Streamlining the MRI-Derived Vertebral Bone Quality Score for Preoperative Osteoporosis and Osteopenia Screening

Design Retrospective study. Objective To evaluate the predictive performance of a simplified, MRI-derived vertebral bone quality score (VBQ) using measurements at L1/2 (VBQ L1/2 ) for opportunistic bone quality screening, compared to the established VBQ L1-4. Methods In patients undergoing lumbar surgery for degenerative spondylolisthesis, VBQ L1/2 was assessed using circular regions of interest on sagittal T1-weighted sequences in L1 and L2, while VBQ L1-4 included measurements from L1 through L4. Measurements were normalized to cerebrospinal fluid intensity at L2/3. Bone mineral density (BMD) was measured by opportunistic qCT, with osteoporosis defined as BMD < 80 mg/cm 3 and impaired bone quality (osteoporosis or osteopenia) as BMD < 120 mg/cm 3 . Agreement between VBQ L1/2 and VBQ L1-4 was determined using the intraclass correlation coefficient (ICC), and predictive performance was evaluated using receiver operating characteristic analysis with Youden’s index optimization. Results Among 144 patients included ((39% male, n = 56) the median age was 69 years (interquartile range 64-67). Osteopenia was present in 47% and osteoporosis in 22%, yielding 69% impaired bone quality. VBQ L1/2 and VBQ L1-4 showed excellent agreement (ICC: 0.988, 95% CI: 0.982–0.991). Predictive performance was comparable for osteoporosis (AUC: VBQ L1/2 0.71 vs. VBQ L1-4 0.69) and impaired bone quality (AUC: 0.68 vs. 0.67). For osteoporosis detection, VBQ L1/2 showed a higher sensitivity (94% vs 71%) but a lower specificity (45% vs 64%), as well as for detecting impaired bone quality (sensitivity 77% vs. 47%, 56%, vs 82%). Conclusions VBQ L1/2 offers a simplified alternative to VBQ L1-4 for MRI-based bone quality assessment. Further validation and threshold refinement are warranted.