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Wang Z, Zhao Z, Li Z, Gao J, Li Y. Fatty Infiltration in Paraspinal Muscles: Predicting the Outcome of Lumbar Surgery and Postoperative Complications. World Neurosurg 2024; 190:218-227. [PMID: 39019431 DOI: 10.1016/j.wneu.2024.07.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
Lumbar spine disorders often cause lower back pain, lower limb radiating pain, restricted movement, and neurological dysfunction, which seriously affect the quality of life of middle-aged and older people. It has been found that pathological changes in the spine often cause changes in the morphology and function of the paraspinal muscles (PSMs). Fatty infiltration (FI) in PSMs is closely associated with disc degeneration and Modic changes. And FI causes inflammatory responses that exacerbate the progression of lumbar spine disease and disrupt postoperative recovery. Magnetic resonance imaging can better distinguish between fat and muscle tissue with the threshold technique. Three-dimensional magnetic resonance imaging multi-echo imaging techniques such as water-fat separation and proton density are currently popular for studying FI. Muscle fat content obtained based on these imaging sequences has greater accuracy, visualization, acquisition speed, and utility. The proton density fat fraction calculated from these techniques has been shown to evaluate more subtle changes in PSMs. Magnetic resonance spectroscopy can accurately reflect the relationship between FI and the degeneration of PSMs by measuring intracellular and extracellular lipid values to quantify muscle fat. We have pooled and analyzed published studies and found that patients with spinal disorders often exhibit FI in PSMs. Some studies suggest an association between FI and adverse surgical outcomes, although conflicting results exist. These suggest that clinicians should consider FI when assessing surgical risks and outcomes. Future studies should focus on understanding the biological mechanisms underlying FI and its predictive value in spinal surgery, providing valuable insights for clinical decision-making.
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Affiliation(s)
- Zairan Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zijun Zhao
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Zhimin Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongning Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Chen J, Huang Y, Yang Y, Wang Z, Zhao D, Luo M, Pu F, Yang J, Zhang Z, He B. Vertebral bone quality score was associated with paraspinal muscles fat infiltration, but not modic classification in patients with chronic low back pain: a prospective cross-sectional study. BMC Musculoskelet Disord 2024; 25:509. [PMID: 38956545 PMCID: PMC11221129 DOI: 10.1186/s12891-024-07626-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The lumbar vertebra and paraspinal muscles play an important role in maintaining the stability of the lumbar spine. Therefore, the aim of this study was to investigate the relationship between paraspinal muscles fat infiltration and vertebral body related changes [vertebral bone quality (VBQ) score and Modic changes (MCs)] in patients with chronic low back pain (CLBP). METHODS Patients with CLBP were prospectively collected in four hospitals and all patients underwent 3.0T magnetic resonance scanning. Basic clinical information was collected, including age, sex, course of disease (COD), and body mass index (BMI). MCs were divided into 3 types based on their signal intensity on T1 and T2-weighted imaging. VBQ was obtained by midsagittal T1-weighted imaging (T1WI) and calculated using the formula: SIL1-4/SICSF. The Proton density fat fraction (PDFF) values and cross-sectional area (CSA) of paraspinal muscles were measured on the fat fraction map from the iterative decomposition of water and fat with the echo asymmetry and least-squares estimation quantitation (IDEAL-IQ) sequences and in/out phase images at the central level of the L4/5 and L5/S1 discs. RESULTS This study included 476 patients with CLBP, including 189 males and 287 females. 69% had no Modic changes and 31% had Modic changes. There was no difference in CSA and PDFF for multifidus(MF) and erector spinae (ES) at both levels between Modic type I and type II, all P values>0.05. Spearman correlation analysis showed that VBQ was weakly negatively correlated with paraspinal muscles CSA (all r values < 0.3 and all p values < 0.05), moderately positive correlation with PDFF of MF at L4/5 level (r values = 0.304, p values<0.001) and weakly positively correlated with PDFF of other muscles (all r values<0.3 and all p values<0.001). Multivariate linear regression analysis showed that age (β = 0.141, p < 0.001), gender (β = 4.285, p < 0.001) and VBQ (β = 1.310, p = 0.001) were related to the total PDFF of muscles. For MCs, binary logistic regression showed that the odds ratio values of age, BMI and COD were 1.092, 1.082 and 1.004, respectively (all p values < 0.05). CONCLUSIONS PDFF of paraspinal muscles was not associated with Modic classification. In addition to age and gender, PDFF of paraspinal muscles is also affected by VBQ. Age and BMI are considered risk factors for the MCs in CLBP patients.
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Grants
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
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Affiliation(s)
- Jiaxin Chen
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, 50032, China
| | - Yilong Huang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, 50032, China
| | - Yingjuan Yang
- Department of Radiology, Dali Bai Autonomous Prefecture People's Hospital, Dali, 671099, China
| | - Zhongwei Wang
- Department of Radiology, Baoshan People's Hospital, Baoshan, 678099, China
| | - Derong Zhao
- Department of Radiology, Baoshan People's Hospital, Baoshan, 678099, China
| | - Mingbin Luo
- Department of Radiology, The First People's Hospital of Honghe State, Mengzi, 661199, China
| | - Fushun Pu
- Department of Radiology, The First People's Hospital of Honghe State, Mengzi, 661199, China
| | - Juntao Yang
- Department of Radiology, Dali Bai Autonomous Prefecture People's Hospital, Dali, 671099, China.
| | - Zhenguang Zhang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, 50032, China.
| | - Bo He
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, 50032, China.
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Wang S, Zhang X, Qu B, Yang K, Hu Y, Liu H, Hong J, Niu H, Yang H. A Novel MRI-Based Paravertebral Muscle Quality (PVMQ) Score for Evaluating Muscle Quality and Bone Quality: A Comparative Study with the VBQ Score. Clin Interv Aging 2024; 19:1203-1215. [PMID: 38974509 PMCID: PMC11227326 DOI: 10.2147/cia.s464187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/15/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose This study aims to develop a novel MRI-based paravertebral muscle quality (PVMQ) score for assessing muscle quality and to investigate its correlation with the degree of fat infiltration (DFF) and the vertebral bone quality (VBQ) score of paravertebral muscles. Additionally, the study compares the effectiveness of the PVMQ score and the VBQ score in assessing muscle quality and bone quality. Methods PVMQ scores were derived from the ratio of paravertebral muscle signal intensity (SI) to L3 cerebrospinal fluid SI on T2-weighted MRI. Image J software assessed paravertebral muscle cross-sectional area (CSA) and DFF. Spearman rank correlation analyses explored associations between PVMQ, VBQ scores, DFF, and T-scores in both genders. Receiver operating characteristic (ROC) curves compared PVMQ and VBQ scores' effectiveness in distinguishing osteopenia/osteoporosis and high paraspinal muscle DFF. Results In this study of 144 patients (94 females), PVMQ scores were significantly higher in osteoporosis and osteopenia groups compared to normals, with variations observed between genders (P < 0.05). PVMQ showed stronger positive correlation with VBQ scores and DFF in females than males (0.584 vs 0.445, 0.579 vs 0.528; P < 0.01). ROC analysis favored PVMQ over VBQ for low muscle mass in both genders (AUC = 0.767 vs 0.718, 0.793 vs 0.718). VBQ was better for bone mass in males (0.737/0.865 vs 0.691/0.858), whereas PVMQ excelled for females (0.808/0.764 vs 0.721/0.718). Conclusion The novel PVMQ score provides a reliable assessment of paravertebral muscle quality and shows a strong correlation with VBQ scores and DFF, particularly in females. It outperforms VBQ scores in evaluating muscle mass and offers valuable insights for assessing bone mass in females. These findings underscore the potential of the PVMQ score as a dual-purpose tool for evaluating both muscle and bone health, informing future research and clinical practice.
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Affiliation(s)
- Song Wang
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Xiang Zhang
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Bo Qu
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Kunhai Yang
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Yongrong Hu
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Hao Liu
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Juntao Hong
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Hao Niu
- Computer Science of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Hongsheng Yang
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
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Li Y, Liu C, Lu J, Sun H, Li Y. Relationship between muscle and subcutaneous adipose tissue size and density and proximal femur bone in elderly women with hip fracture. Aging Clin Exp Res 2024; 36:130. [PMID: 38862865 PMCID: PMC11166751 DOI: 10.1007/s40520-024-02782-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/21/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Both osteoporosis and sarcopenia are associated with aging, increasing the likelihood of falls in older adults and consequently raising the risk of hip fractures (HF). AIMS To explore the relationship between the size and density of muscle and subcutaneous adipose tissue (SAT) and the bone mineral density (BMD) of the proximal femur in elderly women with HF. METHODS Quantitative computed tomography (QCT) was conducted on the hips of 661 female participants who experienced low-energy acute HFs to measure both areal BMD (aBMD) and volume BMD (vBMD). Measurements were taken for the cross-sectional area (CSA) and density of the muscle around the hip and adjacent SAT. Multivariable linear regression models were applied to assess the relationship between these parameters. RESULTS Most increases in the density of the gluteus medius and minimus muscle (G.Med/MinM) were correlated with higher BMD in the femoral neck fracture (FNF) group with osteoporosis. In the FNF group, gluteus maximus muscle (G.MaxM) density was negatively associated with the BMD parameters of the proximal femur in individuals with osteoporosis, while they were positively associated with nonosteoporosis. In the intertrochanteric fracture (ITF) group without osteoporosis, both FN aBMD and FN vBMD showed significant correlations with G.Med/MinM density. DISCUSSION In women with HFs, bone and muscle are closely related. CONCLUSIONS In older women with HFs, density but not CSA of the G.Med/MinM were associated with BMD parameters of the proximal femur. Osteoporosis may influence the relationship between G.MaxM density and proximal femur BMD in elderly women with FNF.
