Diagnostic accuracy of the Vertebral Bone Quality (VBQ) score in differentiating pathologic vertebral fractures

Introduction: The diagnosis of vertebral fractures may be challenging when clinical and radiological findings are inconclusive. The Vertebral Bone Quality (VBQ) score, derived from bone marrow signal intensity on T1-weighted magnetic resonance imaging (MRI) sequences, has been proposed as an objective tool for evaluating bone quality and differentiating osteoporotic fractures from fractures of tumoral origin. Objective: To assess the ability of the VBQ score on MRI to distinguish osteoporotic from neoplastic vertebral fractures. Secondarily, to determine the optimal cut-off value for identifying osteoporotic fractures. Method: Retrospective, cross-sectional, observational study of diagnostic accuracy. A total of 49 spine MRI with vertebral fractures (2017–2024) from patients over 18 years old were reviewed. Exclusion criteria included artifacts, spinal instrumentation, high-energy trauma, or incomplete studies. Three radiologists classified fractures as osteoporotic or neoplastic based on imaging criteria. VBQ was calculated on T1-weighted images as the ratio of signal intensity from L1–L4 to that of cerebrospinal fluid. Study approved by the institutional ethics board. Results: Thirty-two adult patients were analyzed (mean age: 66.2 years). VBQ was significantly higher in osteoporotic fractures (3.76 ± 0.72) compared to neoplastic ones (3.11 ± 0.99) (p = 0.047), with high interobserver agreement (ICC: 0.950). The AUC was 0.722, with an optimal cut-off of 3.17 (sensitivity 66.7% and specificity 87%). Conclusions: The VBQ score is a promising tool to support the differential diagnosis of vertebral fractures in clinical practice.