Skip to main content

Advertisement

SpringerLink
Log in

Assessing lumbar vertebral bone quality: a methodological evaluation of CT and MRI as alternatives to traditional DEXA

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Keaveny TM, Adams AL, Fischer H, Brara HS, Burch S, Guppy KH, Kopperdahl DL (2023) Increased risks of vertebral fracture and reoperation in primary spinal fusion patients who test positive for osteoporosis by biomechanical computed tomography analysis. Spine J 23:412–424. https://doi.org/10.1016/j.spinee.2022.10.018

    Article  PubMed  Google Scholar 

  2. World Health Organization (2003) Prevention and management of osteoporosis. Switzerland, Geneva

    Google Scholar 

  3. Lee CK (2007) Osteopenia and total disc prosthesis subsidence: inclusion/exclusion criteria for total disc replacement. SAS J 1:82–84

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bertagnoli R, Zigler J, Karg A, Voigt S (2005) Complications and strategies for revision surgery in total disc replacement. Orthop Clin North Am 36:389–395

    Article  PubMed  Google Scholar 

  5. Wang Y, Videman T, Boyd SK, Battie MC (2015) The distribution of bone mass in the lumbar vertebrae: are we measuring the right target? Spine J 15:2412–2416

    Article  PubMed  Google Scholar 

  6. Kim KJ, Kim DH, Lee JI, Choi BK, Han IH, Nam KH (2019) Hounsfield units on lumbar computed tomography for predicting regional bone mineral density. Open Med (Wars) 14:545–551. https://doi.org/10.1515/med-2019-0061

    Article  CAS  PubMed  Google Scholar 

  7. Wagner SC, Formby PM, Helgeson MD, Kang DG (2016) Diagnosing the undiagnosed: osteoporosis in patients undergoing lumbar fusion. Spine 41:E1279-e1283. https://doi.org/10.1097/brs.0000000000001612

    Article  PubMed  Google Scholar 

  8. Kulkarni AG, Thonangi Y, Pathan S, Gunjotikar S, Goparaju P, Talwar I, Jaggi S, Shah S, Shah N, Kursija G (2022) Should Q-CT be the gold standard for detecting spinal osteoporosis? Spine 47:E258–E264. https://doi.org/10.1097/brs.0000000000004224

    Article  PubMed  Google Scholar 

  9. Choi MK, Kim SM, Lim JK (2016) Diagnostic efficacy of Hounsfield units in spine CT for the assessment of real bone mineral density of degenerative spine: correlation study between T-scores determined by DEXA scan and Hounsfield units from CT. Acta Neurochir (Wien) 158:1421–1427. https://doi.org/10.1007/s00701-016-2821-5

    Article  PubMed  Google Scholar 

  10. Brett AD, Brown JK (2015) Quantitative computed tomography and opportunistic bone density screening by dual use of computed tomography scans. J Orthop Translat 3:178–184. https://doi.org/10.1016/j.jot.2015.08.006

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ehresman J, Pennington Z, Schilling A, Lubelski D, Ahmed AK, Cottrill E, Khan M, Sciubba DM (2020) Novel MRI-based score for assessment of bone density in operative spine patients. Spine J 20:556–562. https://doi.org/10.1016/j.spinee.2019.10.018

    Article  PubMed  Google Scholar 

  12. Trentadue M, Sozzi C, Idolazzi L, Lazzarini G, Murano RS, Gatti D, Rossini M, Piovan E (2022) Magnetic resonance imaging at 3.0-T in postmenopausal osteoporosis: a prospective study and review of the literature. Radiol Bras 55:216–224. https://doi.org/10.1590/0100-3984.2021.0124

    Article  PubMed  PubMed Central  Google Scholar 

  13. Salzmann SN, Okano I, Jones C, Zhu J, Lu S, Onyekwere I, Balaji V, Reisener MJ, Chiapparelli E, Shue J, Carrino JA, Girardi FP, Cammisa FP, Sama AA, Hughes AP (2022) Preoperative MRI-based vertebral bone quality (VBQ) score assessment in patients undergoing lumbar spinal fusion. Spine J 22:1301–1308. https://doi.org/10.1016/j.spinee.2022.03.006

