Abstract
BACKGROUND: Bone marrow fat increases when the bone volume decreases. The composition of the bone marrow microenvironment can also become altered. Assessments of bone marrow fat and bone marrow structural heterogeneity have the potential to predict abnormal bone mineral density (BMD) and osteoporosis. This study aimed to investigate the diagnostic performance of T2*-corrected Q-Dixon and reduced-field-of-view (FOV) diffusion kurtosis imaging (DKI) parameters in determining abnormal BMD and osteoporosis in postmenopausal women. METHODS: In this prospective study, the individuals who were eligible for inclusion included postmenopausal women (over 50-year-old) with suspected osteoporosis based on experiencing low back pain. This mono-center study was conducted in tertiary care in China. All of the patients were recruited by using the consecutive sampling method. Subjects who underwent T2*-corrected Q-Dixon and reduced-FOV DKI sequences were enrolled. Fat fraction (FF), T2*, mean kurtosis (MK), and mean diffusivity (MD) values were measured on L1, L2, and L3 vertebral bodies. Quantitative computed tomography (QCT) examinations served as the reference standard. All of the subjects were divided into three groups: normal (BMD >120 mg/cm(3)), osteopenia (BMD 80-120 mg/cm(3)), and osteoporosis (BMD <80 mg/cm(3)). One-way analysis of variance, correlation coefficient analysis, and receiver operating characteristic curve analysis were performed. RESULTS: Among all of the enrolled subjects, 52 were in the normal group, 51 were in the osteopenia group, and 52 were in the osteoporosis group. There were significant differences in FF, T2*, MK, and MD values between the three groups (P<0.001, P<0.001, P<0.001, and P=0.003, respectively). FF, T2*, and MK values exhibited significant negative correlations with BMD values (r=-0.739, P<0.001; r=-0,676, P<0.001; and r=-0.626, P<0.001, respectively). Excellent discriminatory capacity was observed in the Q-Dixon [area under the curve (AUC): 0.976, 95% confidence interval (CI): 0.955-0.997] differentiation between normal and abnormal BMD subjects. It was significantly better than the DKI (AUC: 0.812, 95% CI: 0.741-0.882) parameter combination (P<0.001), whereas the DKI model (AUC: 0.825, 95% CI: 0.739-0.910) performed comparably to the Q-Dixon model (AUC: 0.798, 95% CI: 0.710-0.886) for screening osteoporosis (P=0.57). CONCLUSIONS: FF and T2* values measured by using T2*-corrected Q-Dixon, as well as MK and MD values measured by using reduced-FOV DKI, may serve as potential imaging biomarkers in assessing abnormal BMD and osteoporosis in postmenopausal women.