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Affiliation(s)
- Yangtong Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Chenjun Liu
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, China
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Jing Lu
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Hui Sun
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, China
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
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Ozer FF, Güler E. Relation of bone mineral density with fat infiltration of paraspinal muscles: The Goutallier classification. Osteoporos Sarcopenia 2024; 10:84-88. [PMID: 39035231 PMCID: PMC11260011 DOI: 10.1016/j.afos.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/25/2024] [Accepted: 04/14/2024] [Indexed: 07/23/2024] Open
Abstract
Objectives Muscle and bone tissue are interrelated throughout their developmental processes via paracrine and endocrine pathways. Osteosarcopenia has emerged with the growing data proving the high rate of simultaneous occurrence of sarcopenia and osteoporosis. We aimed to evaluate the relationship between osteoporosis, and muscle quality by grading the fatty infiltration in paraspinal muscles according to the Goutallier classification in magnetic resonance imaging (MRI). Methods Data of postmenopausal patients who underwent MRI for low back pain were analyzed retrospectively. Lumbar spine and femoral neck bone mineral density (BMD) were measured by using dual energy X-ray absorptiometry (DXA). Grade of paraspinal muscle fatty infiltration for each level of lumbar vertebrae including L1-L2, L2-L3, L3-L4, was evaluated separately according to Goutallier classification system. Results A total of 91 postmenopausal women were included in the study. The mean age of the study population was 60.5 ± 11. Lumbar vertebrae L1-L4 total T-scores and BMD g/cm2 were lower in patients with higher grades of Goutallier classification (P = 0.031 and P = 0.023, respectively). The distribution of the severity of fatty degeneration was significantly higher in the osteoporosis/osteopenia group at all 3 disc levels. No significant correlation was observed between femoral neck BMD and paraspinal muscle fat infiltration. Conclusions There is a strong relationship between osteoporosis of the lumbar spine and paraspinal muscle quality, which can be considered as a reflection of osteosarcopenia. The Goutailler classification can be an effective and easy method in the evaluation of muscle quality with MRI.
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Affiliation(s)
- Firuzan Fırat Ozer
- Division of Geriatrics, Department of Internal Medicine, Kayseri City Hospital, Kocasinan, 38080, Kayseri, Turkey
| | - Emel Güler
- Division of Algology, Department of Physical Medicine and Rehabilitation, Cumhuriyet School of Medicine, Cumhuriyet University, 58140, Sivas, Turkey
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Li Z, Chen J, Yang J, Wang R, Wang W. Relationship between paraspinal muscle properties and bone mineral density based on QCT in patients with lumbar disc herniation. BMC Musculoskelet Disord 2024; 25:360. [PMID: 38714980 PMCID: PMC11075372 DOI: 10.1186/s12891-024-07484-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE Increasing research suggests that paraspinal muscle fat infiltration may be a potential biological marker for the assessment of osteoporosis. Our aim was to investigate the relationship between lumbar paraspinal muscle properties on MRI and volumetric bone mineral density (vBMD) based on QCT in patients with lumbar disc herniation (LDH). METHODS A total of 383 patients (aged 24-76 years, 193 females) with clinically and radiologically diagnosed LDH were enrolled in this retrospective study. The muscle cross-sectional area (CSA) and the proton density fat fraction (PDFF) were measured for the multifidus (MF), erector spinae (ES) and psoas major (PS) at the central level of L3/4, L4/5 and L5/S1 on lumbar MRI. QCT was used to measure the vBMD of two vertebral bodies at L1 and L2 levels. Patients were divided into three groups based on their vBMD values: normal bone density group (> 120 mg/cm3), osteopenia group (80 to 120 mg/cm3) and osteoporosis group (< 80 mg/cm3). The differences in paraspinal muscle properties among three vBMD groups were tested by one-way ANOVA with post hoc analysis. The relationships between paraspinal muscle properties and vBMD were analyzed using Pearson correlation coefficients. Furthermore, the association between vBMD and paraspinal muscle properties was further evaluated using multiple linear regression analysis, with age and sex also included as predictors. RESULTS Among the 383 LDH patients, 191 had normal bone density, 129 had osteopenia and 63 had osteoporosis. In LDH patients, compared to normal and osteopenia group, paraspinal muscle PDFF was significantly greater in osteoporosis group, while paraspinal muscle CSA was lower (p < 0.001). After adjusting for age and sex, it was found that MF PDFF and PS CSA were found to be independent factors influencing vBMD (p < 0.05). CONCLUSION In patients with LDH, paraspinal muscle properties measured by IDEAL-IQ sequence and lumbar MR scan were found to be related to vBMD. There was a correlation between the degree of paraspinal muscle PDFF and decreasing vBMD, as well as a decrease paraspinal muscle CSA with decreasing vBMD. These findings suggest that clinical management should consider offering tailored treatment options for patients with LDH based on these associations.
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Affiliation(s)
- Ze Li
- School of Sports Medicine and Health, Chengdu Sport University, No.2, Tiyuan Road, Chengdu, Sichuan, China
- Department of radiology, Sichuan Province Orthopedic Hospital, No.132, West Section of 1st Ring Road, Chengdu, Sichuan, China
| | - Junrong Chen
- Department of radiology, Sichuan Province Orthopedic Hospital, No.132, West Section of 1st Ring Road, Chengdu, Sichuan, China.
| | - Jian Yang
- Department of radiology, Sichuan Province Orthopedic Hospital, No.132, West Section of 1st Ring Road, Chengdu, Sichuan, China
| | - Ran Wang
- Department of radiology, Sichuan Province Orthopedic Hospital, No.132, West Section of 1st Ring Road, Chengdu, Sichuan, China
| | - Wenbin Wang
- Department of radiology, Sichuan Province Orthopedic Hospital, No.132, West Section of 1st Ring Road, Chengdu, Sichuan, China
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Li W, Wang F, Chen J, Zhu H, Tian H, Wang L. MRI‑based vertebral bone quality score is a comprehensive index reflecting the quality of bone and paravertebral muscle. Spine J 2024; 24:472-478. [PMID: 37980959 DOI: 10.1016/j.spinee.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/09/2023] [Accepted: 11/12/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Recently, vertebral bone quality (VBQ) score has been shown to predict bone mineral density (BMD) and spine-related postoperative complications. However, in clinical work, we found that patients with higher VBQ scores also had more severe paravertebral muscle degeneration. PURPOSE To explore the ability of the VBQ score to evaluate BMD and paravertebral muscle quality. STUDY DESIGN/SETTING Retrospective single-center cohort. PATIENT SAMPLE Patients in the spinal surgery department of our hospital. OUTCOME MEASURES Bone mineral density and T-score were measured by dual-energy X-ray absorptiometry (DXA). The Picture Archiving and Communication Systems (PACS) measured the cross-sectional area (CSA) of the paravertebral muscles. Image J software was used to measure the degree of fat infiltration (DFF) of the paraspinal muscle. METHODS Patients who underwent lumbar MRI and DXA simultaneously within two weeks were enrolled. The VBQ score was calculated using T1-weighted lumbar MRI images. Firstly, BMD-related and muscle-related parameters of patients with different VBQ scores were compared. Then, the correlation coefficients between the VBQ score and the parameters of BMD and paravertebral muscle were calculated. Finally, multivariate linear analysis was used to compare the contribution of each variable to the VBQ score. RESULTS A total of 101 patients were eventually included in this study for analysis. When the VBQ score was greater than 3.0, the patients were mostly female, older, less likely to smoke, and had lower BMD. Interestingly, we found that patients with VBQ scores greater than 3.0 had smaller CSA of the paravertebral muscles (ES: 17.53±3.36 vs 19.13±3.97, p=.032; total: 29.59±5.27 vs 34.12±7.02, p<.001) and higher DFF (MF: 22.47±5.93 vs 19.64±5.28, p=.015; ES: 17.71±4.67 vs 15.74±4.62, p=.038; PM: 13.70±3.32 vs 11.33±3.02, p<.001; average: 17.96±3.78 vs 15.57±3.42, p=.001). The VBQ score was negatively correlated with the CSA (MF: r=-0.316, p=.001; ES: r =-0.388, p=.001; PM: r=0.388, p=.001) and positively correlated with the DFF (MF: r=0.344, p<.001; ES: r=0.439, p<.001; PM: =0.416, p<.001). In multivariate linear analysis, BMD, total CSA, and average DFF determined the value of the VBQ score, and the contribution of paravertebral muscle was higher than that of BMD (BMD: r=-0.203, p=.024; total CSA: r=-0.294, p=.003; average DFF: r=0.261, p=.011). CONCLUSIONS This study is the first to find a positive association between the VBQ score and paravertebral muscle degeneration, and this association may be independent of BMD. VBQ can reflect the quality of bone and paravertebral muscle, which is its special advantage in clinical application.
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Affiliation(s)
- Wenshuai Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University,139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China
| | - Feng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University,139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China
| | - Junyi Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University,139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China
| | - Houze Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University,139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China
| | - Hongsen Tian
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University,139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University,139 Ziqiang St, Shijiazhuang, 050051, People's Republic of China.
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Harada S, Gersing AS, Stohldreier Y, Dietrich O, Lechner A, Seissler J, Ferrari U, Pappa E, Hesse N. Associations of gestational diabetes and proton density fat fraction of vertebral bone marrow and paraspinal musculature in premenopausal women. Front Endocrinol (Lausanne) 2024; 14:1303126. [PMID: 38292769 PMCID: PMC10824991 DOI: 10.3389/fendo.2023.1303126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
Background and objective Fat content in bones and muscles, quantified by magnetic resonance imaging (MRI) as a proton density fat fraction (PDFF) value, is an emerging non-invasive biomarker. PDFF has been proposed to indicate bone and metabolic health among postmenopausal women. Premenopausal women with a history of gestational diabetes (GDM) carry an increased risk of developing type 2 diabetes and an increased risk of fractures. However, no studies have investigated the associations between a history of GDM and PDFF of bone or of paraspinal musculature (PSM), composed of autochthonous muscle (AM) and psoas muscle, which are responsible for moving and stabilizing the spine. This study aims to investigate whether PDFF of vertebral bone marrow and of PSM are associated with a history of GDM in premenopausal women. Methods A total of 37 women (mean age 36.3 ± 3.8 years) who were 6 to 15 months postpartum with (n=19) and without (n=18) a history of GDM underwent whole-body 3T MRI, including a chemical shift encoding-based water-fat separation. The PDFF maps were calculated for the vertebral bodies and PSM. The cross-sectional area (CSA) of PSM was obtained. Associations between a history of GDM and PDFF were assessed using multivariable linear and logistic regression models. Results The PDFF of the vertebral bodies was significantly higher in women with a history of GDM (GDM group) than in women without (thoracic: median 41.55 (interquartile range 32.21-49.48)% vs. 31.75 (30.03-34.97)%; p=0.02, lumbar: 47.84 (39.19-57.58)% vs. 36.93 (33.36-41.31)%; p=0.02). The results remained significant after adjustment for age and body mass index (BMI) (p=0.01-0.02). The receiver operating characteristic curves showed optimal thoracic and lumbar vertebral PDFF cutoffs at 38.10% and 44.18%, respectively, to differentiate GDM (AUC 0.72 and 0.73, respectively, sensitivity 0.58, specificity 0.89). The PDFF of the AM was significantly higher in the GDM group (12.99 (12.18-15.90)% vs. 10.83 (9.39-14.71)%; p=0.04) without adjustments, while the CSA was similar between the groups (p=0.34). Conclusion A history of GDM is significantly associated with a higher PDFF of the vertebral bone marrow, independent of age and BMI. This statistical association between GDM and increased PDFF highlights vertebral bone marrow PDFF as a potential biomarker for the assessment of bone health in premenopausal women at risk of diabetes.
