Asian Spine J.  2024 Aug;18(4):560-569. 10.31616/asj.2024.0116.

Magnetic resonance imaging phantom-based S1 vertebral scores are indicators of fat–water-like osteoporotic changes in postmenopausal women: a pilot study

• Din RU
• Nishtar T
• Cheng X
• Yang H

• KMID: 2558829
• DOI: http://doi.org/10.31616/asj.2024.0116

Abstract

Study Design: A prospective study. Purpose: To assess fat–water-like tissue changes on the 1st sacral vertebra using novel magnetic resonance imaging (MRI) phantombased F- and W-scores and evaluate their diagnostic performances in osteoporosis detection. Overview of Literature: Using an uncommonly advanced MRI technique, previous studies have found that fat–water changes were consistent with osteoporosis. The role of routine MRI sequences can be extended in this regard. The S1 vertebra is considered a crucial anatomical site in spine surgeries because it seldom suffers from fractures. Thus, S1 could indicate osteoporotic fat–water changes.
Methods
Forty-two female volunteers (aged 62.3±6.3 years) underwent spine examination with both MRI (including a phantom) and dual-energy X-ray absorptiometry (DXA) following ethical approval. MRI phantom-based F- and W-score_S1 were defined by normalizing S1 vertebral signal intensities (SIs) by coconut oil and water SIs of the phantom on T1- and T2-weighted imaging, respectively. Using receiver operating characteristic analysis, the diagnostic performances of the new scores for evaluating osteoporosis and vertebral fractures were investigated against standard areal bone mineral density measured with DXA (DXA-aBMD).
Results
The F-score_S1 and W-score_S1 were greater (4.11 and 2.43, respectively) in patients with osteoporosis than those without osteoporosis (3.25 and 1.92, respectively) and achieved areas under the curve (AUCs) of 0.82 and 0.76 (p<0.05), respectively, for osteoporosis detection. Similarly, the mean F-score_S1 and W-score_S1 were higher (4.11 and 2.63, respectively) in patients with vertebral fractures than in those without fractures (3.30 and 1.82, respectively) and had greater AUCs (0.90 for W-score_S1 and 0.74 for F-score_S1) than DXA-aBMD (AUC, 0.26; p<0.03). In addition, the F- and W-score_S1 demonstrated a strong correlation (r=0.65, p<0.001).
Conclusions
The new S1 vertebral-based MRI scores were developed to detect osteoporotic changes and demonstrated improvements over DXA-aBMD in differentiating patients with vertebral fractures.

Keyword

Osteoporosis; Osteoporotic fracture; Sacral region; Magnetic resonance imaging; Phantom