Magnetic resonance imaging phantom-based S1 vertebral scores are indicators of fat–water-like osteoporotic changes in postmenopausal women: a pilot study

Study Design: A prospective study.Purpose: To assess fat–water-like tissue changes on the 1st sacral vertebra using novel magnetic resonance imaging (MRI) phantombased F- and W-scores and evaluate their diagnostic performances in osteoporosis detection.Overview of Literature: Using an uncommonly advanced MRI technique, previous studies have found that fat–water changes were consistent with osteoporosis. The role of routine MRI sequences can be extended in this regard. The S1 vertebra is considered a crucial anatomical site in spine surgeries because it seldom suffers from fractures. Thus, S1 could indicate osteoporotic fat–water changes.Methods: Forty-two female volunteers (aged 62.3±6.3 years) underwent spine examination with both MRI (including a phantom) and dual-energy X-ray absorptiometry (DXA) following ethical approval. MRI phantom-based F- and W-scoreS1 were defined by normalizing S1 vertebral signal intensities (SIs) by coconut oil and water SIs of the phantom on T1- and T2-weighted imaging, respectively. Using receiver operating characteristic analysis, the diagnostic performances of the new scores for evaluating osteoporosis and vertebral fractures were investigated against standard areal bone mineral density measured with DXA (DXA-aBMD).Results: The F-scoreS1 and W-scoreS1 were greater (4.11 and 2.43, respectively) in patients with osteoporosis than those without osteoporosis (3.25 and 1.92, respectively) and achieved areas under the curve (AUCs) of 0.82 and 0.76 (p