Magnetic resonance imaging at 3.0-T in postmenopausal osteoporosis: a prospective study and review of the literature

Trentadue, Mirko; Sozzi, Carlo; Idolazzi, Luca; Lazzarini, Gianluigi; Murano, Riccardo Sante; Gatti, Davide; Rossini, Maurizio; Piovan, Enrico

doi:10.1590/0100-3984.2021.0124

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Original Article • Radiol Bras 55 (04) • Jul-Aug 2022 • https://doi.org/10.1590/0100-3984.2021.0124 copy

Magnetic resonance imaging at 3.0-T in postmenopausal osteoporosis: a prospective study and review of the literature

Ressonância magnética de 3.0-T na osteoporose pós-menopausa: estudo prospectivo e revisão da literatura

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To promote advanced research using magnetic resonance imaging (MRI) in the diagnosis of and screening for osteoporosis by looking for correlations among the T-scores measured by dual-energy X-ray absorptiometry (DEXA), the apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI), and the T1-weighted signal intensity values.

Materials and Methods:

This was a prospective study of postmenopausal women with no contraindications to MRI and no history of cancer who underwent DEXA within 30 days before or after the MRI examination. A 3.0-T scanner was used in order to acquire sagittal sequences targeting the lumbar spine.

Results:

Thirteen women underwent DEXA and MRI. In two cases, the MRI was discontinued early. Therefore, the final sample comprised 11 patients. The ADC values and T1-weighted signal intensity were found to be higher in patients with osteoporosis. However, among the patients > 60 years of age with osteoporosis, ADC values were lower and T1-weighted signal intensity was even higher.

Conclusion:

It is unlikely that MRI will soon replace DEXA for the diagnostic workup of osteoporosis. Although DWI and ADC mapping are useful for understanding the pathophysiology of osteoporosis, we believe that T1-weighted sequences are more sensitive than is DWI as a means of performing a qualitative analysis of vertebral alterations.

Keywords:
Osteoporosis; Postmenopause; Vertebral body/pathology; Multiparametric magnetic resonance imaging/methods; Bone marrow/pathology

Sequence	Parameters
T1-weighted TSE	TR/TE, 555/8 ms; FOV, 160 × 268 × 49; voxel size, 1 × 1 mm; slices, 15; slice thickness, 3 mm; reconstruction matrix, 560 × 560; acquisition time, 4 min 31 s
Short-tau inversion recovery	TR/TI, 5,406/210 ms; TE, 60 ms; FOV, 160 × 268 × 49; voxel size, 1 × 1.46 mm; slices, 15; slice thickness, 3 mm; reconstruction matrix, 560 × 560; acquisition time, 4 min 30 s; saturation band positioned anterior to the spine
T2-weighted TSE	TR/TE, 4,496/110 ms; FOV, 160 × 268 × 49; voxel size, 1 × 1.25 mm; slices, 15; slice thickness, 3 mm; reconstruction matrix, 560 × 560; flip angle, 90°; acquisition time, 2 min 50 s
DWI	Four b-values (b0; b300; b500; b800); TR/TE, 2,444/56 ms; FOV, 280 × 239 × 89; voxel size, 2.05 × 2.55 mm; slices, 15; slice thickness, 5 mm; reconstruction matrix, 560 × 560; EPI factor, 57; singleshot spin-echo; acquisition time, 3 min 17 s

