Potential Physiological Factors Underlying Diagnostic Discrepancies between MRI-based Cervical Vertebral Bone Quality Scores and dual-energy X-ray Absorptiometry T-scores

Study Design. Retrospective observational study Objective. This study aims to: (1) identify physiological factors influencing cervical vertebral bone quality (C-VBQ) scores, and (2) elucidate the mechanistic basis for diagnostic discrepancies between C-VBQ scores and dual-energy X-ray absorptiometry (DEXA) in bone quality evaluation. Summary of Background Data. C-VBQ scores have emerged as a novel indicator for evaluating cervical bone quality. However, the potential influencing factors of C-VBQ scores, and the reasons for diagnostic discrepancies between C-VBQ scores and DEXA methods, have not been elucidated. Methods. We performed a retrospective analysis of 264 patients with cervical spondylotic myelopathy treated from July 2017 to July 2024. Correlation analyses and multiple linear regression were used to explore the associations between physiological factors and C-VBQ scores. The predictive performance of C-VBQ scores for bone quality was evaluated via receiver operating characteristic analysis. Bone quality was independently assessed using both T-scores and C-VBQ scores. Accordingly, participants were classified into four groups: Healthy Bone (HBG), Damaged Bone (DBG), T-Healthy but VBQ-Damaged (TH-VDG), and T-Damaged but VBQ-Healthy (TD-VHG). Intergroup differences in physiological indicators were analyzed by ANOVA, Kruskal-Wallis test, Chi-square test, and Fisher’s exact test. Results. The C-VBQ score demonstrated a significant positive correlation with glycated albumin (GA) (r=0.425, P <0.001), high-density lipoprotein cholesterol (HDL-C) (r=0.402, P <0.001), and conjugated bilirubin (CB) (r=0.366, P <0.001). Multiple linear regression analysis revealed that GA (β=0.095, P <0.001), HDL-C (β=0.669, P <0.001), and CB (β=0.141, P <0.001) were significant factors contributing to changing C-VBQ scores. The patients in TH-VDG had significantly higher levels of GA, HDL-C, and CB compared to HBG patients. Conclusions. GA, HDL-C, and CB are positively correlated with C-VBQ scores, and these correlations are significantly stronger than those with T-scores. Based on C-VBQ scores, patients with higher levels of GA, HDL-C, and CB tend to be diagnosed with impaired bone quality.