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Affiliation(s)
- Saori Harada
- Medizinische Klinik und Poliklinik IV, Diabetes Zentrum - Campus Innenstadt, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany
| | - Alexandra S. Gersing
- Department of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Yannick Stohldreier
- Department of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Olaf Dietrich
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Andreas Lechner
- Medizinische Klinik und Poliklinik IV, Diabetes Zentrum - Campus Innenstadt, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Jochen Seissler
- Medizinische Klinik und Poliklinik IV, Diabetes Zentrum - Campus Innenstadt, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Uta Ferrari
- Medizinische Klinik und Poliklinik IV, Diabetes Zentrum - Campus Innenstadt, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Eleni Pappa
- Medizinische Klinik und Poliklinik IV, Diabetes Zentrum - Campus Innenstadt, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Nina Hesse
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
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Coulombe JC, Johannesdottir F, Burkhart KA, Brummer H, Allaire BT, Bouxsein ML. Changes in Vertebral Bone Density and Paraspinal Muscle Morphology Following Spaceflight and 1 Year Readaptation on Earth. JBMR Plus 2023; 7:e10810. [PMID: 38130751 PMCID: PMC10731107 DOI: 10.1002/jbm4.10810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/30/2023] [Accepted: 08/07/2023] [Indexed: 12/23/2023] Open
Abstract
Astronauts have an increased risk of back pain and disc herniation upon returning to Earth. Thus, it is imperative to understand the effects of spaceflight and readaptation to gravity on the musculoskeletal tissues of the spine. Here we investigated whether ~6 months of spaceflight led to regional differences in bone loss within the vertebral body. Additionally, we evaluated the relationships between vertebral bone density and paraspinal muscle morphology before flight, after flight, and after readaptation on Earth. We measured vertebral trabecular bone mineral density (Tb.BMD), paraspinal muscle cross-sectional area (CSA), and muscle density in 17 astronauts using computed tomography (CT) images of the lumbar spine obtained before flight (before flight, n = 17), after flight (spaceflight, n = 17), and ~12 months of readaptation to gravitational loading on Earth (follow-up, n = 15). Spaceflight-induced declines in Tb.BMD were greater in the superior region of the vertebral body (-6.7%) than the inferior (-3.1%, p = 0.052 versus superior region) and transverse regions (-4.3%, p = 0.057 versus superior region). After a year of readaptation to Earth's gravity, Tb.BMD in the transverse region remained significantly below preflight levels (-4.66%, p = 0.0094). Paraspinal muscle CSA and muscle density declined -1.0% (p = 0.005) and -0.83% (p = 0.001) per month of spaceflight, respectively. Ultimately, bone loss in the superior vertebral body, along with fatty infiltration of paraspinal muscles and incomplete recovery even after a year of readaptation on Earth, may contribute to spinal pathology in long-duration astronauts. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Jennifer C. Coulombe
- Center for Advanced Orthopedic Studies, Department of Orthopedic SurgeryBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
- Department of Orthopaedic SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Fjola Johannesdottir
- Center for Advanced Orthopedic Studies, Department of Orthopedic SurgeryBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
- Department of Orthopaedic SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Katelyn A. Burkhart
- Center for Advanced Orthopedic Studies, Department of Orthopedic SurgeryBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Henriette Brummer
- Center for Advanced Orthopedic Studies, Department of Orthopedic SurgeryBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Brett T. Allaire
- Center for Advanced Orthopedic Studies, Department of Orthopedic SurgeryBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Mary L. Bouxsein
- Center for Advanced Orthopedic Studies, Department of Orthopedic SurgeryBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
- Department of Orthopaedic SurgeryHarvard Medical SchoolBostonMassachusettsUSA
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10
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Yun JH, Lee DG. Physical Functional Ability and Quantitative Assessment of the Multifidus Muscle of the Lumbar Spine in the Elderly. Diagnostics (Basel) 2023; 13:2423. [PMID: 37510167 PMCID: PMC10378454 DOI: 10.3390/diagnostics13142423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Aging is associated with muscle atrophy and fatty infiltration of skeletal muscle. The multifidus muscle stabilizes the lumbar spine and undergoes adipose accumulation with age, leading to functional decline in the elderly. Therefore, quantitative assessment of the multifidus muscle can be beneficial for the elderly when formulating treatment strategies and reducing future complications. Fifty-seven patients (mean age, 73.89 ± 6.09; 23 male patients) who underwent lumbar Magnetic resonance imaging (MRI) were prospectively recruited. The cross-sectional area (CSA) of the multifidus from the L2-S1 level and the CSA of the L4-5 level psoas muscle were measured. The functional CSA (fCSA) of the multifidus muscle was measured by excluding the fat infiltration area from the multifidus CSA. The CSA to fCSA ratio was obtained by multiplying 100 by the value obtained by dividing CSA by the fCSA. Pfrrmann classification was used to evaluate the degree of disc degeneration. The functional disability measurements were the Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), grip strength, and functional reach test (FRT). Pearson's correlation analysis was used to examine the relationship between the functional disability measurements and the multifidus muscle. The CSA to fCSA ratio value was relatively constant at each spine level and showed a significant correlation with the SPPB, grip strength, FRT, and psoas index (p < 0.05). However, degree of disc and multifidus muscle degeneration was not statistically significant. So, age-related changes play a significant role in developing back muscle fatty infiltration than disc degeneration. Moreover, Grip strength showed a stronger relationship with the quality of the multifidus muscle than other functional disability measurements.
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Affiliation(s)
- Jung Hae Yun
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea
| | - Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea
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11
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You KH, Cho M, Lee JH. Effect of Muscularity and Fatty Infiltration of Paraspinal Muscles on Outcome of Lumbar Interbody Fusion. J Korean Med Sci 2023; 38:e151. [PMID: 37218352 DOI: 10.3346/jkms.2023.38.e151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/08/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Lumbar paraspinal muscles play an important role in maintaining global spinal alignment and are associated with lower back pain; however, only a few studies on the effect of the paraspinal muscles on the surgical outcome exist. Therefore, this study aimed to analyze the association of preoperative muscularity and fatty infiltration (FI) of paraspinal muscles with the outcome of lumbar interbody fusion. METHODS Postoperative clinical and radiographic outcomes were analyzed in 206 patients who underwent surgery for a degenerative lumbar disease. The preoperative diagnosis was spinal stenosis or low-grade spondylolisthesis, and the surgery performed was posterior lumbar interbody fusion or minimally invasive transforaminal lumbar interbody fusion. Indications for surgery were a complaint of severe radiating pain that did not improve with conservative treatment and neurological symptoms accompanied by lower extremity motor weakness. Patients with fractures, infections, tumors, or a history of lumbar surgery were excluded from this study. Clinical outcome measures included functional status, measured using the Oswestry disability index (ODI) and visual analog scale (VAS) score for lower back and leg pain. Other radiographic parameters included measures of spinal alignment, including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, C7 sagittal vertical axis, and pelvic incidence-lumbar lordosis mismatch. Lumbar muscularity (LM) and FI were measured preoperatively using a lumbar magnetic resonance image (MRI). RESULTS The high LM group showed more significant improvement in VAS score for lower back pain than the low LM group. In contrast, the VAS score for leg pain demonstrated no statistical significance. The high LM group showed more significant improvement in ODI postoperatively than the medium group. The severe FI group showed more significant improvement in ODI postoperatively, whereas the less severe FI group showed more significant improvement in the sagittal balance postoperatively. CONCLUSION Patients with high LM and mild FI ratio observed on preoperative MRI demonstrated more favorable clinical and radiographic outcomes after lumbar interbody fusion. Therefore, preoperative paraspinal muscle condition should be considered when planning lumbar interbody fusion.
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Affiliation(s)
- Ki-Han You
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Minjoon Cho
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyup Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
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12
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Filimonova GN, Diuriagina OV, Antonov NI, Stogov MV, Ryabykh SO, Tushina NV. Characteristics of <i>m. Psoas minor</i> and <i>m. Sacrocaudalis (coccygeus)</i> dorsalis lateralis in simultaneous modeling of lateral interbodial spinnylodesis and posterior sacro-iliac joint arthodesis. N.N. PRIOROV JOURNAL OF TRAUMATOLOGY AND ORTHOPEDICS 2023; 29:379-390. [DOI: 10.17816/vto253610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
BACKGROUND: Simultaneous surgical interventions on the spine with the use of high-tech instruments and minimally invasive access techniques allow to eliminate several problems all at once, to activate patients at an early date and to reduce the number of complications.
AIM: To evaluate morphological changes to evaluate morphological changes in the m. Psoas minor and m. Sacrocaudalis dorsalis lateralis during simultaneous modeling of lateral interbody fusion and posterior sacroiliac joint arthrodesis
MATERIALS AND METHODS: Experiments were carried out on 14 outbred dogs; 3 animals formed a control group. The animals underwent consecutive lateral interbody fusion of the lumbar spine and posterior arthrodesis of the sacroiliac joint. The lumbar spine and sacroiliac joint were stabilized with external fixation device. Paraffin sections of muscles were stained with hematoxylin-eosin, according to Van Gieson, and Masson. Biochemical analysis of blood serum was performed during the experiment.