Patient	Age (years)	T-score	BMD	ADC			T1
Patient	Age (years)	T-score	BMD	b300	b500	b800	T1
3	56	-0.2	1.159	0.594	0.412	0.326	370.1
5	59	-0.5	1.12	0.6975	0.505	0.3725	322.0475
7	59	-0.7	1.098	0.752	0.548	0.454	359.08
2	53	-0.7	1.099	N/A	N/A	N/A	274.834
6	59	-1.6	0.985	0.784	0.594	0.446	289.524
12^† † For patient no. 12, the femur BMD value was 0.884 g/cm2.	70	-1.6	N/A	0.786	0.758	0.428	455.4475
9	63	-1.9	0.947	0.672	0.482	0.338	302.4
8	59	-2.0	0.945	0.598	0.47	0.358	418.498
4	58	-2.2	0.914	0.766	0.592	0.46	385.234
10	65	-2.6	0.864	0.512	0.42	0.37	442.136
1	50	-2.8	0.846	1.258	0.828	0.574	541.348
11	66	-3.5	0.757	N/A	N/A	N/A	856.096
13	72	-3.8	0.745	0.74	0.48	0.356	419.656

Patient	Age (years)	T-score	BMD	ADC			T1
Patient	Age (years)	T-score	BMD	b300	b500	b800	T1
1	50	-2,8	0,846	1,258	0,828	0,574	541,348
2	53	-0.7	1.099	N/A	N/A	N/A	274.834
3	56	-0.2	1.159	0.594	0.412	0.326	370.1
4	58	-2.2	0.914	0.766	0.592	0.46	385.234
5	59	-0.5	1.12	0.6975	0.505	0.3725	322.0475
6	59	-1.6	0.985	0.784	0.594	0.446	289.524
7	59	-0.7	1.098	0.752	0.548	0.454	359.08
8	59	-2	0.945	0.598	0.47	0.358	418.498
9	63	-1.9	0.947	0.672	0.482	0.338	302.4
10	65	-2.6	0.864	0.512	0.42	0.37	442.136
11	66	-3.5	0.757	N/A	N/A	N/A	856.096
12^† † For patient no. 12, the femur BMD value was 0.884 g/cm2.	70	-1.6	N/A	0.786	0.758	0.428	455.4475
13	72	-3.8	0.745	0.74	0.48	0.356	419.656

Osteoporosis (n = 3)	Osteopenia (n = 5)	Normal BMD (n = 3)
	b300
0.512	0.784	0.594
1.258	0.786	0.6975
0.74	0.672	0.752
	0.598
	0.766
Mean, 0.836666667	Mean, 0.7212	Mean, 0.681166667
	b500
0.42	0.594	0.412
0.828	0.758	0.505
0.48	0.482	0.548
	0.47
	0.592
Mean, 0.576	Mean, 0.5792	Mean, 0.488333333
	b800
0.37	0.446	0.326
0.574	0.428	0.3725
0.356	0.338	0.454
	0.358
	0.46
Mean, 0.433333333	Mean, 0.406	Mean, 0.384166667
	T1
442.136	289.524	370.1
541.348	455.4475	322.0475
856.096	302.4	359.08
419.656	418.498	274.834
	385.234
Mean, 564.809	Mean, 370.2207	Mean, 331.515375

Patient		Age (years)	T-score	BMD	ADC			T1
Patient		Age (years)	T-score	BMD	b300	b500	b800	T1
≤ 60 years of age	1	50	-2.8	0.846	1.258	0.828	0.574	541.35
	2	53	-0.7	1.099	N/A	N/A	N/A	274.83
	3	56	-0.2	1.159	0.594	0.412	0.326	370.1
	4	58	-2.2	0.914	0.766	0.592	0.46	385.23
	5	59	-0.5	1.12	0.6975	0.505	0.3725	322.05
	6	59	-1.6	0.985	0.784	0.594	0.446	289.52
	7	59	-0.7	1.098	0.752	0.548	0.454	359.08
	8	59	-2.0	0.945	0.598	0.47	0.358	418.5
Mean		—	—	—	0.7785	0.564143	0.427214286	370.08
> 60 years of age	9	63	-1.9	0.947	0.672	0.482	0.338	302.4
	10	65	-2.6	0.864	0.512	0.42	0.37	442.14
	11	66	-3.5	0.757	N/A	N/A	N/A	856.1
	12	70	-1.6	N/A	0.786	0.758	0.428	455.45
	13	72	-3.8	0.745	0.74	0.48	0.356	419.66
Mean		—	—	—	0.6775	0.535	0.373	414.75

