting that physiologic variables which impact bone composition may influence the VBQ score. Specifically, elevated high-density lipoprotein may contribute to this. The microarchitectural changes and the clinical implications of these factors need further exploration. |
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