    Article  PubMed  Google Scholar 

  14. Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163. https://doi.org/10.1016/j.jcm.2016.02.012

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zou KH, Tuncali K, Silverman SG (2003) Correlation and simple linear regression. Radiology 227:617–622. https://doi.org/10.1148/radiol.2273011499

    Article  PubMed  Google Scholar 

  16. Courtois EC, Ohnmeiss DD, Guyer RD Evaluating Alternatives to DEXA for Assessing Bone Quality in Patients Undergoing Spine Surgery.

  17. Zaidi Q, Danisa OA, Cheng W (2019) Measurement techniques and utility of hounsfield unit values for assessment of bone quality prior to spinal instrumentation: a review of current literature. Spine 44:E239-e244. https://doi.org/10.1097/brs.0000000000002813

    Article  PubMed  Google Scholar 

  18. Li R, Zhang W, Xu Y, Ma L, Li Z, Yang D, Ding W (2022) Vertebral endplate defects are associated with bone mineral density in lumbar degenerative disc disease. Eur Spine J 31:2935–2942. https://doi.org/10.1007/s00586-022-07329-1

    Article  PubMed  Google Scholar 

  19. Roch PJ, Çelik B, Jäckle K, Reinhold M, Meier MP, Hawellek T, Kowallick JT, Klockner FS, Lehmann W, Weiser L (2023) Combination of vertebral bone quality scores from different magnetic resonance imaging sequences improves prognostic value for the estimation of osteoporosis. Spine J 23:305–311. https://doi.org/10.1016/j.spinee.2022.10.013

    Article  PubMed  Google Scholar 

  20. Ehresman J, Ahmed AK, Lubelski D, Schilling A, Pennington Z, Cottrill E, McCracken J, Khan M, Witham T, Sciubba DM (2020) Vertebral bone quality score and postoperative lumbar lordosis associated with need for reoperation after lumbar fusion. World Neurosurg 140:e247–e252. https://doi.org/10.1016/j.wneu.2020.05.020

    Article  PubMed  Google Scholar 

  21. Kadri A, Binkley N, Hernando D, Anderson PA (2022) Opportunistic use of lumbar magnetic resonance imaging for osteoporosis screening. Osteoporos Int 33:861–869. https://doi.org/10.1007/s00198-021-06129-5

    Article  CAS  PubMed  Google Scholar 

  22. Huang W, Gong Z, Wang H, Zheng C, Chen Y, Xia X, Ma X, Jiang J (2023) Use of MRI-based vertebral bone quality score (VBQ) of S1 body in bone mineral density assessment for patients with lumbar degenerative diseases. Eur Spine J. https://doi.org/10.1007/s00586-023-07643-2

    Article  PubMed  Google Scholar 

  23. Mengyang P, Zhong W, Heng H, Jiahao Y, Han W, Jin Y, Zhang P, Shen Y (2023) Vertebral bone quality score provides preoperative bone density assessment for patients undergoing lumbar spine surgery: a retrospective study. J Neurosurg Spine. https://doi.org/10.3171/2023.1.SPINE221187

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Texas Back Institute, Plano, TX, USA

    Emily C. Courtois

  2. Texas Back Institute Research Foundation, 6020 W Parker Rd #200, Plano, TX, 75093, USA

    Donna D. Ohnmeiss

  3. Center for Disc Replacement at Texas Back Institute, Plano, TX, USA

    Richard D. Guyer

Authors
  1. Emily C. Courtois
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donna D. Ohnmeiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard D. Guyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Donna D. Ohnmeiss.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

The study was submitted to an IRB review process and a waiver of consent was granted.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Courtois, E.C., Ohnmeiss, D.D. & Guyer, R.D. Assessing lumbar vertebral bone quality: a methodological evaluation of CT and MRI as alternatives to traditional DEXA. Eur Spine J 32, 3176–3182 (2023). https://doi.org/10.1007/s00586-023-07855-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07855-6

Keywords

Search

Navigation