MRI Study Of The Relationship Between Spinal Fracture And Vertebral And Paraspinal Muscle Structure In Type 2 Diabetic Patients

Objective : To assess vertebral and paravertebral muscle changes in patients with type 2 diabetes mellitus spinal fractures based on MRI imaging and to investigate their correlation with the degree of vertebral fractures.Methods: 168 patients(male: 88,female: 80)who were clinically diagnosed with T2 DM and underwent lumbar MRI at the First Affiliated Hospital of Kunming Medical University from January 18,2020 to January 31,2022 were retrospectively collected.All patients were assessed for the presence of fractures by Genant semi-quantitative method and vertebral morphometry,and the degree of fractures was assessed.They were divided into two groups according to whether they had fractures:T2DM vertebral fracture group(49 males and 32 females)and no fracture group(39males and 48 females),and into mild fracture group(36 males and 15 females)and moderate to severe fracture group(13 males and 17 females)according to the degree of fracture.In all patients,the signal intensity of cerebrospinal fluid at the L1-4vertebral body and L3 level was measured on T1 WI sagittal images of the lumbar spine,and the Vertebral Bone Quality score of the vertebral body was calculated;the total CSA,fat CSA,and vertebral CSA of the paravertebral muscles at the lower edge of the L3 vertebral body were measured using Image J software,and the relative CSA and paravertebral Fat Infiltration were calculated.Independent sample t-test or Mann-Whitney U test was used to compare the differences in vertebral VBQ,total paraspinal muscle CSA,relative CSA,FI and clinically relevant risk factors of T2 DM fractures between the T2 DM vertebral fracture group and the no fracture group,moderate to severe T2 DM vertebral fracture group,and mild fracture group;logistic regression analysis was used to analyze the risk factors of T2 DM vertebral fracture and fracture degree;Pearson correlation analysis was used to analyze the correlation between VBQ and paraspinal muscle CSA,relative CSA,and FI in T2 DM patients.Results: Age,BMI,VBQ,and FI of the paravertebral muscles were higher in the T2 DM fracture group than in the no-fracture group,and the difference was statistically significant(P< 0.05);the relative CSA of the paravertebral muscles was smaller than that in the no-fracture group,and the difference was statistically significant(P= 0.000);male gender(OR = 8.407,95% CI 1.841–38.385),BMI(OR= 1.337,95% CI 1.104–1.620),fall risk score(OR = 1.345,95% CI 1.104-1.638),ADL score(OR = 0.935,95% CI 0.882–0.992),lumbar VBQ score(OR = 3.743,95% CI 1.459–9.607),relative CSA of the paravertebral muscles(OR = 0.294,95%CI 0.141-0.613),and FI of the paravertebral muscles(OR = 1.271,95% CI 1.022–1.580)were risk factors for vertebral fractures in T2 DM patients(P< 0.05);age(OR =1.066,95% CI 1.130–1.232)95% CI 1.046–1.451)and paravertebral muscle FI(OR = 1.406,Fig.95% CI 1.176 – 1.681)was a factor influencing the degree of vertebral fractures in T2 DM patients(P< 0.05);T2DM lumbar VBQ score was mildly negatively correlated with paravertebral muscle CSA(r =-0.223,P< 0.001),VBQ score was mildly negatively correlated with relative CSA(r =-0.280,P< 0.001),and VBQ score was mildly positively correlated with paravertebral muscle fat infiltration(r = 0.281,p < 0.001).Conclusions: 1.lumbar fat infiltration is increased in patients with T2 DM vertebral fractures,and the higher the VBQ,the greater the risk of vertebral fractures,and VBQ can be used to assess the risk of vertebral fractures in patients with T2 DM.2.patients with T2 DM vertebral fractures had significant changes in paravertebral muscle degeneration,and compared with patients without fractures,patients with fractures had decreased relative cross-sectional area of paravertebral muscles and increased fat infiltration,and fat infiltration of paravertebral muscles was related to the degree of fractures.3.BMI is a risk factor for vertebral fractures in T2 DM patients,and high BMI increases the risk of vertebral fractures and the degree of fracture compression in T2 DM patients.