High correlation of temporal muscle thickness with lumbar skeletal muscle cross-sectional area in patients with brain metastases

The association of BMI and sarcopenia with survival in patients with glioblastoma multiforme

Background: The association between obesity and sarcopenia (via temporal muscle thickness) with overall survival (OS) has been evaluated in several glioblastoma multiforme studies, however, the data are inconclusive. Methods: The authors conducted meta-analyses via the generic inverse-variance method with a random-effects model. Results: In the pooled analysis of five studies, including 973 patients, patients with lower temporal muscle thickness had significantly decreased OS (HR: 1.62, 95% CI: 1.16-2.28, p = 0.005). The pooled analysis of five studies, including 2131 patients, demonstrated decreased OS in patients with lower BMI compared with patients with obesity (HR: 1.45, 95% CI: 1.12-1.88, p = 0.005). Conclusion: Readily available body composition parameters could be used for prognosis prediction and to aid in treatment decisions in patients with glioblastoma multiforme.

Combined Assessment of Preoperative Frailty and Sarcopenia Allows the Prediction of Overall Survival in Patients with Lung Cancer (NSCLC) and Surgically Treated Brain Metastasis

Simple Summary

Patients with brain metastasis are at a severe stage of cancer, and brain surgery can prevent neurological morbidity. However, the success of brain surgery might require a patient’s physical integrity prior to the operation. In the present study, we asked whether a preoperative physical decline affects survival in patients with brain metastasis from lung cancer. In order to measure the physical condition, we used a commonly-known index—the so-called frailty index—and additionally measured the thickness of a particular masticatory muscle as muscle loss correlates to physical decline. We found that a decreased muscle thickness was accompanied by worsened survival for patients < 65 years and an increased frailty index correlated to worsened survival for patients ≥ 65 years. These results encourage to use of the frailty index and muscle thickness as easily available parameters in order to more sufficiently estimate individual treatment success in patients with metastatic lung cancer.

Abstract

Neurosurgical resection represents an important therapeutic pillar in patients with brain metastasis (BM). Such extended treatment modalities require preoperative assessment of patients’ physical status to estimate individual treatment success. The aim of the present study was to analyze the predictive value of frailty and sarcopenia as assessment tools for physiological integrity in patients with non-small cell lung cancer (NSCLC) who had undergone surgery for BM. Between 2013 and 2018, 141 patients were surgically treated for BM from NSCLC at the authors’ institution. The preoperative physical condition was assessed by the temporal muscle thickness (TMT) as a surrogate parameter for sarcopenia and the modified frailty index (mFI). For the ≥65 aged group, median overall survival (mOS) significantly differed between patients classified as ‘frail’ (mFI ≥ 0.27) and ‘least and moderately frail’ (mFI < 0.27) (15 months versus 11 months (p = 0.02)). Sarcopenia revealed significant differences in mOS for the <65 aged group (10 versus 18 months for patients with and without sarcopenia (p = 0.036)). The present study confirms a predictive value of preoperative frailty and sarcopenia with respect to OS in patients with NSCLC and surgically treated BM. A combined assessment of mFI and TMT allows the prediction of OS across all age groups.

A novel radiographic marker of sarcopenia with prognostic value in glioblastoma

OBJECTIVE

Sarcopenia is an important prognostic consideration in surgical oncology that has received relatively little attention in brain tumor patients. Temporal muscle thickness (TMT) has recently been proposed as a novel radiographic marker of sarcopenia that can be efficiently obtained within existing workflows. We investigated the prognostic value of TMT in primary and progressive glioblastoma.

METHODS

TMT measurements were performed on magnetic resonance images of 384 patients undergoing 541 surgeries for glioblastoma. Relationships between TMT and clinical characteristics were examined on bivariate analysis. Optimal TMT cutpoints were established using maximally selected rank statistics. Predictive value of TMT upon postoperative survival (PS) was assessed using Cox proportional hazards regression adjusted for age, sex, Karnofsky performance status (KPS), Stupp protocol completion, extent of resection, and tumor molecular markers.

