Radiography (London, England : 1995) · 2026
Diagnostic accuracy of MRI-Based vertebral bone quality score for detecting low bone mass and osteoporosis: A systematic review and meta-analysis.
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Wulandari M D, Jorisal P, Sulay C B H, Octavius G S
Аннотация
INTRODUCTION: Dual-energy X-ray absorptiometry (DXA) is the reference standard for osteoporosis diagnosis, but access remains limited in many settings. MRI-based vertebral bone quality (VBQ) has emerged as an opportunistic screening tool derived from routine lumbar imaging; however, its diagnostic performance is uncertain.
METHODS: A PRISMA-DTA-compliant systematic review and meta-analysis (PROSPERO CRD420251264768) was conducted across five databases (2020-December 2025). Studies evaluating lumbar VBQ against DXA were included. Pooled sensitivity, specificity, likelihood ratios, and hierarchical summary ROC curves were estimated using a bivariate random-effects model for two contrasts: (1) normal vs. low bone mass and (2) non-osteoporosis vs. osteoporosis.
RESULTS: Thirty-six studies (6521 participants) were included. For detecting low bone mass, pooled sensitivity was 72% and specificity 67% (AUC 0.75). For diagnosing osteoporosis, sensitivity was 67% and specificity 75% (AUC 0.77). Likelihood ratios were modest (LR+ 2.19-2.73; LR- 0.42-0.43), indicating limited rule-in and rule-out capability. Substantial heterogeneity (I2 98-99%) and publication bias were observed. Test performance varied with disease prevalence and sex distribution.
CONCLUSION: VBQ demonstrated only moderate diagnostic accuracy, with substantial heterogeneity and modest likelihood ratios limiting its rule-in and rule-out capability. Accordingly, it is best suited for opportunistic case-finding rather than definitive diagnosis.
IMPLICATIONS FOR PRACTICE: VBQ is best used for opportunistic case-finding during routine lumbar MRI. Elevated VBQ values should prompt confirmatory DXA rather than guide treatment decisions independently. Incorporating VBQ into routine reporting may improve early identification of at-risk patients, particularly when lumbar MRI has already been performed for another clinical indication.
METHODS: A PRISMA-DTA-compliant systematic review and meta-analysis (PROSPERO CRD420251264768) was conducted across five databases (2020-December 2025). Studies evaluating lumbar VBQ against DXA were included. Pooled sensitivity, specificity, likelihood ratios, and hierarchical summary ROC curves were estimated using a bivariate random-effects model for two contrasts: (1) normal vs. low bone mass and (2) non-osteoporosis vs. osteoporosis.
RESULTS: Thirty-six studies (6521 participants) were included. For detecting low bone mass, pooled sensitivity was 72% and specificity 67% (AUC 0.75). For diagnosing osteoporosis, sensitivity was 67% and specificity 75% (AUC 0.77). Likelihood ratios were modest (LR+ 2.19-2.73; LR- 0.42-0.43), indicating limited rule-in and rule-out capability. Substantial heterogeneity (I2 98-99%) and publication bias were observed. Test performance varied with disease prevalence and sex distribution.
CONCLUSION: VBQ demonstrated only moderate diagnostic accuracy, with substantial heterogeneity and modest likelihood ratios limiting its rule-in and rule-out capability. Accordingly, it is best suited for opportunistic case-finding rather than definitive diagnosis.
IMPLICATIONS FOR PRACTICE: VBQ is best used for opportunistic case-finding during routine lumbar MRI. Elevated VBQ values should prompt confirmatory DXA rather than guide treatment decisions independently. Incorporating VBQ into routine reporting may improve early identification of at-risk patients, particularly when lumbar MRI has already been performed for another clinical indication.