Correlation between Vertebral Marrow Fat Fraction in MRI Using DIXON Technique and BMD in DXA in Patients of Suspected Osteoporosis

 

 Permissions and Reprints

Abstract

Aim Osteoporosis is a common metabolic bone disease accounting for low back pain (LBP). It is diagnosed by dual-energy X-ray absorptiometry (DXA). Magnetic resonance imaging (MRI), a routine investigation for LBP, is also sensitive to detect fat fraction (FF) of the vertebral body that increases with increasing age. This study aimed to correlate vertebral marrow FF using MRI and bone mineral density (BMD).

Material and Methods Patients presenting with low backache and suspected osteoporosis were included. All patients underwent an MRI of lumbosacral spine and DXA. Patients were categorized into an osteoporotic and a nonosteoporotic group based on the T-score obtained from DXA. “T-scores” of < –2.5 on BMD were considered as osteoporotic spine. T-score of > –2.5 was considered as nonosteoporotic. The FF obtained from the DIXON sequence of MRI was correlated between the two groups.

Result Thirty-one patients were included with a mean age of 54.26 ± 11.6 years. Sixteen patients were osteoporotic based on the defined criteria in the methods. The mean vertebral marrow FF was significantly higher in the osteoporotic patients (64.98 ± 8.8%) compared with the nonosteoporotic (45.18 ± 13.2%) (p = 0.001). The mean FF of the vertebra having fracture (69.19 ± 7.73%) was significantly higher than that of patients without fracture (57.96 ± 5.75%) (p = 0.03). Taking a cutoff value of vertebral marrow FF of 54.85, the sensitivity and specificity of diagnosing osteoporosis were 93 and 80%, respectively, with a confidence interval of 95%. The area under the curve was 0.925.

Conclusion Increased vertebral marrow FF is noted in the osteoporotic spine. FF has an inverse correlation with the T-score obtained from BMD. MRI with FF measurement can provide indirect evidence of osteoporosis, which can be done under one roof, especially in young patients where we need to avoid ionizing radiation.

Informed Consent

Informed consent was obtained from all the patients included in the study.

Authors' Contributions

S.N. contributed with conceptualisation, design, data analysis, literature search, manuscript editing, and manuscript review. M.J. contributed with conceptualisation, design, data analysis, literature search, manuscript editing, and manuscript review. S.K.B. took part in data analysis, literature search, manuscript editing, and manuscript review. S.T. contributed with literature search, manuscript editing, and manuscript review.

Publication History

Article published online:
04 December 2023

© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

• References

• 1 Griffith JF, Yeung DK, Antonio GE. et al. Vertebral marrow fat content and diffusion and perfusion indexes in women with varying bone density: MR evaluation. Radiology 2006; 241 (03) 831-838
  CrossrefPubMedGoogle Scholar
• 2 Bauer JS, Link TM. Advances in osteoporosis imaging. Eur J Radiol 2009; 71 (03) 440-449
  CrossrefPubMedGoogle Scholar
• 3 Kanis JA. WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int 1994; 4 (06) 368-381
  CrossrefPubMedGoogle Scholar
• 4 Bandirali M, Di Leo G, Papini GD. et al. A new diagnostic score to detect osteoporosis in patients undergoing lumbar spine MRI. Eur Radiol 2015; 25 (10) 2951-2959
  CrossrefPubMedGoogle Scholar
• 5 Jain M, Naik S, Mishra NP. et al. 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
  CrossrefPubMedGoogle Scholar
• 6 Griffith JF, Yeung DK, Antonio GE. et al. Vertebral bone mineral density, marrow perfusion, and fat content in healthy men and men with osteoporosis: dynamic contrast-enhanced MR imaging and MR spectroscopy. Radiology 2005; 236 (03) 945-951
  CrossrefPubMedGoogle Scholar
• 7 Kim DH, Yoo HJ, Hong SH, Choi JY, Chae HD, Chung BM. Differentiation of acute osteoporotic and malignant vertebral fractures by quantification of fat fraction with a Dixon MRI sequence. Am J Roentgenol 2017; 209 (06) 1331-1339
  CrossrefPubMedGoogle Scholar
• 8 Lewiecki EM, Borges JL. Bone density testing in clinical practice. Arq Bras Endocrinol Metabol 2006; 50 (04) 586-595
  CrossrefPubMedGoogle Scholar
• 9 Rosen CJ, Klibanski A. Bone, fat, and body composition: evolving concepts in the pathogenesis of osteoporosis. Am J Med 2009; 122 (05) 409-414
  CrossrefPubMedGoogle Scholar
• 10 Tang G, Liu Y, Li W, Yao J, Li B, Li P. Optimization of b value in diffusion-weighted MRI for the differential diagnosis of benign and malignant vertebral fractures. Skeletal Radiol 2007; 36 (11) 1035-1041
  CrossrefPubMedGoogle Scholar
• 11 Ishijima H, Ishizaka H, Horikoshi H, Sakurai M. Water fraction of lumbar vertebral bone marrow estimated from chemical shift misregistration on MR imaging: normal variations with age and sex. Am J Roentgenol 1996; 167 (02) 355-358
  CrossrefPubMedGoogle Scholar
• 12 Kühn JP, Hernando D, Meffert PJ. et al. Proton-density fat fraction and simultaneous R2* estimation as an MRI tool for assessment of osteoporosis. Eur Radiol 2013; 23 (12) 3432-3439
  CrossrefPubMedGoogle Scholar
• 13 Chang R, Ma X, Jiang Y. et al. Percentage fat fraction in magnetic resonance imaging: upgrading the osteoporosis-detecting parameter. BMC Med Imaging 2020; 20 (01) 30
  CrossrefPubMedGoogle Scholar
• 14 Gassert FT, Kufner A, Gassert FG. et al. MR-based proton density fat fraction (PDFF) of the vertebral bone marrow differentiates between patients with and without osteoporotic vertebral fractures. Osteoporos Int 2022; 33 (02) 487-496
  CrossrefPubMedGoogle Scholar
• 15 Reeder SB, Pineda AR, Wen Z. et al. Iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL): application with fast spin-echo imaging. Magn Reson Med 2005; 54 (03) 636-644
  CrossrefPubMedGoogle Scholar
• 16 Aoki T, Yamaguchi S, Kinoshita S, Hayashida Y, Korogi Y. Quantification of bone marrow fat content using iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL): reproducibility, site variation and correlation with age and menopause. Br J Radiol 2016; 89 (1065): 20150538
  CrossrefPubMedGoogle Scholar
• 17 Fatima K, Naik S, Jain M. et al. Diffusion-weighted imaging and chemical shift imaging to differentiate benign and malignant vertebral lesion: a hospital-based cross-sectional study. Indian J Radiol Imaging 2023; . Online ahead of print. DOI: 10.1055/s-0043-1772848.
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Lindsay R, Silverman SL, Cooper C. et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001; 285 (03) 320-323
  CrossrefPubMedGoogle Scholar