RESULTS

Average TMT for the primary and progressive glioblastoma cohorts was 9.55 mm and 9.40 mm, respectively. TMT was associated with age (r = -0.14, p = 0.0008), BMI (r = 0.29, p < 0.0001), albumin (r = 0.11, p = 0.0239), and KPS (r = 0.11, p = 0.0101). Optimal TMT cutpoints for the primary and progressive cohorts were ≤ 7.15 mm and ≤ 7.10 mm, respectively. High TMT was associated with increased Stupp protocol completion (p = 0.001). On Cox proportional hazards regression, high TMT predicted increased PS in progressive [HR 0.47 (95% confidence interval (CI)) 0.25-0.90), p = 0.023] but not primary [HR 0.99 (95% CI 0.64-1.51), p = 0.949] glioblastoma.

CONCLUSIONS

TMT correlates with important prognostic variables in glioblastoma and predicts PS in patients with progressive, but not primary, disease. TMT may represent a pragmatic neurosurgical biomarker in glioblastoma that could inform treatment planning and perioperative optimization.

Temporal muscle thickness is associated with the severity of dysphagia in patients with acute stroke

BACKGROUND

Post-stroke dysphagia is a common and expensive complication of acute stroke. The relationship between dysphagia and skeletal muscle loss (sarcopenia) has been recently highlighted. This study aimed to determine the relationship between temporal muscle thickness (TMT) measured by head magnetic resonance imaging (MRI) and dysphagia in patients with acute stroke.

METHODS

Seventy participants (43 men and 27 women; mean age, 75.6 ± 12.7 years) were included in this study. TMT was measured by T2-magnetic resonance images within seven days of hospitalization. The severity of dysphagia was assessed using the Functional Oral Intake Scale (FOIS). Participants were classified into three categories according to the severity of dysphagia (severe: FOIS score, 1-3; mild: FOIS score, 4-6; normal: FOIS score, 7). Linear regression analysis was used to determine the independent explanators of dysphagia severity.

RESULTS

Twenty participants (28.6%) had severe dysphagia, 31 participants (44.3%) had mild dysphagia, and 19 participants (27.1%) had normal swallowing function at discharge. The results of the linear regression analysis showed that TMT was a significant explanator of dysphagia severity following stroke, along with age and National Institute of Health Stroke Scale (NIHSS) score (P < 0.05, effect size: f² = 0.72).

CONCLUSIONS

TMT was an independent risk factor for dysphagia in patients with acute stroke. Skeletal muscle loss may be secondarily involved in dysphagia with acute stroke, and measurement of TMT with head MRI is a useful method to assess skeletal muscle loss.

Skeletal muscle metastases of hepatocellular carcinoma: A case report and literature review

BACKGROUND

The metastasis of liver cancer to skeletal muscle is extremely rare compared to other sites. We herein report a case of rapidly developing skeletal metastases following liver transplantation due to primary liver cancer.

CASE SUMMARY

A 70-year-old male with underlying chronic hepatitis B virus infection was diagnosed with hepatocellular carcinoma (HCC), for which he underwent liver transplantation in 2014. Six years after receiving the transplant, pathological examination confirmed the presence of HCC without vascular invasion. He was admitted to the hospital with a rapidly growing mass on his right thigh. Ultrasound examination revealed a mixed echo mass in the lateral soft tissue of the middle part of the right femur. Magnetic resonance imaging showed heterogeneous iso-signal intensity on T1-weighted images and heterogeneous hyper-intensity on T2-weighted images compared to the surrounding muscles. Pathological examination of the ultrasound-guided needle biopsy specimen revealed that it was similar to the previously detected liver cancer; the diagnosis was metastasis of HCC. Surgical excision was performed. There were no other sites of metastasis, and the patient recovered well after surgery.

CONCLUSION

This report presents a rare case of skeletal metastasis following liver transplantation for HCC. The study suggests a possible role for skeletal muscle metastasis mechanisms, which should be the focus of future research.

Temporal muscle thickness and area are an independent prognostic factors in patients aged 75 or younger with aneurysmal subarachnoid hemorrhage treated by clipping

BACKGROUND

Skeletal muscle mass is an important factor for various diseases' outcomes. As for its indicators, temporal muscle thickness (TMT) and temporal muscle area (TMA) on the head computed tomography are useful, and TMT and TMA were reported as potential prognostic factors for aneurysmal subarachnoid hemorrhage (SAH). We examined the clinical characteristics, including TMT and TMA, of SAH patients aged 75 or younger.