RESULTS: The morphological study of the muscles revealed pathohistological features such as an increase in the variety of myosymplast diameters, loss of their profiles polygonality, massive fibers fatty degeneration, endo- and perimysial fibrosis, sclerotization of vessel membranes, obliteration of their lumens. At the end of the experiment, the degree of the small lumbar muscle fibrosis was 161% and of the sacrocaudal dorsal lateral muscle fibrosis was 240% of the control parameters (p 0.05); the rate of the muscle fatty infiltration was 339 and 310% of the normal value, respectively. The sacroiliac-caudal dorsal lateral muscle underwent more marked changes, especially in the early stages of the experiment. A significant increase in the enzymes activity, skeletal muscle damage markers was detected on the 14th day after surgery.
CONCLUSION: Simultaneous surgical interventions on the spine should minimize mechanical effects on the paravertebral muscles and use techniques to stimulate their function in the postoperative period, which will reduce the processes of fibrogenesis and fat involution as well as provide an overall shorter rehabilitation period for the target patients.
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Bian T, Zhang L, Man S, Li H, Li W, Zhou Y. A Cross-Sectional Study on Gluteal Muscles in Patients with Ankylosing Spondylitis at Different Stages of Hip Involvement. J Clin Med 2023; 12:jcm12020464. [PMID: 36675392 PMCID: PMC9866124 DOI: 10.3390/jcm12020464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Hip involvement in ankylosing spondylitis (AS) is associated with severe functional impairment, and early diagnosis can improve the disease prognosis. We investigated gluteal muscle cross-sectional area (CSA) and radiodensity at different stages of hip involvement and their associations with AS-related clinical and laboratory parameters. This cross-sectional study included 83 patients with AS and 83 age- and sex-matched controls. Patients with AS were divided into three groups according to the Bath Ankylosing Spondylitis Radiology Hip Index system. The CSA and radiodensity of the gluteus maximus, medius, and minimus muscles were measured using computed tomography images. Muscle parameters were compared, and their relationships with clinical and laboratory parameters were evaluated. For the gluteus maximus, patients with AS had a lower CSA than controls, regardless of the degree of hip involvement. For the gluteus medius and minimus, patients with moderate/advanced hip involvement had significantly lower CSA and radiodensity than those with mild to no hip involvement. The severity of hip involvement was negatively associated with muscle parameters. CSA of the gluteus maximus decreased in early-stage hip involvement without any changes in radiographs, while radiodensity decreased in the later stages. Muscle parameters on computed tomography may be a more sensitive indicator than radiographic findings.
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Affiliation(s)
- Tao Bian
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Liang Zhang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Siliang Man
- Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Hongchao Li
- Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Weiyi Li
- Department of Rehabilitation, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yixin Zhou
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
- Correspondence: ; Tel.: +86-10-58516724
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14
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Jung M, Rospleszcz S, Löffler MT, Walter SS, Maurer E, Jungmann PM, Peters A, Nattenmüller J, Schlett CL, Bamberg F, Kiefer LS, Diallo TD. Association of lumbar vertebral bone marrow and paraspinal muscle fat composition with intervertebral disc degeneration: 3T quantitative MRI findings from the population-based KORA study. Eur Radiol 2023; 33:1501-1512. [PMID: 36241920 PMCID: PMC9935727 DOI: 10.1007/s00330-022-09140-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the association of lumbar bone marrow adipose tissue fat fraction (BMAT-FF) and paraspinal muscle proton density fat fraction (PDFF) and their interplay with intervertebral disc degeneration (IVDD). METHODS In this retrospective cross-sectional study based on a prospective population-based cohort, BMAT-FF and PDFF of asymptomatic individuals were calculated based on 3T-MRI dual-echo and multi-echo Dixon VIBE sequences. IVDD was assessed at motion segments L1 to L5 and dichotomized based on Pfirrmann grade ≥ 4 and/or presence of other severe degenerative changes or spinal abnormalities at least at one segment. Pearson's correlation coefficients were calculated for BMAT-FF and PDFF. Univariable and multivariable logistic regression models for IVDD were calculated. RESULTS Among 335 participants (mean age: 56.2 ± 9.0 years, 43.3% female), the average BMI was 27.7 ± 4.5 kg/m2 and the prevalence of IVDD was high (69.9%). BMAT-FF and PDFF were significantly correlated (r = 0.31-0.34; p < 0.001). The risk for IVDD increased with higher PDFF (OR = 1.45; CI 1.03, 2.04) and BMAT-FF (OR = 1.56; CI 1.16, 2.11). Pairwise combinations of PDFF and BMAT-FF quartiles revealed a lower risk for IVDD in individuals in the lowest BMAT-FF and PDFF quartile (OR = 0.21; CI 0.1, 0.48). Individuals in the highest BMAT-FF and PDFF quartile showed an increased risk for IVDD (OR = 5.12; CI 1.17, 22.34) CONCLUSION: Lumbar BMAT-FF and paraspinal muscle PDFF are correlated and represent both independent and additive risk factors for IVDD. Quantitative MRI measurements of paraspinal myosteatosis and vertebral bone marrow fatty infiltration may serve as imaging biomarkers to assess the individual risk for IVDD. KEY POINTS • Fat composition of the lumbar vertebral bone marrow is positively correlated with paraspinal skeletal muscle fat. • Higher fat-fractions of lumbar vertebral bone marrow and paraspinal muscle are both independent as well as additive risk factors for intervertebral disc degeneration. • Quantitative magnetic resonance imaging measurements of bone marrow and paraspinal muscle may serve as imaging biomarkers for intervertebral disc degeneration.
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Affiliation(s)
- Matthias Jung
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - Susanne Rospleszcz
- grid.4567.00000 0004 0483 2525Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Oberschleißheim, Germany ,grid.5252.00000 0004 1936 973XDepartment of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University München, Munich, Germany
| | - Maximilian T. Löffler
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany ,grid.6936.a0000000123222966Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Sven S. Walter
- grid.10392.390000 0001 2190 1447Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany ,grid.137628.90000 0004 1936 8753Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, New York, NY 10016 USA
| | - Elke Maurer
- grid.482867.70000 0001 0211 6259Department of Trauma and Reconstructive Surgery, BG Unfallklinik, Schnarrenbergstraße 95, 72070 Tuebingen, Germany
| | - Pia M. Jungmann
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Annette Peters
- grid.4567.00000 0004 0483 2525Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Oberschleißheim, Germany ,grid.5252.00000 0004 1936 973XDepartment of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University München, Munich, Germany
| | - Johanna Nattenmüller
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Christopher L. Schlett
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Fabian Bamberg
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Lena S. Kiefer
- grid.10392.390000 0001 2190 1447Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Thierno D. Diallo
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
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Yang F, Liu Z, Zhu Y, Zhu Q, Zhang B. Imaging of muscle and adipose tissue in the spine: A narrative review. Medicine (Baltimore) 2022; 101:e32051. [PMID: 36626484 PMCID: PMC9750571 DOI: 10.1097/md.0000000000032051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Interpretation of the morphology and characteristics of soft tissues, such as paravertebral muscles and fat, has always been a "relative blind spot" in the spine. The imaging features of the non-bony structures of the spine have been studied and reinterpreted, and changes in the non-bony structure are associated with spinal disease. Soft tissue parameters such as, the "paraspinal muscle cross-sectional area," "subcutaneous fat thickness," and the "paraspinal muscle fat infiltration rate" on computed tomography, magnetic resonance imaging and other imaging techniques are reproducible in the diagnosis, treatment and prognosis of spinal disorders and have the potential for clinical application. In addition, focus on the association between sarcopenia and spinal epidural lipomatosis with spinal disorders is increasing. Currently, there is no summary of studies on fat and muscle in the spinal region. Given this, within the context of recent research trends, this article provides a synthesis of research on adipose and muscle tissue in the spine, discusses advances in the study of the imaging manifestations of these structures in spinal disorders, and expands the perspectives.
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Affiliation(s)
- Fan Yang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhengang Liu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuhang Zhu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qingsan Zhu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Boyin Zhang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
- * Correspondence: Boyin Zhang, Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun 130033, China (e-mail: )
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Gong Z, Li D, Zou F, Liu S, Wang H, Ma X. Low lumbar multifidus muscle status and bone mineral density are important risk factors for adjacent segment disease after lumbar fusion: a case–control study. J Orthop Surg Res 2022; 17:490. [DOI: 10.1186/s13018-022-03388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
The quantity and quality of the paraspinal muscles are important factors that lead to spinal diseases. However, the role of paraspinal muscles in the pathogenesis of adjacent segment disease (ASD) after lumbar fusion surgery is rarely studied. The purpose of the research is to investigate the relationship between paraspinal muscles and ASD.
Methods
Thirty-three patients with ASD were included, and 33 controls without ASD were matched according to the basic demographic information. Cross-sectional images of the paraspinal muscles at each intervertebral disk level (L1–S1) before the first operation were analyzed, and the cross-sectional area (CSA) and degree of fat infiltration (FI) of the multifidus (MF) muscle and the erector spinae muscle were compared.
Results
There was no significant difference in demographic characteristics (P > 0.05) except for the bone mineral density (BMD) (P = 0.037) between the two groups. There were significant differences in the CSA and FI of the lower lumbar multifidus (P < 0.05). The CSA of the MF muscle at L3–L4, FI of the MF muscle at L4–L5 and L5–S1 and BMD were important risk factors for ASD. Among patients who received two-segment fusion for the first time, significant difference was observed in the degree of FI of the MF muscle in the lower lumbar segment (P < 0.05).
Conclusions
The CSA, FI and BMD of the lower lumbar MF muscle were closely related to the occurrence of ASD. The CSA of the MF muscle at L3–L4, the degree of FI of the MF muscle at L4–L5 and L5–S1 and BMD were important risk factors for ASD. The number of fusion segments in the first operation has a certain impact on the above-mentioned conclusions.
