Comparison of DXA and MRI methods for interpreting femoral neck bone mineral density

The aim of the study was to improve the practical implementation of the dual X-ray absorptiometry (DXA) by converting the areal bone mineral density BMD (BMDareal) to volumetric BMD using magnetic resonance (MR) imaging (MRI) because a failure to control for the femoral neck size can lead to erroneous interpretation of BMD values. We also evaluated the feasibility of MR T2* relaxation time in assessing bone mineral status of the femoral neck. Twenty-eight randomly selected 47- to 64-yr-old healthy men were studied. The men had neither unilateral nor bilateral hip osteoarthritis according to radiographs. Bone width, mineral content (BMC), BMDareal, and apparent volumetric BMD (BMDvol) of the right femoral neck were measured with DXA. The BMDvol was calculated by approximating the femoral neck to be cylindrical with a circular cross-section (Vol(dxa)). Volumetric measurements from MR (Vol(mri)) images of the femoral neck were also used to create a BMD measure that was corrected for the femoral neck volume (BMDmri). T2* measurements were performed with a 1.5-T scanner (Siemens Magnetom 63SP, Erlangen, Germany). A single 10-mm-thick coronal slice was generated on the femur with a repetition time of 60 ms, and nine echo times (4-20 ms) were used to derive T2* values. Vol(mri) correlated positively (r = 0.828, p < 0.001) with Vol(dxa). However, the Vol(mri) of the femoral neck was 18% lower than the Vol(dxa). Similarly, the BMDmri was related to the BMDvol (r = 0.737, p < 0.001). Because of the difference in the volumetric measures, the BMDmri of the femoral neck was 21% higher than the BMDvol (p < 0.001). T2* relaxation time showed a significant negative correlation with BMC, BMDareal, BMDvol, and BMDmri (r = -0.423 to -0.757, p < 0.05-0.001). In conclusion, these results are evidence that DXA-derived volume approximations by the cylinder with circular cross-section geometry may lead to lower DXA-derived BMDvol values, as compared to true MRI-derived volumetric bone mineral density. Thus, the BMDvol may not be an accurate method to calculate the true volumetric BMD in the femoral neck. Our results also suggest that the MRI-derived T2* method may be used to approximate the BMD in the proximal femur.