METHODS

We retrospectively investigated 127 SAH patients with all World Federation of Neurosurgical Societies (WFNS) grades and treated by clipping between 2009 and 2019. Clinical outcome was measured with the modified Rankin Scale (mRS) at 6 months, with favorable outcome defined as mRS 0-2. The associations between the clinical variables and the outcomes were analyzed.

RESULTS

The mean age was 60.6 (32-74) years, and 65% were women. The mean ± standard deviation of WFNS grade was 2.8 ± 1.4. TMT and TMA were larger in the favorable outcome group than the poor one. Multivariate analysis revealed that age, smoking, WFNS grade, and TMT or TMA were associated with favorable outcome. Receiver operating characteristic analysis found that the threshold of TMT was 4.9 mm in female and 6.7 mm in male, and that of TMA was 193 mm2 in female and 333 mm2 in male.

CONCLUSION

The odds ratios for TMT and TMA related to clinical outcome were lower than for smoking and WFNS grade; however, on multivariate analysis they remained independent prognostic factors in SAH patients aged 75 or younger treated by clipping. Further studies are needed to confirm these findings.

Measuring and Monitoring Skeletal Muscle Mass after Stroke: A Review of Current Methods and Clinical Applications

OBJECTIVES

Muscle mass at admission is important to survive stroke, and stroke-induced sarcopenia is a serious problem because of its poor prognosis. Muscle mass measurement and monitoring are essential for appropriate rehabilitation and nutrition management. However, few reviews are available about the muscle mass measurement and monitoring after stroke.

MATERIAL AND METHODS

Several methods are used to assess skeletal muscle mass in stroke, such as computed tomography (CT), ultrasound, bioelectrical impedance analysis, dual-energy X-ray absorptiometry, biomarkers, and anthropometrics. We summarized the current methods and clinical applications in stroke.

RESULTS

In stroke, a head CT is used to estimate muscle mass by measuring the temporal muscle. However, it can be conducted retrospectively due to radiation exposure. After stroke, limb muscle atrophy and diaphragm dysfunction are observed using ultrasound. However, ultrasound requires an understanding of the methods and skill. A bioelectrical impedance analysis can be used to assess muscle mass in patients after a stroke unless they have dynamic fluid changes. Dual-energy X-ray absorptiometry is used for follow-up after hospital discharge. Urinary titin N-fragment and serum C-terminal agrin fragment reflect muscle atrophy after stroke. Anthropometrics may be useful with limited resources.

CONCLUSIONS

We summarized the features of each measurement and proved the recent evidence to properly measure and monitor skeletal muscle mass after stroke.

Standard values for temporal muscle thickness in the Japanese population who undergo brain check-up by magnetic resonance imaging

BACKGROUND

Skeletal muscle mass is an important factor for various diseases' outcomes. The psoas muscle cross-sectional area on the abdominal computed tomography (CT), gait speed, and handgrip strength is used to measure it. However, it is difficult to measure the neurological patients' muscle mass or function because (1) we do not perform abdominal CT. (2) Such patients have impaired consciousness, gait disturbance, paresis, and need of rest. Temporal muscle thickness (TMT) on magnetic resonance imaging (MRI) is now attractive for skeletal muscle volume indicator, but the reference values are not established. We herein investigated the standard value of the Japanese TMT using the brain check-up database by MRI.

METHODS

We retrospectively investigated 360 Japanese individuals from two institutions between 2017 and 2019. We measured TMT on the T1-weighted images in the previously reported way. The associations between TMT and other variables were analyzed.

RESULTS

TMT of 214 women and 146 men, ranging from 35 to 84 years old, was investigated. TMT ranged from 3.69 to 16.90 mm. Mean TMT values were significantly higher in men compared to women except for the over 70-year-old cohort. TMT was correlated to weight and body mass index in both sexes.

CONCLUSION

This is the first retrospective study on the standard TMT values from the Japanese brain check-up database. Our results were just reference values, but these would be useful for further investigation in other neurosurgical and neurological diseases regarding muscle volume or sarcopenia.