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Laskou F, Westbury LD, Fuggle NR, Harvey NC, Patel HP, Cooper C, Ward KA, Dennison EM. Determinants of muscle density and clinical outcomes: Findings from the Hertfordshire Cohort Study. Bone 2022; 164:116521. [PMID: 35985467 DOI: 10.1016/j.bone.2022.116521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The age-related loss of skeletal muscle mass and strength is associated with adverse health outcomes. However, to date, peripheral quantitative computed tomography (pQCT)-derived muscle density has been little studied. We used a well characterised cohort of older adults to identify lifestyle and anthropometric determinants of pQCT-derived muscle density measured 11 years later, and to report relationships between pQCT-derived muscle density with history of falls and prevalent fractures. METHODS A lifestyle questionnaire was administered to 197 men and 178 women, aged 59-70 at baseline. After a median of 11.5 (IQR 10.9, 12.3) years, pQCT (Stratec XCT2000) of the radius and tibia was performed to measure forearm muscle density (FMD) and calf muscle density (CMD). Presence of falls and fractures since the age of 45 were determined through participant recall; vertebral fractures were also ascertained through vertebral fracture assessment using iDXA. Total hip BMD (TH aBMD) was assessed using DXA. Baseline characteristics in relation to muscle density at follow-up were examined using linear regression; associations between muscle density and prior falls and fractures were investigated using logistic regression. All analyses were adjusted for sex and age. RESULTS Mean (SD) age at muscle density measurement was 76.3 (2.6) years. Mean (SD) FMD was 79.9 (3.1) and 77.2 (3.2) among males and females, respectively; CMD was 80.7 (2.6) and 78.5 (2.6) among males and females, respectively. Significant sex-differences in muscle density were observed at each site (p < 0.001). Female sex, lower weight, and lower body mass index were associated (p < 0.05) with both lower FMD and CMD. Additional correlates of lower CMD included older age and shorter stature. Lifestyle measures were not associated with muscle density in this cohort. Lower FMD was related to increased risk of previous fracture (odds ratio (95 % CI) per SD lower FMD: 1.42 (1.07, 1.89), p = 0.015) but not after adjustment for TH aBMD (p > 0.08). No significant relationships were seen between muscle density and falls. CONCLUSION Female sex, older age, and lower BMI were associated with subsequent lower muscle density in older community-dwelling adults. Lower FMD was related to increased risk of previous fracture. Changes in muscle density over time might precede adverse outcomes such as falls and fractures and may be a long-term predictor of frailty. It could be also suggested that muscle density could be a more clinically meaningful surrogate of functional decline and disability than muscle size or mass, but more studies are needed to support this notion.
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Affiliation(s)
- Faidra Laskou
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Leo D Westbury
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Nicholas R Fuggle
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; The Alan Turing Institute, London, UK
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Harnish P Patel
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK; Medicine for Older People, University Hospital Southampton, Southampton, UK; Academic Geriatric Medicine, University of Southampton, Southampton, UK
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Kate A Ward
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Elaine M Dennison
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; Victoria University of Wellington, Wellington, New Zealand.
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18
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Zhou S, Chen S, Zhu X, You T, Li P, Shen H, Gao H, He Y, Zhang K. Associations between paraspinal muscles fatty infiltration and lumbar vertebral bone mineral density - An investigation by fast kVp switching dual-energy CT and QCT. Eur J Radiol Open 2022; 9:100447. [PMID: 36277658 PMCID: PMC9579482 DOI: 10.1016/j.ejro.2022.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 10/27/2022] Open
Abstract
Purpose To investigate the relationship between paraspinal muscles fat content and lumbar bone mineral density (BMD). Methods A total of 119 participants were enrolled in our study (60 males, age: 50.88 ± 17.79 years, BMI: 22.80 ± 3.80 kg·m-2; 59 females, age: 49.41 ± 17.69 years, BMI: 22.22 ± 3.12 kg·m-2). Fat content of paraspinal muscles (erector spinae (ES), multifidus (MS), and psoas (PS)) were measured at (ES L1/2-L4/5; MS L2/3-L5/S1; PS L2/3-L5/S1) levels using dual-energy computed tomography (DECT). Quantitative computed tomography (QCT) was used to assess BMD of L1 and L2. Linear regression analysis was used to assess the relationship between BMD of the lumbar spine and paraspinal muscles fat content with age, sex, and BMI. The variance inflation factor (VIF) was used to detect the degree of multicollinearity among the variables. P < .05 was considered to indicate a statistically significant difference. Results The paraspinal muscles fat content had a fairly significant inverse association with lumbar BMD after controlling for age, sex, and BMI (adjusted R 2 = 0.584-0.630, all P < .05). Conclusion Paraspinal muscles fat content was negatively associated with BMD.Paraspinal muscles fatty infiltration may be considered as a potential marker to identify BMD loss.
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Key Words
- ASiR-V, Adaptive statistical iterative reconstruction-Veo
- BIA, Bioimpedance analysis
- BMD, Bone mineral density
- Bone density
- CNR, Contrast-to-noise ratio
- DECT, Dual-energy computed tomography
- DXA, Dual-energy x-ray absorptiometry
- EMCL, extramyocellular lipids
- ES, Erector spinae
- FF, fat fraction
- FI %, Fatty infiltration ratio
- FM, Fat mass
- GSI, Gemstone spectral imaging
- IMCL, intramyocellular lipids
- LM, Lean mass
- MD, Material decomposition
- MRI, Magnetic resonance imaging
- MS, Multifidus
- MSK, Musculoskeletal
- Osteoporosis
- PDFF, Proton density fat fractions
- PS, Psoas
- Paraspinal muscles
- QCT, Quantitative computed tomography
- Tomography
- VIF, Variance inflation factor
- X-Ray computed
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Affiliation(s)
- Shuwei Zhou
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China,The College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, 300 Xueshi Road, Yuelu District, Changsha 410208, PR China
| | - Suping Chen
- GE Healthcare (Shanghai) Co., Ltd., Shanghai 201203, PR China
| | - Xu Zhu
- The College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, 300 Xueshi Road, Yuelu District, Changsha 410208, PR China
| | - Tian You
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Ping Li
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Hongrong Shen
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Hui Gao
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Yewen He
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Kun Zhang
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China,The College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, 300 Xueshi Road, Yuelu District, Changsha 410208, PR China,Corresponding author at: Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007 PR China.
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19
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Gassert FT, Glanz L, Boehm C, Stelter J, Gassert FG, Leonhardt Y, Feuerriegel GC, Graf M, Wurm M, Baum T, Braren RF, Schwaiger BJ, Makowski MR, Karampinos D, Gersing AS. Associations between Bone Mineral Density and Longitudinal Changes of Vertebral Bone Marrow and Paraspinal Muscle Composition Assessed Using MR-Based Proton Density Fat Fraction and T2* Maps in Patients with and without Osteoporosis. Diagnostics (Basel) 2022; 12:diagnostics12102467. [PMID: 36292156 PMCID: PMC9600908 DOI: 10.3390/diagnostics12102467] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Proton-density fat fraction (PDFF) and T2* of the vertebrae, as well as the cross-sectional area (CSA) of the paraspinal musculature (PSM), have been suggested as biomarkers for bone fragility. The aim of this study was to longitudinally assess changes in PDFF, T2* and CSA of the PSM over 6 months in patients with and without osteoporosis. Methods: Opportunistic bone mineral density (BMD) measurements (BMD < 120 mg/cm3) were obtained from a CT acquired during the clinical routine work up in osteoporotic/osteopenic patients (n = 29, mean age 72.37 ± 10.12 years, 16 women). These patients were frequency-matched for age and sex to subjects with normal BMD values (n = 29). All study patients underwent 3T MR imaging at baseline and 6-month follow up, including spoiled gradient echo sequences for chemical shift encoding-based water-fat separation, from which T2* and PDFF values of the lumbar spine and the PSM were obtained. Moreover, the CSA of the PSM was assessed longitudinally. Changes in T2*, PDFF and CSA over 6 months were calculated for the vertebrae and PSM and associations with baseline BMD values were assessed. Results: The change in CSA of the PSM over 6 months was significantly lower in the osteoporotic/osteopenic group (−91.5 ± 311.7 mm2), compared to the non-osteoporotic group, in which the CSA increased (29.9 ± 164.0 mm2, p = 0.03). In a further analysis, patients with higher vertebral PDFF at baseline showed a significantly stronger increase in vertebral T2*, compared to those patients with lower vertebral PDFF at baseline (0.9 ± 1.6 ms vs. 0.0 ± 1.8 ms, p = 0.04). Moreover, patients with higher PSM PDFF at baseline showed a significantly stronger increase in vertebral T2*, compared to those patients with lower PSM PDFF at baseline (0.9 ± 2.0 ms vs. 0.0 ± 1.3 ms, p = 0.03). Conclusion: The PSM CSA decreased significantly longitudinally in patients with osteoporosis/osteopenia, compared to those without. Additionally, higher vertebral and PSM PDFF at baseline were associated with stronger changes in vertebral bone marrow T2*. Therefore, longitudinal PDFF and T2* mapping may be useful quantitative radiation-free tools for the assessment and prediction of muscle and bone health in patients with suspected osteoporosis/osteopenia.
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Affiliation(s)
- Florian Tilman Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- Correspondence:
| | - Leander Glanz
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Christof Boehm
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Jonathan Stelter
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Felix Gerhard Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Yannik Leonhardt
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Georg C. Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Markus Graf
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Rickmer F. Braren
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, DKFZ Heidelberg, 68120 Heidelberg, Germany
| | - Benedikt J. Schwaiger
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Marcus R. Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Dimitrios Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Alexandra S. Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- Department of Neuroradiology, Ludwig-Maximilians-University, 80333 Munich, Germany
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20
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Greater bone marrow fat and myosteatosis are associated with lower vBMD but not asymptomatic vertebral fracture. Eur Radiol 2022; 33:578-586. [PMID: 35932305 DOI: 10.1007/s00330-022-08979-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Organ fat may affect bone metabolism and be associated with vertebral fracture (VF). This study aimed to explore relationships between VF, adiposity indexes measured by MRI, and volumetric BMD (vBMD) measured by quantitative CT (QCT). METHODS Four hundred volunteers, ranging in age from 22 to 83 years, were recruited and underwent same-day abdominal QCT and chemical shift-encoded (CSE) MRI. We used MRI to quantify the fat content of bone marrow (BMF), psoas major and paraspinal muscles, and the liver. Abdominal fat, VF, and vBMD of the lumbar spine were measured by QCT. For VF discrimination analysis, we examined both the whole cohort (60 VF cases in 30 men and 30 women) and a restricted subgroup of those aged over 50 years (50 VF cases in 23 men and 27 women). RESULTS Amongst the men, a 1 SD increase in BMF was associated with a 27.67 (95% CI, -32.71 to -22.62) mg/cm3 decrease in vBMD after adjusting for age and BMI. Amongst women, all adiposity indexes except for liver fat were significantly associated with vBMD, with BMF having the strongest association (β, -24.00; 95% CI, -28.54 to -19.46 mg/cm3). Similar findings were also observed in participants aged over 50 years. The associations of adiposity indexes with vertebral fracture were not significant after adjusting for age in both sexes aged over 50 years. CONCLUSIONS In both sexes, higher bone marrow fat was associated with lower vBMD at the spine. However, marrow fat and other adipose tissues were not associated with radiographic-based prevalent vertebral fractures. KEY POINTS • In both sexes, higher bone marrow fat was associated with lower vBMD at the spine. • Among women, all adiposity indexes except for liver fat content were significantly associated with vBMD, with bone marrow fat having the strongest association. • Marrow fat and other adipose tissues were not associated with radiographic-based asymptomatic vertebral fractures.
