MRI-Based Vertebral Bone Quality Scoring for Opportunistic Osteoporosis Screening in Postmenopausal Women: A QCT-Referenced Study.

This retrospective cross-sectional study investigated the diagnostic performance of four magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) scoring methods for identifying osteoporosis in postmenopausal women and explored the impact of MRI system variability, using quantitative computed tomography (QCT) as the reference standard. A total of 181 women who underwent lumbar spine QCT and MRI within a six-month interval were included. VBQ scores were calculated from routine sagittal T1-weighted images. Diagnostic performance was assessed using receiver operating characteristic curve analysis, correlations with QCT-derived bone mineral density (BMD) were evaluated using Spearman's correlation, and agreement and inter-method variability were analyzed using appropriate comparative and agreement analyses. All four VBQ scoring methods demonstrated moderate diagnostic performance, with areas under the curve ranging from 0.739-0.783, and showed moderate negative correlations with BMD (R = - 0.488 to - 0.549). Significant differences were observed among VBQ scoring methods (p = 0.018) and across MRI systems from different vendors (p < 0.001). An optimal cutoff value of VBQ > 4.0 was identified using the Youden index. These findings suggest that MRI-derived VBQ scoring may serve as a useful, radiation-free, opportunistic adjunct for osteoporosis assessment in postmenopausal women undergoing lumbar MRI for other clinical indications. However, the observed inter-method and inter-scanner variability highlights the need for further standardization of VBQ scoring approaches and MRI acquisition protocols before broader clinical implementation.