Evaluating the feasibility of diffusion models for diagnosis of osteoporosis in women: A clinical diagnostic analysis of DWI, CTRW, and FROC diffusion models

Abstract Background This study investigated the use of diffusion MRI models for diagnosing osteoporosis in women. Traditional methods, like DXA, struggle to assess bone quality. The research found that CTRW and FROC models effectively distinguished between healthy and osteoporotic bones, offering a promising approach for bone quality assessment and fracture risk prediction. Purpose This study aims to evaluate the diagnostic efficacy of the conventional diffusion‐weighted imaging (DWI), continuous‐time random walk (CTRW), and fractional order calculus (FROC) models for osteoporosis in women. Methods A total of 131 women with an average age of 60.6 ± 8.5 years underwent magnetic resonance imaging (MRI) and dual‐energy X‐ray absorptiometry (DXA) of the lumbar spine. Diffusion metrics were derived from regions of interest (ROIs) on the b = 0 map, and applied to the quantitative map of conventional DWI (ADC), CTRW ( α CTRW , β CTRW , and D CTRW ), and FROC ( µ FROC , β FROC , and D FROC ) models. These metrics were compared among three groups of normal, osteopenia, and osteoporosis subjects. Receiver operating characteristic (ROC) curves evaluated their diagnostic performance, and Spearman correlation assessed the relationship between diffusion parameters and clinical factors. P < 0.05 was considered statistically significant. Results ADC, D CTRW , D FROC , and µ FROC values were significantly different in the osteoporosis and osteopenia groups compared to the normal group ( p = 0.001 ∼ 0.014). The D CTRW and D FROC metrics exhibited superior diagnostic performance, with the areas under the ROC curves (AUC) values of 0.699 and 0.697, respectively, surpassing the AUC of the conventional ADC of 0.687. Furthermore, a composite model combining α CTRW , β CTRW , and D CTRW achieved an AUC of 0.722 for differentiating between the normal and osteoporosis groups, outperforming individual diffusion metrics and the combined FROC model. Moreover, Spearman correlations analysis showed that ADC, D CTRW , D FROC and µ FROC metrics exhibited significant correlation with FRAX (Fracture Risk Assessment Tool) scores. Conclusion The CTRW diffusion metrics demonstrate significant potential as biomarkers for osteoporosis diagnosis in women, offering a valuable method for assessing bone quality and predicting fracture risk.