Evaluation of the Temporal Muscle Thickness as an Independent Prognostic Biomarker in Patients with Primary Central Nervous System Lymphoma

Simple Summary

Primary central nervous system lymphoma (PCNSL) is a rare brain tumor with an exceedingly poor outcome. Although some of the established prognostic parameters in PCNSL patients, such as age, blood-related parameters, or the involvement of deep brain structures, are objectively evaluable, the information about the patient’s physical condition is still based on the subjective perception of the attending physician. The thickness of the temporal muscle has previously shown to be a biomarker of skeletal muscle quantity and quality, and thus be a potential parameter reflecting sarcopenia, which is a main feature of cancer-related cachexia and a well-known prognostic marker in various disease entities. In the current study we show that temporal muscle thickness is an independent and objectively assessable parameter for outcome prognostication in PCNSL patients and may facilitate the selection and stratification of patients for treatment options or clinical trials in the future.

Abstract

In this study, we assessed the prognostic relevance of temporal muscle thickness (TMT), likely reflecting patient’s frailty, in patients with primary central nervous system lymphoma (PCNSL). In 128 newly diagnosed PCNSL patients TMT was analyzed on cranial magnetic resonance images. Predefined sex-specific TMT cutoff values were used to categorize the patient cohort. Survival analyses, using a log-rank test as well as Cox models adjusted for further prognostic parameters, were performed. The risk of death was significantly increased for PCNSL patients with reduced muscle thickness (hazard ratio of 3.189, 95% CI: 2–097–4.848, p < 0.001). Importantly, the results confirmed that TMT could be used as an independent prognostic marker upon multivariate Cox modeling (hazard ratio of 2.504, 95% CI: 1.608–3.911, p < 0.001) adjusting for sex, age at time of diagnosis, deep brain involvement of the PCNSL lesions, Eastern Cooperative Oncology Group (ECOG) performance status, and methotrexate-based chemotherapy. A TMT value below the sex-related cutoff value at the time of diagnosis is an independent adverse marker in patients with PCNSL. Thus, our results suggest the systematic inclusion of TMT in further translational and clinical studies designed to help validate its role as a prognostic biomarker.

Reliability and validity of measuring temporal muscle thickness as the evaluation of sarcopenia risk and the relationship with functional outcome in older patients with acute stroke

BACKGROUND

Pre-stroke sarcopenia associated with poor functional outcomes. However, diagnosis of pre-stroke sarcopenia is often difficult in patients with acute stroke. Thus, we investigated the reliability and validity of measuring temporal muscle thickness (TMT) as an indicator of sarcopenia risk and its relationship with functional outcome in older patients with acute stroke.

METHODS

We conducted a cross-sectional and longitudinal study of the patients with acute elderly stroke in a single neurosurgical hospital. We measured TMT manually using brain computed tomography (CT) by two examiners. Sarcopenia risk, malnutrition risk, inflammation, comorbidities, and modified Rankin Scale (mRS) scores at 3 months after stroke were additionally assessed. Inter-rater reliability of TMT was determined by calculating the intra-class correlation coefficient ([ICC] _2,1). Multiple linear regression analyses was used to determine whether sarcopenia risk was independently associated with TMT, and logistic regression was used to evaluate the relationship between TMT and poor functional outcome (mRS > 3).

RESULTS

A total 289 acute elderly stroke patients (163 men and 126 women; mean age: 76 years) were enrolled in this study. Regarding the reproducibility of TMT, good reliability was found; ICC_2,1 = 0.759 (95 % confidence interval = 0.705-0.804). Multiple linear regression analyses for TMT after adjusting for potential confounders showed that sarcopenia risk was independently associated with TMT in older patients with acute stroke (β = -0.138, p = 0.02). After adjusting for variables, disease severity and comorbidities were the only independent predictors for poor functional outcome, but not TMT.

CONCLUSIONS

TMT measurement using brain CT is a reliable and variable method to evaluate sarcopenia risk, but is not related to functional outcome in older patients with acute stroke.

