MRI signal intensity per vertebral volume: a novel biomarker in pediatric osteoporosis

Abstract Purpose This study aimed to evaluate the diagnostic performance of a novel MRI-based parameter—MRI signal intensity per unit vertebral volume—in identifying low bone mineral density (BMD) in children and adolescents, alongside established MRI metrics including mean L1-L4 signal intensity and vertebral bone quality (VBQ) score. Materials diagnostic accuracy was assessed via ROC curve analysis. Results In the childhood group, all MRI parameters significantly differed between low bone mineral density and control subjects ( p < 0.05). In adolescents, only mean signal intensity and signal intensity per unit volume were significant. The new parameter demonstrated the highest diagnostic value, with AUCs of 0.792 and 0.836 in childhood and adolescence groups, respectively. Conclusions MRI signal intensity per unit vertebral volume showed superior performance in detecting low BMD compared to existing MRI-based indices. This parameter offers a radiation-free, size-adjusted alternative to DXA, particularly valuable in pediatric patients requiring long-term monitoring.