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21
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An externally validated deep learning model for the accurate segmentation of the lumbar paravertebral muscles. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2156-2164. [PMID: 35852607 DOI: 10.1007/s00586-022-07320-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Imaging studies about the relevance of muscles in spinal disorders, and sarcopenia in general, require the segmentation of the muscles in the images which is very labour-intensive if performed manually and poses a practical limit to the number of investigated subjects. This study aimed at developing a deep learning-based tool able to fully automatically perform an accurate segmentation of the lumbar muscles in axial MRI scans, and at validating the new tool on an external dataset. METHODS A set of 60 axial MRI images of the lumbar spine was retrospectively collected from a clinical database. Psoas major, quadratus lumborum, erector spinae, and multifidus were manually segmented in all available slices. The dataset was used to train and validate a deep neural network able to segment muscles automatically. Subsequently, the network was externally validated on images purposely acquired from 22 healthy volunteers. RESULTS The median Jaccard index for the individual muscles calculated for the 22 subjects of the external validation set ranged between 0.862 and 0.935, demonstrating a generally excellent performance of the network, although occasional failures were noted. Cross-sectional area and fat fraction of the muscles were in agreement with published data. CONCLUSIONS The externally validated deep neural network was able to perform the segmentation of the paravertebral muscles in an accurate and fully automated manner, although it is not without limitations. The model is therefore a suitable research tool to perform large-scale studies in the field of spinal disorders and sarcopenia, overcoming the limitations of non-automated methods.
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22
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Banitalebi H, Aaen J, Storheim K, Negård A, Myklebust TÅ, Grotle M, Hellum C, Espeland A, Anvar M, Indrekvam K, Weber C, Brox JI, Brisby H, Hermansen E. A novel MRI index for paraspinal muscle fatty infiltration: reliability and relation to pain and disability in lumbar spinal stenosis: results from a multicentre study. Eur Radiol Exp 2022; 6:38. [PMID: 35854201 PMCID: PMC9296716 DOI: 10.1186/s41747-022-00284-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fatty infiltration of the paraspinal muscles may play a role in pain and disability in lumbar spinal stenosis. We assessed the reliability and association with clinical symptoms of a method for assessing fatty infiltration, a simplified muscle fat index (MFI). METHODS Preoperative axial T2-weighted magnetic resonance imaging (MRI) scans of 243 patients aged 66.6 ± 8.5 years (mean ± standard deviation), 119 females (49%), with symptomatic lumbar spinal stenosis were assessed. Fatty infiltration was assessed using both the MFI and the Goutallier classification system (GCS). The MFI was calculated as the signal intensity of the psoas muscle divided by that of the multifidus and erector spinae. Observer reliability was assessed in 102 consecutive patients for three independent investigators by intraclass correlation coefficient (ICC) and 95% limits of agreement (LoA) for continuous variables and Gwet's agreement coefficient (AC1) for categorical variables. Associations with patient-reported pain and disability were assessed using univariate and multivariate regression analyses. RESULTS Interobserver reliability was good for the MFI (ICC 0.79) and fair for the GCS (AC1 0.33). Intraobserver reliability was good or excellent for the MFI (ICC range 0.86-0.91) and moderate to almost perfect for the GCS (AC1 range 0.55-0.92). Mean interobserver differences of MFI measurements ranged from -0.09 to -0.04 (LoA -0.32 to 0.18). Adjusted for potential confounders, none of the disability or pain parameters was significantly associated with MFI or GCS. CONCLUSION The proposed MFI demonstrated high observer reliability but was not associated with preoperative pain or disability.
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Affiliation(s)
- Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Jørn Aaen
- Department of Orthopaedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Anne Negård
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Registration, Cancer Registry Norway, Oslo, Norway
| | - Margreth Grotle
- Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.,Department of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, P.O. box 4, St. Olafs plass, Oslo, Norway
| | - Christian Hellum
- Division of Orthopaedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Kari Indrekvam
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Kysthospitalet in Hagevik. Orthopaedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway.,Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute for clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erland Hermansen
- Department of Orthopaedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Hofseth BioCare, Ålesund, Norway
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23
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Li X, Zhang Y, Xie Y, Lu R, Tao H, Chen S. Correlation Between Bone Mineral Density (BMD) and Paraspinal Muscle Fat Infiltration Based on QCT: A Cross-Sectional Study. Calcif Tissue Int 2022; 110:666-673. [PMID: 35006307 DOI: 10.1007/s00223-022-00944-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/04/2022] [Indexed: 12/18/2022]
Abstract
To investigate the correlation between fatty infiltration of the paraspinal muscle and bone mineral density (BMD). In total, 367 subjects (182 men and 185 women) who underwent quantitative computed tomography (QCT) examination were enrolled in this study. A QCT Pro workstation was used to obtain the mean BMD of the lower lumbar spine (L3, L4, L5) and fat fraction (FF) of the paraspinal muscle (psoas and erector spinae) at the corresponding levels. The patient's age, sex, body mass index, number of previous vertebral fractures, physical activity level, and visual analog scale (VAS) score for lower back pain were recorded. For categorical variables, one-way ANOVA and independent-samples t tests were performed. Spearman and Pearson correlation coefficients were used to analyze the correlations among continuous variables. Influential factors were analyzed by multivariate linear regression analysis. Regarding the mean paraspinal muscle FF, there were significant differences between the different vertebral fracture groups (P < 0.05). Age and VAS score showed a positive correlation with the mean paraspinal muscle FF (r = 0.389, 0.454). BMD showed a negative correlation with the mean paraspinal muscle FF (r = - 0.721). The multiple linear regression analysis showed that vertebral fracture (β = 0.851, P = 0.021) and BMD (β = - 4.341, P = 0.004) were independent factors of the mean paraspinal muscle FF. This study demonstrated that an advanced age, a greater VAS score, a higher number of vertebral fractures, and a lower BMD may be associated with more severe fatty infiltration of the paraspinal muscle.
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Affiliation(s)
- Xiangwen Li
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyang Zhang
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuxue Xie
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Lu
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyue Tao
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuang Chen
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China.
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24
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Yang Q, Yan D, Wang L, Li K, Liang W, Zhang W, Liu YD, Li XM, Blake GM, Konerth N, Cheng X, Tian W, Hind K. Muscle fat infiltration but not muscle cross-sectional area is independently associated with bone mineral density at the lumbar spine. Br J Radiol 2022; 95:20210371. [PMID: 35333587 PMCID: PMC10996424 DOI: 10.1259/bjr.20210371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 12/02/2021] [Accepted: 03/14/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Although sarcopenia and osteoporosis are inter-related conditions that are common with advancing age, few studies have explored relationships between muscle quality and bone mineral density (BMD). We investigated age- and sex-specific paraspinal muscle fat infiltration (MFI), muscle cross-sectional area (CSA), and spine volumetric BMD (vBMD) in healthy Chinese adults. METHODS 605 healthy adults aged 20-59 years (340 women, mean age 39.2 years; 265 men, mean age 38.8 years) had axial T2WI MRI imaging of the lumbar spine and CSA (cm2) and MFI (%) were measured in the psoas and multifidus and erector spinae (MF-ES) muscles (L3-L4). MFI measurements were calibrated against a region of interest in an adjacent area of subcutaneous pure fat. L2-L4 vBMD was measured by quantitative CT. Age- and sex-specific subgroups were compared using the Mann-Whitney test. Multiple regression was used to test independent associations of MFI and CSA with vBMD. RESULTS Females had lower CSA and higher MFI than males in both the psoas and MF-ES muscles (p < 0.001). In females and males, MF-ES MFI increased with age (p < 0.001) and in females age-related increases were observed for the psoas muscles (p < 0.05). Greater fat infiltration of the MS-ES muscle unit was associated with lower vBMD in both sexes (p < 0.001) but not with CSA. Following adjustment for demographic variables and CSA, MS-ES MFI remained predictive of vBMD (β = -0.408 to -0.157, p < 0.001). CONCLUSION We have demonstrated that, independent of CSA and demographic variables, MFI of the MF-ES muscles is predictive of lower lumbar spine vBMD in both sexes. ADVANCES IN KNOWLEDGE This is the first study to demonstrate that, independent of muscle size and demographic variables, MFI of the paraspinal MF-ES muscles is predictive of lower lumbar spine vBMD in both sexes.
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Affiliation(s)
- Qian Yang
- Department of Radiology, Tongji Hospital, Tongji Medical
College, Huazhong University of Science and Technology,
Wuhan, Hubei, China
| | - Dong Yan
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Kai Li
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Wei Liang
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Wei Zhang
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Yan Dong Liu
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Xiao Min Li
- Department of Radiology, Tongji Hospital, Tongji Medical
College, Huazhong University of Science and Technology,
Wuhan, Hubei, China
| | - Glen M Blake
- School of Biomedical Engineering and Imaging Sciences, Kings
College London, St Thomas’ Hospital,
London, United Kingdom
| | - Natalie Konerth
- Department of Sport and Exercise Sciences, Durham
University, Durham, United
Kingdom
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan
Hospital, Beijing,
China
| | - Karen Hind
- Department of Sport and Exercise Sciences, Durham
University, Durham, United
Kingdom
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25
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Meloni A, Positano V, Pistoia L, Cademartiri F. Pancreatic iron quantification with MR imaging: a practical guide. Abdom Radiol (NY) 2022; 47:2397-2407. [PMID: 35596775 DOI: 10.1007/s00261-022-03552-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Abstract
Accurate determination of pancreatic iron status is crucial for preventing impairment of the exocrine and endocrine function of the pancreas and for prospectively stratifying the cardiac iron risk. The following article should be a sort of practical guide for radiologists interested in quantifying pancreatic iron overload by Magnetic Resonance Imaging (MRI). After a brief background on iron-deposition diseases, we will describe basic principles and relative advantages and disadvantages of the more widely used and clinically feasible MRI-based techniques for pancreatic iron assessment. These methods can be classified into signal intensity ratio (SIR) and relaxometry methods. We will examine different technical aspects representing the key for accurate and precise relaxation time measurement.
