Systematic review and meta-analysis: the value of MRI chemical-shift imaging in the evaluation of bone quality in patients with osteoporosis

Background: Osteoporosis is a systemic skeletal disease with no obvious symptoms in its early stages. The decreases in bone density and bone mass are associated with the deterioration of bony microstructure in the body, due to a variety of reasons. The current assessment criteria for osteoporosis are still not perfect. MRI chemical-shift imaging shows potential to be a valuable technique in the bone quality assessment of osteoporotic patients. Methods: Randomized controlled studies on osteoporosis assessment were searched for in English-language databases, including PubMed, Web of Science, Embase, and The Cochrane Library. Inclusion criteria were: (I) literature focused on the assessment of osteoporosis by chemical displacement imaging; (II) studies evaluating the bone quality of osteoporosis; (III) studies with at least 15 samples; (IV) studies concerned with the evaluation of osteoporosis by chemical shift encoded magnetic resonance imaging (CSE-MRI); and (V) studies with outcome indexes for bone mineral density (BMD), body mass index (BMI), and bone marrow fat fraction (BMFF). The Jadad tool was used to evaluate the quality of the included studies, and the Review Manager v. 5.3 software was used to conduct the meta-analysis of the experimental data. Results: A total of 7 suitable articles were selected. According to the results of the meta-analysis, for the osteoporosis group and normal group: BMD: MD=41.91 [95% confidence interval (CI): 40.15 to 43.66], Z=46.82 (P<0.00001); BMI: MD=-1.43 (95% CI: -2.02 to -0.84), Z=4.76 (P<0.00001); BMFF: MD=-18.34 (95% CI: -20.32 to -16.36), Z=18.15 (P<0.00001). Discussion: MRI chemical-shift imaging can effectively measure BMD and bone mass, including in osteoporotic patients. However, the outcome indicators included in this study are not sufficient to assess the utility of MRI chemical shift imaging for evaluating bone mass in osteoporotic patients, and further expansion of the sample size and outcome indicators is needed.