Predictive Value of Temporal Muscle Thickness Measurements on Cranial Magnetic Resonance Images in the Prognosis of Patients With Primary Glioblastoma

Objective: To investigate the predictive value of prognosis of primary GBM patients using TMT on three-dimensional (3D) MR images of the brain. Methods: Data of 130 patients with primary GBM from the TCGA-GBM database were analyzed retrospectively. TMT was measured on the axial plane by multi-planar reformation (MPR) of T1WI MR images perpendicular to the long axis of the temporal muscle at the level of the orbital roof. The axial MR plane was oriented parallel to the anterior commissure-posterior commissure line. Student's t-test or Mann-Whitney U-test was utilized to determine whether there were significant differences in the TMT and OS between male and female patients. The Pearson correlation analysis was adopted to evaluate the correlation between the age at GBM diagnosis and TMT. All patients were divided into two groups based on their median TMT, and the Kaplan-Meier curve was used to calculate the OS curve. The association between TMT and OS of GBM patients, as well as the multivariate analysis of TMT and other clinical factors affecting the survival time, was evaluated with Cox regression model. Results: TMT was a risk factor for the prognosis of GBM with its hazard ratio (HR) of 0.802 (95% CI 0.698-0.922; P = 0.002; Cox regression model). Grouped by median TMT, the group with above-median TMT demonstrated a significant increase in survival time (15.6 months) compared with the one with below-median TMT (11.2 months) (P < 0.001; log-rank test). In the multivariate survival analysis using a Cox regression model, TMT (HR 0.863; 95% CI 0.748-0.996; P = 0.044), age at the diagnosis of GBM (HR 1.042; 95% CI 1.024-1.060; P < 0.001), and concurrent chemoradiotherapy (HR 0.510; 95% CI 0.336-0.775; P = 0.002) were significantly associated with survival time. Conclusion: TMT as an independent predictor is sensitive to the survival prognosis of primary GBM patients, which has potential to predict the survival time.

Prognostic relevance of temporal muscle thickness as a marker of sarcopenia in patients with glioblastoma at diagnosis

OBJECTIVES

Temporal muscle thickness (TMT) is a surrogate marker of sarcopenia, correlated with survival expectancy in patients suffering from brain metastases and recurrent or treated glioblastoma. We evaluated the prognostic relevance of TMT measured on brain MRIs acquired at diagnosis in patients affected by glioblastoma.

METHODS

We retrospectively enrolled 51 patients in our Institution affected by methylated MGMT promoter, IDH1-2 wild-type glioblastoma, who underwent complete surgical resection and subsequent radiotherapy with concomitant and maintenance temozolomide, from January 1, 2015, to April 30, 2017. The last clinical/radiological follow-up date was set to September 3, 2019. TMT was measured bilaterally on reformatted post-contrast 3D MPRAGE images, acquired on our 3-T scanner no more than 2 days before surgery. The median, 25th, and 75th percentile TMT values were identified and population was subdivided accordingly; afterwards, statistical analyses were performed to verify the association among overall survival (OS) and TMT, sex, age, and ECOG performance status.

RESULTS

In our cohort, the median OS was 20 months (range 3-51). Patients with a TMT ≥ 8.4 mm (median value) did not show a statistically significant increase in OS (Cox regression model: HR 1.34, 95% CI 0.68-2.63, p = 0.403). Similarly, patients with a TMT ≥ 9.85 mm (fourth quartile) did not differ in OS compared to those with TMT ≤ 7 mm (first quartile). The statistical analyses confirmed a significant association among TMT and sex (p = 0.0186), but none for age (p = 0.642) and performance status (p = 0.3982).

CONCLUSIONS

In our homogeneous cohort of patients with glioblastoma at diagnosis, TMT was not associated with prognosis, age, or ECOG performance status.

KEY POINTS

• Temporal muscle thickness (TMT) is a surrogate marker of sarcopenia and has been correlated with survival expectancy in patients suffering from brain metastases and recurrent or treated glioblastoma. • We appraised the correlation among TMT and survival, sex, age at surgery, and performance status, measured on brain MRIs of patients affected by glioblastoma at diagnosis. • TMT did not show any significant correlation with prognosis, age at surgery, or performance status, and its usefulness might be restricted only to patients with brain metastases and recurrent or treated glioblastoma.

The dataset on the characteristics of the intracerebral hemorrhage patients treated by endoscopic hematoma removal or craniotomy

These data present the characteristics of 148 intracerebral hemorrhage (ICH) patients surgically treated. We retrospectively collected data from the medical records of Suwa Red Cross Hospital, including neurological and physiological symptoms, laboratory data, radiological data on admission, complication rate, Glasgow Coma Scale scores on admission or postoperative day 7, and modified Rankin Scale scores at 6 months. Our two articles on the endoscopic hematoma removal and craniotomy for ICH were based on these data [1,2]. This dataset includes detailed laboratory data and radiological features, and it would be useful for reference value for other neurosurgeons or further analysis.

