Correlation Between Quantitative Analysis Of Multifidus Muscle Based On MRI And Bone Status In Postmenopausal Women

Objective: By studying the degree of lumbar spine CT value decline and multifidus muscle atrophy in postmenopausal women with different bone mineral states,we aim to evaluate the correlation between lumbar spine CT values,multifidus muscle atrophy,and bone loss,osteoporosis(OP),and osteoporotic vertebral compression fractures(OVCF).Method: From June 1,2018 to June 30,2022,we reviewed data from patients admitted to our hospital’s Spinal Diseases Department.We collected complete medical records,test results and imaging data based on inclusion criteria.Participants were divided into groups based on T-values and whether or not they had fractures,and physicians from different groups measured lumbar vertebra CT values through the Picture Archiving and Communication System(PACS).Additionally,Total Multifidus Muscle Cross-Sectional Area(TCSA),Fat Infiltration(FI)and Functional CSA were measured using Image-Pro Plus software.The measurement data was analyzed for reliability and repeatability utilizing the Interclass Correlation Coefficient(ICC).The normality of quantitative data was assessed using the Kolmogorov-Smirnov test.For normally distributed quantitative data,one-way ANOVA was used to compare between multiple groups.For non-normally distributed quantitative data,Kruskal-Wallis H test was performed for multi-group analysis.Correlation analysis was conducted on the measurement data.We utilized Receiver Operating Characteristic(ROC)curves to assist in the diagnosis of bone loss,osteoporosis and fractures,and evaluate the sensitivity and specificity through the Area Under the Curve(AUC).Result: A total of 290 patients who met inclusion criteria participated in this study,including 15 patients with normal bone mass(Group A),70 with decreased bone mass(Group B),102 with osteoporosis(Group C),and 103 with osteoporosis and fractures(Group D).There were statistically significant differences in CT value(H=136.339,P<0.001),Fat Infiltration(FI)(H=124.267,P<0.001),and Functional CSA(FCSA)(H=101.587,P<0.001)among the four groups.The CT values of group D were lower than those of groups A,B,and C,and the CT values of group C were lower than those of groups A and B(P<0.001).The FI of group D was higher than those of groups A,B,and C,and the FI of group C was higher than those of groups A and B(P<0.001).The FCSA of group D was lower than those of groups A,B,and C,and the FCSA of group C was lower than those of groups A and B(P<0.001).Correlation analysis showed that T-scores were positively correlated with CT values(r=0.723,P<0.001)and FCSA(r=0.488,P=0.001),and negatively correlated with FI(r=-0.528,P<0.001).CT values were positively correlated with FCSA(r=0.371,P<0.001)and negatively correlated with FI(r=-0.437,P<0.001).FI was negatively correlated with FCSA(r=-0.911,P<0.001).ROC curves were used to aid in the diagnosis of bone loss.CT values had an AUC of 0.809(P<0.001)and the optimal cut-off point was 141.75 HU;FI had an AUC of 0.820(P<0.001)and the optimal cut-off point was 0.15;FCSA had an AUC of 0.720(P=0.001)and the optimal cut-off point was 1288.35 mm2.Among the indicators,there was a statistically significant difference in AUC between FI and FCSA(Z=2.009,P=0.045).ROC curves were also used to aid in the diagnosis of osteoporosis.CT values had an AUC of 0.933(P<0.001)and the optimal cut-off point was 100.00HU;FI had an AUC of 0.930(P<0.001)and the optimal cut-off point was 0.17;FCSA had an AUC of 0.907(P<0.001)and the optimal cut-off point was1249.14 mm2.There were no statistically significant differences in AUCs between the groups.Finally,theROC curves were used to diagnose fractures.CT values had an AUC of0.984(P<0.001)and the optimal cut-off point was 64.25 HU;FI had an AUC of0.952(P<0.001)and the optimal cut-off point was 0.021;FCSA had an AUC of0.932(P<0.001)and the optimal cut-off point was 1206.18 mm2.There was a statistically significant difference in AUC between CT values and FCSA(Z=2.090,P=0.037)..Conclusion:(1)The lumbar spine CT values and FCSA of OVCF and OP patients decreased significantly,while the FI significantly increased,indicating a correlation between the changes in bone quality after menopause in women and the lumbar spine CT values and multifidus muscle.This also suggests that the decrease in lumbar spine CT values and the degeneration of the multifidus muscle are potential high-risk factors for OVCF and OP.(2)Lumbar spine CT values,FCSA,and FI have certain value in assisting in the diagnosis of decreased bone mass,OP,and OVCF,and can serve as a supplement to bone density examinations.