• Shi Yan, Yinhao Liu, Lei Yuan, Guohong Du, Weishi Li, and Yan Zeng.
• Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
• Eur Spine J. 2024 Dec 7.

ObjectiveTo evaluate the modified vertebral bone quality (VBQ) method on the magnetic resonance imaging (MRI) T1-weighted (T1w), T2-weighted (T2w), and fat suppression (FS) series in evaluating bone mineral density (BMD) for patients with degenerative lumbar disease.MethodsWe reviewed preoperative data of postmenopausal female patients aged ≥ 50 years hospitalized to undergo lumbar surgery for degenerative lumbar disease with available MRI and dual-energy X-ray absorptiometry (DEXA). Patients were categorized into three groups according to T-score. The VBQCSF score was calculated as the L1-L4 median signal intensity (SI) divided by the L3 CSF SI. One-way analysis of variance was applied to assess the discrepancy between groups. The diagnostic performance of VBQ scores for distinguishing low BMD was analyzed using receiver operating characteristic (ROC) analysis.ResultsThe study included 253 patients. T2 VBQCSF was significantly different between groups (p < 0.001). The interclass correlation coefficient for inter and intra-rater reliability was 0.767 (95%CI 0.650-0.849) and 0.893 (95%CI 0.834-0.932), respectively. The T2 VBQCSF showed moderate correlations with DEXA BMD (r =  - 0.442, p < 0.001). The area under the ROC curve indicated a predictive accuracy of 76%. A sensitivity of 59.0% with a specificity of 87.5% was achieved for distinguishing low BMD by setting the T2 VBQCSF cutoff at 0.607.ConclusionCompared to the traditional VBQ score, T2 VBQCSF is a more promising tool for distinguishing poor bone quality in patients with degenerative lumbar disease. A T2 VBQCSF score > 0.607 can identify patients who require additional diagnostic evaluation.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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