Association between temporal muscle thickness and clinical outcomes in patients with newly diagnosed glioblastoma

PURPOSE

Temporal muscle thickness (TMT) has been suggested as a novel biomarker that can represent sarcopenia in head and neck malignancies. This study investigated the association of TMT with clinical outcomes in patients with newly diagnosed glioblastoma (GBM).

METHODS

Using electronic medical records, all GBM patients between 2008 and 2018 at Seoul St. Mary's Hospital were reviewed. Total 177 patients met our eligibility criteria.

RESULTS

The thinner group who had TMT less than the median showed shorter overall survival (OS) and progression-free survival (PFS) than the thicker group who had TMT more than median (OS; 11.0 versus 18.0 months, p < 0.001, and PFS; 6.0 versus 11.0 months, p < 0.001). In the multivariate analysis, the thinner group had negative associations with OS and PFS (OS; HR 2.63 (1.34-2.63), p < 0.001, and PFS; HR 2.21 (1.34-2.50), p = 0.002). We also performed propensity score matching between the thinner and thicker groups to minimize the potential bias. The thinner group showed shorter OS and PFS (OS; 13.5 versus 19.0 months, p = 0.006, and PFS; 6.5 versus 9.0 months, p = 0.028) and had negative associations with OS and PFS than the thicker group (OS; HR 1.90 (1.19-3.03), p = 0.008, and PFS; HR 1.70 (1.07-2.70), p = 0.026) in matched patients.

CONCLUSION

Our findings suggest that TMT can be a useful prognostic biomarker for clinical outcomes in GBM patients. Further preclinical and clinical studies could help elucidate this association of sarcopenia with clinical outcomes in GBM patients.

Temporal muscle thickness is an independent prognostic marker in patients with progressive glioblastoma: translational imaging analysis of the EORTC 26101 trial

BACKGROUND

Temporal muscle thickness (TMT) was described as a surrogate marker of skeletal muscle mass. This study aimed to evaluate the prognostic relevance of TMT in patients with progressive glioblastoma.

METHODS

TMT was analyzed on cranial MR images of 596 patients with progression of glioblastoma after radiochemotherapy enrolled in the European Organisation for Research and Treatment of Cancer 26101 trial. An optimal TMT cutoff for overall survival (OS) and progression-free survival (PFS) was defined in the training cohort (n = 260, phase II). Patients were grouped as "below" or "above" the TMT cutoff and associations with OS and PFS were tested using the Cox model adjusted for important risk factors. Findings were validated in a test cohort (n = 308, phase III).

RESULTS

An optimal baseline TMT cutoff of 7.2 mm was obtained in the training cohort for both OS and PFS (area under the curve = 0.64). Univariate analyses estimated a hazard ratio (HR) of 0.54 (95% CI: 0.42, 0.70; P < 0.0001) for OS and an HR of 0.49 (95% CI: 0.38, 0.64; P < 0.0001) for PFS for the comparison of training cohort patients above versus below the TMT cutoff. Similar results were obtained in Cox models adjusted for important risk factors with relevance in the trial for OS (HR, 0.54; 95% CI: 0.41, 0.70; P < 0.0001) and PFS (HR, 0.47; 95% CI: 0.36, 0.61; P < 0.0001). Results were confirmed in the validation cohort.

CONCLUSION

Reduced TMT is an independent negative prognostic parameter in patients with progressive glioblastoma and may help to facilitate patient management by supporting patient stratification for therapeutic interventions or clinical trials.

Is temporal muscle thickness a survival predictor in newly diagnosed glioblastoma multiforme?

AIM

Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor in adults. In this study, we aimed to show the relationship between temporal muscle thickness (TMT) measurement and survival in newly diagnosed patients with GBM.

METHODS

Forty-seven patients with newly diagnosed GBM were evaluated, retrospectively. TMT at diagnosis of GBM before any surgical procedure was measured on the contrast-enhanced axial longitudinal relaxation time (T1)-weighted magnetic resonance images. Overall survival (OS) was analyzed by the Kaplan-Meier method and log-rank test was used to determine the differences between the groups. The median TMT was used to determine the cutoff point.