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Affiliation(s)
- Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124, Pisa, Italy
- U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124, Pisa, Italy
- U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124, Pisa, Italy.
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Li X, Xie Y, Lu R, Zhang Y, Tao H, Chen S. Relationship between oseteoporosis with fatty infiltration of paraspinal muscles based on QCT examination. J Bone Miner Metab 2022; 40:518-527. [PMID: 35239028 DOI: 10.1007/s00774-022-01311-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/07/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION To investigate the correlation between paraspinal muscles features and osteoporosis in lumbar spine. MATERIALS AND METHODS A total of 367 subjects who underwent quantitative computed tomography (QCT) examination were enrolled in this study. QCT pro workstation was used to obtain the mean bone mineral density (BMD) of the lower lumbar spine. Fat fraction (FF) and cross-section area (CSA) of the paraspinal muscles at the corresponding levels were measured. All participants were divided into normal, osteopenia, and osteoporosis groups. One-way ANOVA and independent samples t tests were performed to compare differences between groups. Pearson and Spearman correlation coefficients and partial correlation analysis after controlling for confounding factors were used to analyze the correlation between BMD and paraspinal muscles measurements. RESULTS Among the 367 participants included, 116 were in the normal group, 130 in the osteopenia group and 121 in the osteoporosis group. There were significant differences among the three groups for the mean and multifidus FF. BMD showed negative correlations with the FF of the paraspinal muscles. Multifidus and mean FF showed the best correlation (r = - 0.654, - 0.777). There were also significant differences in the mean and multifidus FF between different age groups, while after controlling for confounding factors, there was no correlation between age and FF of the paraspinal muscles. CONCLUSION This preliminary study demonstrated the association of BMD with fatty infiltration of paraspinal muscles. Different muscles might have specific effects in different sex and age groups.
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Affiliation(s)
- Xiangwen Li
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Yuxue Xie
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Rong Lu
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Yuyang Zhang
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Hongyue Tao
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Shuang Chen
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, 200040, China.
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Bartenschlager S, Dankerl P, Chaudry O, Uder M, Engelke K. BMD accuracy errors specific to phantomless calibration of CT scans of the lumbar spine. Bone 2022; 157:116304. [PMID: 34973497 DOI: 10.1016/j.bone.2021.116304] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 01/22/2023]
Abstract
Opportunistic screening using existing CT images may be a new strategy to identify subjects at increased risk for osteoporotic fracture. Low bone mineral density (BMD) is a key parameter but routine clinical CT scans do not include a calibration phantom to calculate BMD from the measured CT values. An alternative is internal or phantomless calibration, which is based on the CT values of air and of internal tissues of the subject such as blood, muscle or adipose tissue. However, the composition and as a consequence the CT values of these so-called internal calibration materials vary among subjects, which introduces additional BMD accuracy errors compared to phantom based calibration. The objective of this study was to quantify these accuracy errors and to identify optimum combinations of internal calibration materials (IM) for BMD assessments in opportunistic screening. Based on the base material decomposition theory we demonstrate how BMD can be derived from the CT values of the internal calibration materials. 121 CT datasets of the lumbar spine form postmenopausal women were used to determine the population variance of blood assessed in the aorta or the inferior vena cava, skeletal muscle of the erector spinae or psoas, subcutaneous adipose tissue (SAT) and air. The corresponding standard deviations were used for error propagation to determine phantomless calibration related BMD accuracy errors. Using a CT value of 150 HU, a typical value of trabecular bone, simulated BMD accuracy errors for most IM combinations containing air as one of the two base materials were below 5% or 6 mg/cm3. The lowest errors were determined for the combination of blood and air (<2 mg/cm3). The combination of blood and skeletal muscle resulted in higher errors (>10.5% or >12 mg/cm3) and is not recommended. Due to possible age-related differences in tissue composition, the selection of IMs is suggested to be adapted according to the measured subject. In younger subjects without significant aortic calcifications, air and blood of the aorta may be the best combination whereas in elderly subjects, air and SAT (error of 4%) may be preferable. The use of skeletal muscle as one of the two IMs is discouraged, in particular in elderly subjects because of varying fatty infiltration. A practical implementation of the internal calibration with different IM pairs confirmed the theoretical results. In summary, compared to a phantom based calibration the phantomless approach used for opportunistic screening creates additional BMD accuracy errors of 2% or more, dependent on the used internal reference tissues. The impact on fracture prediction still must be evaluated.
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Affiliation(s)
- Stefan Bartenschlager
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany; Institute of Medical Physics, FAU University Erlangen-Nürnberg, Erlangen, Germany.
| | - Peter Dankerl
- Institute of Radiology, FAU University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
| | - Oliver Chaudry
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany; Institute of Medical Physics, FAU University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, FAU University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
| | - Klaus Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany; Institute of Medical Physics, FAU University Erlangen-Nürnberg, Erlangen, Germany; Bioclinica Inc, Hamburg, Germany
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Han G, Zou D, Liu Z, Zhou S, Li W, Gong C, Sun Z, Li W. Paraspinal muscle characteristics on MRI in degenerative lumbar spine with normal bone density, osteopenia and osteoporosis: a case-control study. BMC Musculoskelet Disord 2022; 23:73. [PMID: 35057764 PMCID: PMC8780389 DOI: 10.1186/s12891-022-05036-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background To investigate the difference of paraspinal muscles in patients with normal bone density, osteopenia and osteoporosis. Methods Patients undergoing surgery for lumbar spinal stenosis were included. Thirty-eight patients with osteoporosis were matched to patients with osteopenia and patients with normal bone density in a 1:1 manner according to WHO criteria. Dual-energy X-ray absorptiometry (DXA) scans and lumbar CT were performed preoperatively to measure the BMD of lumbar, femur and hip and HU values of L1-L4 respectively. The relative total cross-sectional area (rTCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES), and the relative functional CSA (rFCSA) of psoas major (PS) were measured at L4–5 and L5-S level on preoperative MRI. Results Osteoporotic patients showed lower BMI, higher MF FI and higher ES FI when compared with normal bone density group (25.57 ± 3.71 vs 27.46 ± 3.11; 0.38 ± 0.1 vs 0.32 ± 0.08; 0.33 ± 0.1 vs 0.28 ± 0.08; all adjusted p < 0.05). Both the MF FI and ES FI were significantly correlated with lumbar T-score (r = − 0.223, p < 0.05; r = − 0.208, p < 0.05) and the averaged lumbar HU value (r = − 0.305, p < 0.01; r = − 0.239, p < 0.05). Conclusions Osteoporosis and paraspinal muscle degeneration might interact with each other and coexist in patients with degenerative lumbar diseases. It is recommended that the paraspinal muscle degeneration should be considered simultaneously when finding a patient with low bone mass before surgery.
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Huang Y, Wang L, Zeng X, Chen J, Zhang Z, Jiang Y, Nie L, Cheng X, He B. Association of Paraspinal Muscle CSA and PDFF Measurements With Lumbar Intervertebral Disk Degeneration in Patients With Chronic Low Back Pain. Front Endocrinol (Lausanne) 2022; 13:792819. [PMID: 35721738 PMCID: PMC9204273 DOI: 10.3389/fendo.2022.792819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/21/2022] [Indexed: 12/01/2022] Open
Abstract
There is an interaction between the lumbar spine and paraspinal muscles, which may play a role in the development of intervertebral disc (IVD) degeneration and may affect CLBP. The study aims to assess the relationship between IVD degeneration and paraspinal muscle fat infiltration in CLBP patients by quantitative MR imaging, and to evaluate the influence of sex and age on CLBP muscle fat infiltration. Sixty CLBP patients (46.3 years ±17.0) and thirty-two healthy subjects (44.9 years ±17.6) were recruited for this study. 3.0 T MRI was used to perform the sagittal and axial T1, T2 of the lumbar spine, and axial paraspinal muscle IDEAL imaging at the L4/5 and L5/S1 levels. Proton density fat fraction (PDFF) of the multifidus and erector spinae at two IVD levels were measured. The Pfirrmann grades of IVD degeneration, Oswestry Disability Index (ODI), and Visual Analog Scale (VAS) were also evaluated. Compare the cross-sectional area (CSA) and PDFF of the paraspinal muscles between CLBP patients and healthy subjects, and analyze the relationship between the muscle PDFF and Pfirrmann grades, gender, and age of CLBP patients. Compared with healthy subjects, the CSA of the multifidus muscle in CLBP patients decreased (1320.2±188.1mm2vs. 1228.7±191.0 mm2, p<0.05) at the L4/5 level, the average PDFF increased, (7.7±2.6% vs. 14.79±5.3%, 8.8±4.2% vs. 16.03±5.3%, all p<0.05) at both L4/5 and L5/S1 levels. The PDFF of paraspinal muscles were correlated with adjacent IVD degeneration, ODI and VSA in CLBP patients (all p<0.05). After using age and body mass index (BMI) as control variables, significance was retained (all p<0.05). Multiple regression analysis revealed sex and age also were significantly associated with multifidus PDFF (all p < 0.05). This study confirmed that the CSA decreased and the PDFF increased of the paraspinal muscles in CLBP patients. It reveals a significant correlation between the PDFF of CLBP paraspinal muscles and the grade of IVD degeneration. Sex and age are also important factors influencing CLBP paraspinal muscle infiltration.
