Studying the capabilities of IDEAL MR-sequence and fat fraction in osteoporosis diagnostics: a retrospective descriptive single-center study

Introduction: Bone strength is 60–70% depends on its mineral density. The remaining 30–40% of strength depend on the microarchitecture and composition. Osteoporosis is characterized by fatty involution of bone marrow. Based on this, it has been proposed to determine the amount of adipose tissue in bone as a fat fraction. Magnetic resonance imaging can be used to assess the fat fraction. The IDEAL MR sequence has not been sufficiently studied for the research of fat fraction and correlation with data of dual-energy X-ray absorptiometry.

Objective: To investigate the possibility of using fat fraction derived from the IDEAL sequence in MRI in the diagnosis of osteoporosis for women over 50 years of age.

Materials and Methods: Magnetic resonance imaging of I–IV lumbar vertebrae (IDEAL pulse sequence) and dual-energy X-ray absorptiometry data of 43 women over 50 years of age (mean age 63.9±8.4 years) were analyzed. MRI was performed on a GE Signa Voyager. DRA was performed on a Dexxum osteodensitometer. Fat fraction was calculated as the ratio of signal intensity at fat to signal from water. Statistics: Pearson’s coefficient (r) was calculated for correlation analysis, ROC analysis was used, sensitivity and specificity were assessed. Values were considered statistically significant at p<0.05. RESULTS: Fat fraction less than 0.66 corresponds to normal IPC values, fat fraction greater than 0.71 corresponds to osteoporosis (p=0.030). The sensitivity of MRI for detecting osteoporosis was 99%, specificity 87%, accuracy 88% (p><0.05). The correlation coefficient between IPC and fat fraction is negative and statistically significant (r=–0.316; (p=0.041). The correlation coefficient between T-criterion and fat fraction is statistically significant, negative (r=–0.300; (p=0.05). The correlation coefficient between age and fat fraction is positive, statistically significant (r=0.374; (p=0.015). The correlation coefficient between BMI and fat fraction is not statistically significant (r=–0.147; (p=0.347). DISCUSSION: With decreasing bone mineral density the fat fraction increases, with decreasing T-score the fat fraction increases, with increasing age the fat fraction increases. No correlation was found between body mass index and fat fraction. The data of the study are consistent with the data of other studies. CONCLUSION: IDEAL MR-sequencing is a promising technique for assessing fat fraction that can be used as a dose-free opportunistic screening of osteoporosis. Magnetic resonance imaging is widely used in the diagnosis of degenerative-dystrophic diseases of the spine. The IDEAL sequence lasts just over 3 minutes and can be added to the routine lumbar spine MRI protocol without significantly increasing the examination time, without prescribing additional examination methods, without exposure to ionizing radiation and with a significant increase in the amount of diagnostic information for detecting osteoporosis. KEYWORDS: osteoporosis, dual-energy X-ray absorptiometry, magnetic resonance imaging > < 0.05. RESULTS: Fat fraction less than 0.66 corresponds to normal IPC values, fat fraction greater than 0.71 corresponds to osteoporosis (p=0.030). The sensitivity of MRI for detecting osteoporosis was 99%, specificity 87%, accuracy 88% (p < 0.05). The correlation coefficient between IPC and fat fraction is negative and statistically significant (r=–0.316; (p=0.041). The correlation coefficient between T-criterion and fat fraction is statistically significant, negative (r=–0.300; (p=0.05). The correlation coefficient between age and fat fraction is positive, statistically significant (r=0.374; (p=0.015). The correlation coefficient between BMI and fat fraction is not statistically significant (r=–0.147; (p=0.347).

Discussion: With decreasing bone mineral density the fat fraction increases, with decreasing T-score the fat fraction increases, with increasing age the fat fraction increases. No correlation was found between body mass index and fat fraction. The data of the study are consistent with the data of other studies.

Conclusion: IDEAL MR-sequencing is a promising technique for assessing fat fraction that can be used as a dose-free opportunistic screening of osteoporosis. Magnetic resonance imaging is widely used in the diagnosis of degenerative-dystrophic diseases of the spine. The IDEAL sequence lasts just over 3 minutes and can be added to the routine lumbar spine MRI protocol without significantly increasing the examination time, without prescribing additional examination methods, without exposure to ionizing radiation and with a significant increase in the amount of diagnostic information for detecting osteoporosis.

1. Nizovtsova L.A., Morozov S.P., Petryaykin A.V., Bosin V.Yu., Sergunova K.A., Vladzimirskiy A.V., Shantarevich M.Yu. On the unification of bone densitometry and interpretation of its results. Journal of radiology and nuclear medicine, 2018, No. 99 (3), pp. 158–163 (In Russ.). https://doi.org/10.20862/0042-4676-2018-99-3-158-163.

