A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis

Jeff Ehresman, Andrew Schilling, Zach Pennington, Chengcheng Gui, Xuguang Chen, Daniel Lubelski, A. Karim Ahmed, Ethan Cottrill, Majid Khan, Kristin J. Redmond, Daniel M. Sciubba

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE Vertebral compression fractures (VCFs) in patients with spinal metastasis can lead to destabilization and often carry a high risk profile. It is therefore important to have tools that enable providers to predict the occurrence of new VCFs. The most widely used tool for bone quality assessment, dual-energy x-ray absorptiometry (DXA), is not often available at a patient's initial presentation and has limited sensitivity. While the Spinal Instability Neoplastic Score (SINS) has been associated with VCFs, it does not take patients' baseline bone quality into consideration. To address this, the authors sought to develop an MRI-based scoring system to estimate trabecular vertebral bone quality (VBQ) and to assess this system's ability to predict the occurrence of new VCFs in patients with spinal metastasis. METHODS Cases of adult patients with a diagnosis of spinal metastasis, who had undergone stereotactic body radiation therapy (SBRT) to the spine or neurosurgical intervention at a single institution between 2012 and 2019, were retrospectively reviewed. The novel VBQ score was calculated for each patient by dividing the median signal intensity of the L1-4 vertebral bodies by the signal intensity of cerebrospinal fluid (CSF). Multivariable logistic regression analysis was used to identify associations of demographic, clinical, and radiological data with new VCFs. RESULTS Among the 105 patients included in this study, 56 patients received a diagnosis of a new VCF and 49 did not. On univariable analysis, the factors associated with new VCFs were smoking status, steroid use longer than 3 months, the SINS, and the novel scoring system-the VBQ score. On multivariable analysis, only the SINS and VBQ score were significant predictors of new VCFs and, when combined, had a predictive accuracy of 89%. CONCLUSIONS As a measure of bone quality, the novel VBQ score significantly predicted the occurrence of new VCFs in patients with spinal metastases independent of the SINS. This suggests that baseline bone quality is a crucial factor that requires assessment when evaluating these patients' conditions and that the VBQ score is a novel and simple MRIbased measure to accomplish this.

Original languageEnglish (US)
Pages (from-to)499-506
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume32
Issue number4
DOIs
StatePublished - 2020

Keywords

  • Bone
  • Compression fracture
  • Magnetic resonance imaging
  • Metastasis
  • Oncology
  • Trabecular bone
  • Vertebral bone quality

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

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