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Affiliation(s)
- Yilong Huang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaomin Zeng
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
- GE Healthcare, Magnetic Resonance Field Application Team, Chengdu, China
| | - Jiaxin Chen
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhenguang Zhang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuanming Jiang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lisha Nie
- GE Healthcare, Magnetic Resonance Research China, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Bo He, ; Xiaoguang Cheng,
| | - Bo He
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Bo He, ; Xiaoguang Cheng,
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Li J, Wang Y, Zhang X, Zhang P, Su Y, Bai L, Wang Y, Wang M, Zhao J. Associations of muscle size and fatty infiltration with bone mineral density of the proximal femur bone. Front Endocrinol (Lausanne) 2022; 13:990487. [PMID: 36237187 PMCID: PMC9552015 DOI: 10.3389/fendo.2022.990487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the relationship of muscle atrophy and fat infiltration around the hip joint with areal bone mineral density (aBMD) in each subregion of the proximal femur. MATERIALS AND METHODS In total, 144 participants (66 women and 78 men) were examined by quantitative computed tomography (QCT), and areal bone mineral density (aBMD) of the femoral neck (FN), trochanter (TR), and intertrochanter (IT) of the proximal femur were obtained. The cross-sectional area (CSA) and proton density fat fraction (PDFF) of the gluteus maximus (G.MaxM), gluteus medius (G.MedM), gluteus minimus (G.MinM), and iliopsoas (IliopM) were obtained via magnetic resonance imaging (MRI) using the mDIXON-Quant sequence. A multivariate generalized linear model was used to evaluate the correlation of the CSA and PDFF of muscles with aBMD in all subregions of the proximal femur. RESULTS The FN integral (Int) aBMD was significantly associated with the G.MaxM CSA (men: P = 0.002; women: P = 0.008) and PDFF (men: P < 0.001; women: P = 0.047). Some muscle indexes were related to the FN aBMD in males or females, including the CSA of G.MedM, G.MinM, and IliopM as well as the PDFF of IliopM and G.MinM. Associations of hip muscle parameters with the TR Int aBMD in both males and females were observed, including G.MaxM CSA (men: P < 0.001; women: P = 0.028) and G.MaxM PDFF (men: P = 0.031; women: P = 0.038). Other muscle indexes, including G.MedM and IliopM, were related to the TR aBMD, mainly affecting the aBMD of TR cortical (Cort) and TR Int. The IT Int aBMD and IT Cort aBMD showed significant correlation with the muscle indexes of G. MaxM, IliopM, and G.MedM, including the PDFF and CSA in males and females. Further, more indicators of the G.MedM and IliopM correlated with the TR and IT aBMD compared to the FN aBMD. CONCLUSIONS The CSA of gluteus muscles and iliopsoas had a positive association with the aBMD in the proximal femur, and the PDFF of gluteus muscles and iliopsoas had a negative correlation with the aBMD in the proximal femur. In addition, there was an interaction of the proximal femur aBMD with the muscle size and fatty infiltration of hip muscles.
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Affiliation(s)
- Junfei Li
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yijing Wang
- Department of Radiology, Hebei General Hospital, Shijiazhuang, China
| | - Xuesong Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ping Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yunshan Su
- Department of Pediatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lin Bai
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yali Wang
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ming Wang
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Ming Wang, ; Jian Zhao,
| | - Jian Zhao
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Ming Wang, ; Jian Zhao,
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Pinter ZW, Wagner SC, Sebastian AS. Reply to the Letter to the Editor: Cervical Paraspinal Muscle Fatty Degeneration is Not Associated with Muscle Cross-sectional Area: Qualitative Assessment is Preferable for Cervical Sarcopenia. Clin Orthop Relat Res 2021; 479:1860-1861. [PMID: 33938459 PMCID: PMC8277244 DOI: 10.1097/corr.0000000000001811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 01/31/2023]
Affiliation(s)
| | - Scott C. Wagner
- Walter Reed National Military Medical Center, Bethesda, MD, USA
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Obesity, dynapenia, and their combination: Implications for bone mineral density in Brazilian adults-the Pró-Saúde study. Nutrition 2020; 81:110898. [PMID: 32739661 DOI: 10.1016/j.nut.2020.110898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/07/2020] [Accepted: 05/16/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study aimed to evaluate bone mineral density (BMD) in the presence or absence of dynapenia or obesity in Brazilian adults. METHODS This is a cross-sectional study conducted in 502 adults (age: 33-81 y; 51% women) participating in the Pró-Saúde study, a cohort of civil servants at the university campuses in Rio de Janeiro, Brazil. Body composition and BMD were determined by dual energy x-ray absorptiometry. Handgrip strength was measured using a dynamometer. According to measures of handgrip strength (≤19 kg for women; ≤32 kg for men) and fat mass (>30% for men; >40% for women), participants were classified into four groups: non-obese non-dynapenic, obese non-dynapenic, non-obese dynapenic, and obese dynapenic. The association between BMD at each specific bone site and obesity, dynapenia, and their interaction was evaluated using a general linear model. RESULTS The prevalence of dynapenic obesity was 14% in men and 15.2% in women. Dynapenia alone was not associated with BMD at any site in either men nor women. Obesity and dynapenia interacted to influence BMD in women (P < 0.05). Total body, lumbar spine, and femoral neck BMD were higher by 6.3%, 9.3%, and 10.4%, respectively, in dynapenic obese women compared with their non-obese counterparts (P < 0.05). In men, obesity, dynapenia, and their combination were not associated with BMD at any site. CONCLUSIONS Our results suggest that dynapenia, obesity, and their combination may affect BMD in a sex-dependent manner. In the presence of dynapenia, fat mass appears to exert a protective effect on BMD in women, but not in men.
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Age- and BMI-related variations of fat distribution in sacral and lumbar bone marrow and their association with local muscle fat content. Sci Rep 2020; 10:9686. [PMID: 32546722 PMCID: PMC7297969 DOI: 10.1038/s41598-020-66649-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
This analysis investigated the age- and BMI-related variations of fat distribution in sacral and lumbar bone marrow and their association with local muscle fat content in order to detect fat distribution patterns and variations in healthy adults using proton density fat fraction (PDFF) measurements. A six-echo 3D spoiled gradient-echo sequence was used for chemical shift encoding-based water-fat separation at the sacral and lower lumbar region in 103 healthy volunteers. PDFF values of the sacrum, 5th lumbar vertebral body, the gluteal and paraspinal muscles were determined. Correlation with age was significant (p < 0.05) for PDFF of the sacrum (men (m): r = 0.58; women (w): r = 0.54), L5 (m: r = 0.58; w: r = 0.54), the gluteal (m: r = 0.51; w: r = 0.44) and paraspinal (m: r = 0.36; w: r = 0.49) muscles in both genders. BMI correlated significantly with the paraspinal musculature in men (r = 0.46) and women (r = 0.33). Correlation testing revealed significant correlations (p < 0.05) between the two osseous (m: r = 0.63, w: r = 0.75) and the muscle compartments (m: r = 0.63, w: r = 0.33) in both genders. Bone marrow and muscle fat infiltration patterns were not significantly associated with each other at the sacral and lower lumbar spine region. The presented data suggest that the two compartments may have distinct pathophysiological fat infiltration patterns. However, further clinical studies are needed to support the results.
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Yin L, Xu Z, Wang L, Li W, Zhao Y, Su Y, Sun W, Liu Y, Yang M, Yu A, Blake GM, Wu X, Veldhuis-Vlug AG, Cheng X, Hind K, Engelke K. Associations of Muscle Size and Density With Proximal Femur Bone in a Community Dwelling Older Population. Front Endocrinol (Lausanne) 2020; 11:503. [PMID: 32849289 PMCID: PMC7399084 DOI: 10.3389/fendo.2020.00503] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background and Purpose: Muscle weakness and bone fragility are both associated with hip fracture. In general, muscle contractions create forces to the bone, and bone strength adapts to mechanical loading through changes in bone architecture and mass. However, the relationship between impairment of muscle and bone function remain unclear. In particular, the associations of muscle with properties of proximal femur cortical and trabecular bone are still not well understood. The aim of this study was to explore the associations of hip/thigh muscle density (CT attenuation value in Hounsfield units) and size with cortical and trabecular bone mineral density (BMD) of the proximal femur. Materials and Methods: Three-dimensional quantitative computed tomography (QCT) imaging of the lumber, hip and mid-thigh was performed in a total of 301 participants (mean age 68.4 ± 6.1 years, 194 women and 107 men) to derive areal BMD (aBMD) and volumetric BMD (vBMD). Handgrip strength (HGS) and the Timed Up and Go (TUG) test were also performed. From the CT images, cross-sectional area (CSA), and density were determined for the gluteus maximus muscle (G.MaxM), trunk muscle at the vertebrae L2 level, and mid-thigh muscle. Multivariate generalized linear models were applied to assess associations. Results: Total hip (TH) aBMD was associated significantly with G.MaxM CSA (men: P = 0.042; women: P < 0.001) and density (men: P = 0.012; women: P = 0.043). In women, 0.035 cm2 of mid-thigh CSA (95% CI, 0.014-0.057; P = 0.002) increased per SD increase in TH aBMD, but this significance was not observed in men (P = 0.095). Trunk muscle density and CSA were not associated with proximal femur BMD. The associations of hip/thigh muscle parameters with femoral neck BMD were weaker than those with trochanter and intertrochanter BMD. Furthermore, compared to muscle density, muscle CSA showed better associations with vBMD. G.MaxM CSA was associated with trochanter (TR) Cort. vBMD in men (β, 19.898; 95% CI, 0.924-38.871; P = 0.040) and in women (β, 15.426; 95% CI, 0.893-29.958; P = 0.038). Handgrip strength was only associated with TR aBMD (β, 0.038; 95% CI, 0.006-0.070; P = 0.019) and intertrochanter aBMD (β, 0.049; 95% CI, 0.009-0.090; P = 0.016) in men. Conclusions: We observed positive associations of the gluteus and thigh muscle size with proximal femur volumetric BMD. Specifically, the gluteus maximus muscle CSA was associated with trochanter cortical vBMD in both men and women.
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Affiliation(s)
- Lu Yin
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyang Xu
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Ling Wang
| | - Wei Li
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Wei Li
| | - Yue Zhao
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Sun
- Xinjiekou Community Health Service Center, Beijing, China
| | - Yandong Liu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Minghui Yang
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Aihong Yu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Glen Mervyn Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Xinbao Wu
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Annegreet G. Veldhuis-Vlug
- Division of Endocrinology, Department of Internal Medicine, Center for Bone Quality, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Karen Hind
- Department of Sport and Exercise Sciences, Durham University, Durham, United Kingdom
| | - Klaus Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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