2. Maslaris A., Bungartz M., Layher F. et al. Feasibility Analysis of a Novel Method for the Estimation of Local Bone Mechanical Properties: A Preliminary Investigation of Different Pressure Rod Designs on Synthetic Cancellous Bone Models // Arch. Bone Jt. Surg. 2021. No. 9. Р. 203–210. https://doi: 10.22038/abjs.2020.47854.2365.

3. Calciolari E., Donos N., Park J.C. et al. Panoramic measures for oral bone mass in detecting osteoporosis: a systematic review and meta-analysis // J. Dent. Res. 2015. No. 94 (3 Suppl). Р. 17S–27S. https://doi: 10.1177/0022034514554949.

4. Jafari R., Spincemaille P., Zhang J. et al. Deep neural network for water/fat separation: Supervised training, unsupervised training, and no training // Magn. Reson. Med. 2021. No. 85. Р. 2263–2277. https://doi: 10.1002/mrm.28546.

5. Dixon W.T. Simple proton spectroscopic imaging // Radiology. 1984. Vol. 153. No. 1. Р. 189–194. https://doi.org/10.1148/radiology.153.1.6089263.

6. Bydder M., Yokoo T., Hamilton G. et al. Relaxation effects in the quantification of fat using gradient echo imaging // Magn. Reson. Imaging. 2008. No. 26 (3). Р. 347– 359. https://doi: 10.1016/j.mri.2007.08.012.

7. Xin-Chen Huang, Yi-Long Huang, Yi-Tong Guo et al. An experimental study for quantitative assessment of fatty infiltration and blood flow perfusion in quadriceps muscle of rats using IDEAL-IQ and BOLD-MRI for early diagnosis of sarcopenia // Experimental Gerontology. 2023. No. 183. Р. 112322. doi: https://doi.org/10.1016/j.exger.2023.112322.

8. Petraikin A.V., Skripnikova I.A. Quantitative Computed Tomography, modern data. Review. Medical Visualization, 2021, No. 25 (4), рр. 134–146 (In Russ.). https://doi.org/10.24835/1607-0763-1049.

9. Panina O.Yu., Gromov A.I., Akhmad E.S. et al. Accuracy of fat fraction estimation using Dixon: experimental phantom study // Medical Visualization. 2022. No. 26 (4). Р. 147–158. https://doi.org/10.24835/1607-0763-1160.

10. Aoki T., Yamaguchi S., Kinoshita S. et al. Quantification of bone marrow fat content using iterative decomposition of water and fat with echo asymmetry and leastsquares estimation (IDEAL): reproducibility, site variation and correlation with age and menopause // British Journal of Radiology. 2016. No. 89. Р. 20150538. https://doi:10.1259/bjr.20150538.

11. He J., Fang H., Li X. Vertebral bone marrow fat content in normal adults with varying bone densities at 3T magnetic resonance imaging // Acta Radiologica. 2018. No. 60 (4). Р. 509–515. https://doi:10.1177/0284185118786073.

12. Lukashew A.D., Akhatov A.F., Ryzhkin S.A., Mikhailov M.K., Zalaeva D.R. Application of DIXON MRI sequencing in the diagnosis of changes in the spongy substance of vertebral bodies in comparison with osteodensitometry data. Medical Visualization, 2023, No. 27 (3), pр. 76–83 (In Russ.). https://doi.org/10.24835/1607-0763-1201.

13. Zhou F., Sheng B., Lv F. Quantitative analysis of vertebral fat fraction and R2* in osteoporosis using IDEAL-IQ sequence // BMC Musculoskelet. Disord. 2023. No. 11. Р. 1–8. https://doi: 10.1186/s12891-023-06846-4.

14. Bilge E.F., Gulsah G., Elcin Y.A. et al. Fat Fraction Estimation of the Vertebrae in Females Using the T2*-IDEAL Technique in Detection of Reduced Bone Mineralization Level: Comparison With Bone Mineral Densitometry // Journal of Computer Assisted Tomography. 2014. No. 38. P. 320–324. https://doi: 10.1097/RCT.0b013e3182aa4d9d.

15. Zhao Y., Huang M., Ding J. et al. Prediction of Abnormal Bone Density and Osteoporosis From Lumbar Spine MR Using Modified Dixon Quant in 257 Subjects With Quantitative Computed Tomography as Reference // J. Magn. Reson. Imaging. 2019. No. 49 (2). Р. 390–399. https://doi: 10.1002/jmri.26233.

16. Liu Z., Huang D., Jiang Y., Ma X., Zhang Y., Chang R. Correlation of R2* with fat fraction and bone mineral density and its role in quantitative assessment of osteoporosis // Eur. Radiol. 2023. No. 33 (9). Р. 6001–6008. https://doi: 10.1007/s00330-023-09599-9.