Variable		Statistic	T-score	BMD	ADC			T1
Variable		Statistic	T-score	BMD	b300	b500	b800	T1
T-score		r	1	0.999	-0.276	-0.182	-0.192	-0.634
		p	—	0.000	0.412	0.593	0.571	0.020
		n	13	12	11	11	11	13
BMD		r	0.999	1	-0.285	-0.261	-0.214	-0.653
		p	0.000	—	0.426	0.466	0.553	0.021
		n	12	12	10	10	10	12
ADC	b300	r	-0.276	-0.285	1	0.870	0.879	0.503
		p	0.412	0.426	—	0.000	0.000	0.115
		n	11	10	11	11	11	11
	b500	r	-0.182	-0.261	0.870	1	0.862	0.521
		p	0.593	0.466	0.000	—	0.001	0.100
		n	11	10	11	11	11	11
	b800	r	-0.192	-0.214	0.879	0.862	1	0.480
		p	0.571	0.553	0.000	0.001	—	0.135
		n	11	10	11	11	11	11
T1		r	-0.634	-0.653	0.503	0.521	0.480	1
		p	0.020	0.021	0.115	0.100	0.135	—
		n	13	12	11	11	11	13

Age group	Variable		Statistic	T-score	BMD	ADC			T1
Age group	Variable		Statistic	T-score	BMD	b300	b500	b800	T1
≤ 60 years of age (n = 8)	T-score		r	1	1.000	-0.657	-0.751	-0.707	-0.688
			p	—	0.000	0.109	0.052	0.076	0.059
			n	8	8	7	7	7	8
	BMD		r	1.000	1	-0.658	-0.755	-0.713	-0.678
			p	0.000	—	0.108	0.050	0.072	0.065
			n	8	8	7	7	7	8
	ADC	b300	r	-0.657	-0.658	1	0.979	0.932	0.702
			p	0.109	0.108	—	0.000	0.002	0.079
			n	7	7	7	7	7	7
		b500	r	-0.751	-0.755	0.979	1	0.971	0.640
			p	0.052	0.050	0.000	—	0.000	0.121
			n	7	7	7	7	7	7
		b800	r	-0.707	-0.713	0.932	0.971	1	0.569
			p	0.076	0.072	0.002	0.000	—	0.183
			n	7	7	7	7	7	7
	T1		r	-0.688	-0.678	0.702	0.640	0.569	1
			p	0.059	0.065	0.079	0.121	0.183	—
			n	8	8	7	7	7	8
> 60 years of age (n = 5)	T-score		r	1	0.996	0.084	0.567	0.446	-0.504
			p	—	0.004	0.916	0.433	0.554	0.387
			n	5	4	4	4	4	5
	BMD		r	0.996	1	-0.387	-0.074	-0.473	-0.638
			p	0.004	—	0.747	0.953	0.686	0.362
			n	4	4	3	3	3	4
	ADC	b300	r	0.084	-0.387	1	0.736	0.400	0.032
			p	0.916	0.747	—	0.264	0.600	0.968
			n	4	3	4	4	4	4
		b500	r	0.567	-0.074	0.736	1	0.871	0.366
			p	0.433	0.953	0.264	—	0.129	0.634
			n	4	3	4	4	4	4
		b800	r	0.446	-0.473	0.400	0.871	1	0.735
			p	0.554	0.686	0.600	0.129	—	0.265
			n	4	3	4	4	4	4
	T1		r	-0.504	-0.638	0.032	0.366	0.735	1
			p	0.387	0.362	0.968	0.634	0.265	—
			n	5	4	4	4	4	5

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[1] Correspondence: Mirko Trentadue, MD. Radiology Unit, Hospital “M. Magalini”, AULSS 9 Scaligera, Via Ospedale Magalini, 5, Villafranca di Verona, Italy - 37069. mirko.trentadue@aulss9.veneto.it.