RESULTS

The median TMT was 4.7 mm (range, 2.8-6.6) in females and 5.4 mm (range, 2.9-8.1) in males. Median survival for TMT < 4.9 mm was 12.9 ± 3.5 (95% CI, 6.0-19.8) months, and 39.4 ± 11.9 (95% CI, 16.0-62.8) months for TMT ≥ 4.9 (P = .023). In the multivariate Cox regression model, the TMT group (Hazard ratio [HR] = 2.07, 95% CI, 0.92-4.61, P = .032) and age group (HR = 2.18, 95% CI, 1.01-4.67, P = .014) showed statistically significant difference.

CONCLUSION

TMT is not an independent predictor of response but a predictor of sarcopenia and survival in newly diagnosed GBM. TMT measurement is an easy and practical method. Survival prediction will provide useful information in GBM patients having poor prognosis.

Comparison of quantity and quality of muscle as clinical prognostic markers in patients undergoing carotid endarterectomy

OBJECTIVE

The measurement of muscle area is routinely utilised in determining sarcopaenia in clinical research. However, this simple measure fails to factor in age-related morphometric changes in muscle quality such as myosteatosis. The aims of this study were to: firstly investigate the relationship between the masseter area (quantity) and density (quality), and secondly compare the prognostic clinical relevance of each parameter.

METHODS

Cross-sectional CT head scans were reviewed for patients undergoing carotid endarterectomy. The masseter was manually delineated and the total masseter area (TMA) and the total masseter density (TMD) calculated. Measurements of the TMA were standardised against the cranial circumference. Observer variability in measurements were assessed using Bland-Altman plots. The relationship between TMA and TMD were evaluated using Pearson's correlation and linear regression analyses. The prognostic value of TMA and TMD were assessed using receiver operator curves and cox-regression analyses.

RESULTS

In total, 149 patients who had undergone routine CT scans prior to a carotid endarterectomy were included in this study. No significant observer variations were observed in measuring the TMA, TMD and cranium circumference. There was a significant positive correlation between standardised TMA and TMD (Pearson's correlation 0.426, p < 0.001, adjusted R-squared 17.6%). The area under the curve for standardised TMA in predicting all-cause mortality at 30 days, 1 year and 4 years were higher when compared to TMD. Standardised TMA was only predictive of post-operative overall all-cause mortality (adjusted hazard ratio 0.38, 95% confidence interval 0.15-0.97, p = 0.043).

CONCLUSION

We demonstrate a strong relationship between muscle size and density. However, the utilisation of muscle area is likely to be limited in routine clinical care.

ADVANCES IN KNOWLEDGE

Our study supports the utilisation of muscle area in clinical sarcopaenia research. We did not observe any additional prognostic advantage in quantifying muscle density.

Sarcopenia in Neurological Patients: Standard Values for Temporal Muscle Thickness and Muscle Strength Evaluation

Temporal muscle thickness (TMT) was investigated as a novel surrogate marker on MRI examinations of the brain, to detect patients who may be at risk for sarcopenia. TMT was analyzed in a retrospective, normal collective cohort (n = 624), to establish standard reference values. These reference values were correlated with grip strength measurements and body mass index (BMI) in 422 healthy volunteers and validated in a prospective cohort (n = 130) of patients with various neurological disorders. Pearson correlation revealed a strong association between TMT and grip strength (retrospective cohort, ρ = 0.746; p < 0.001; prospective cohort, ρ = 0.649; p < 0.001). A low or no association was found between TMT and age (retrospective cohort, R² correlation coefficient 0.20; p < 0.001; prospective cohort, ρ = −0.199; p = 0.023), or BMI (retrospective cohort, ρ = 0.116; p = 0.042; prospective cohort, ρ = 0.227; p = 0.009), respectively. Male patients with temporal wasting and unintended weight loss, respectively, showed significantly lower TMT values (p = 0.04 and p = 0.015, unpaired t-test). TMT showed a high correlation with muscle strength in healthy individuals and in patients with various neurological disorders. Therefore, TMT should be integrated into the diagnostic workup of neurological patients, to prevent, delay, or treat sarcopenia.