A new diagnostic score to detect osteoporosis in patients undergoing lumbar spine MRI

Michele Bandirali, Giovanni Di Leo, Giacomo Davide Edoardo Papini, Carmelo Messina, Luca Maria Sconfienza, Fabio Massimo Ulivieri, Francesco Sardanelli

Research output: Contribution to journalArticlepeer-review


Objectives: Signal intensity of lumbar-spine at magnetic resonance imaging (MRI) correlates to bone mineral density (BMD). Our aim was to define a quantitative MRI-based score to detect osteoporosis on lumbar-spine MRI. Methods: After Ethics Committee approval, we selected female patients who underwent both lumbar-spine MRI and dual-energy X-ray absorptiometry (DXA) and a reference group of 131 healthy females (20–29 years) who underwent lumbar-spine MRI. We measured the intra-vertebral signal-to-noise ratio in L1-L4. We introduced an MRI-based score (M-score), on the model of T-score. M-score diagnostic performance in diagnosing osteoporosis was estimated against DXA using receiver operator characteristic (ROC) analysis. Results: We included 226 patients (median age 65 years), 70 (31 %) being osteoporotic at DXA. MRI signal-to-noise ratio correlated to BMD (r = −0.677, P <0.001). M-score negatively correlated to T-score (r = −0.682, P <0.001). Setting a 90 %-specificity, an M-score threshold of 5.5 was found, distinguishing osteoporosis from non-osteoporosis (sensitivity 54 %; ROC AUC 0.844). Thirty-one (14 %) patients had a fragility fracture, with osteoporosis detected in 15 (48 %) according to M-score and eight (26 %) according to T-score (P = 0.016). Conclusions: M-score obtained on lumbar spine MRI is a quantitative method correlating with osteoporosis. Its diagnostic value remains to be demonstrated on a large prospective cohort of patients. Key Points: • M-score is a quantitative score potentially screening osteoporosis on lumbar-spine MRI; • This method showed good intra- and inter-reader reproducibility; • M-score may be used for identifying patients who should undergo DXA.

Original languageEnglish
Pages (from-to)2951-2959
Number of pages9
JournalEuropean Radiology
Issue number10
Publication statusPublished - Apr 22 2015


  • Bone mineral density
  • Dual-energy X-ray absorptiometry
  • Lumbar spine
  • Magnetic resonance imaging
  • Osteoporosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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