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Yik V, Kok SSX, Chean E, Lam YE, Chua WT, Tan WJ, Foo FJ, Ng JL, Su SS, Chong CXZ, Aw DKL, Khoo NAX, Wischmeyer PE, Molinger J, Wong S, Ong LWL, Koh FHX. Diagnosing Sarcopenia with AI-Aided Ultrasound (DINOSAUR)-A Pilot Study. Nutrients 2024; 16:2768. [PMID: 39203903 PMCID: PMC11357450 DOI: 10.3390/nu16162768] [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: 07/22/2024] [Revised: 08/11/2024] [Accepted: 08/13/2024] [Indexed: 09/03/2024] Open
Abstract
Background: Sarcopenia has been recognized as a determining factor in surgical outcomes and is associated with an increased risk of postoperative complications and readmission. Diagnosis is currently based on clinical guidelines, which includes assessment of skeletal muscle mass but not quality. Ultrasound has been proposed as a useful point-of-care diagnostic tool to assess muscle quality, but no validated cut-offs for sarcopenia have been reported. Using novel automated artificial intelligence (AI) software to interpret ultrasound images may assist in mitigating the operator-dependent nature of the modality. Our study aims to evaluate the fidelity of AI-aided ultrasound as a reliable and reproducible modality to assess muscle quality and diagnose sarcopenia in surgical patients. Methods: Thirty-six adult participants from an outpatient clinic were recruited for this prospective cohort study. Sarcopenia was diagnosed according to Asian Working Group for Sarcopenia (AWGS) 2019 guidelines. Ultrasonography of the rectus femoris muscle was performed, and images were analyzed by an AI software (MuscleSound® (Version 5.69.0)) to derive muscle parameters including intramuscular adipose tissue (IMAT) as a proxy of muscle quality. A receiver operative characteristic (ROC) curve was used to assess the predictive capability of IMAT and its derivatives, with area under the curve (AUC) as a measure of overall diagnostic accuracy. To evaluate consistency between ultrasound users of different experience, intra- and inter-rater reliability of muscle ultrasound parameters was analyzed in a separate cohort using intraclass correlation coefficients (ICC) and Bland-Altman plots. Results: The median age was 69.5 years (range: 26-87), and the prevalence of sarcopenia in the cohort was 30.6%. The ROC curve plotted with IMAT index (IMAT% divided by muscle area) yielded an AUC of 0.727 (95% CI: 0.551-0.904). An optimal cut-off point of 4.827%/cm2 for IMAT index was determined with a Youden's Index of 0.498. We also demonstrated that IMAT index has excellent intra-rater reliability (ICC = 0.938, CI: 0.905-0.961) and good inter-rater reliability (ICC = 0.776, CI: 0.627-0.866). In Bland-Altman plots, the limits of agreement were from -1.489 to 1.566 and -2.107 to 4.562, respectively. Discussion: IMAT index obtained via ultrasound has the potential to act as a point-of-care evaluation for sarcopenia screening and diagnosis, with good intra- and inter-rater reliability. The proposed IMAT index cut-off maximizes sensitivity for case finding, supporting its use as an easily implementable point-of-care test in the community for sarcopenia screening. Further research incorporating other ultrasound parameters of muscle quality may provide the basis for a more robust diagnostic tool to help predict surgical risk and outcomes.
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Affiliation(s)
- Vanessa Yik
- Duke-NUS Medical School, Singapore 169857, Singapore;
| | - Shawn Shi Xian Kok
- Department of Radiology, Sengkang General Hospital, Singapore 544886, Singapore
| | - Esther Chean
- Department of Radiology, Sengkang General Hospital, Singapore 544886, Singapore
| | - Yi-En Lam
- Department of Radiology, Sengkang General Hospital, Singapore 544886, Singapore
| | - Wei-Tian Chua
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Winson Jianhong Tan
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Fung Joon Foo
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Jia Lin Ng
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Sharmini Sivarajah Su
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Cheryl Xi-Zi Chong
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Darius Kang-Lie Aw
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | | | - Paul E. Wischmeyer
- Department of Anesthesia, Duke University Medical Center, Durham, NC 27710, USA
| | - Jeroen Molinger
- Department of Anesthesia, Human Pharmacology and Physiology Lab (HPPL), Duke University Medical Center, Durham, NC 27710, USA
- Department of Intensive Care Adults, Erasmus Medical Center University, 3015 GD Rotterdam, The Netherlands
| | - Steven Wong
- Department of Radiology, Sengkang General Hospital, Singapore 544886, Singapore
| | - Lester Wei-Lin Ong
- Department of Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Frederick Hong-Xiang Koh
- Duke-NUS Medical School, Singapore 169857, Singapore;
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
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Vilas-Boas F, Rizzo GEM, De Ponthaud C, Robinson S, Gaujoux S, Capurso G, Vanella G, Bozkırlı B. Unveiling hidden outcomes in malignant gastric outlet obstruction research - insights from a "Pancreas 2000" review. World J Gastrointest Endosc 2024; 16:451-461. [PMID: 39155997 PMCID: PMC11325868 DOI: 10.4253/wjge.v16.i8.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/06/2024] [Accepted: 07/16/2024] [Indexed: 08/01/2024] Open
Abstract
Malignant gastric outlet obstruction (mGOO) is a major condition affecting patients with periampullary tumors, including pancreatic cancer. The current treatment options include surgical gastroenterostomy, endoscopic stenting and more recently EUS-guided gastroenterostomy. Most studies comparing the outcomes of the three procedures focus on technical success, clinical success and safety. Several "occult" outcomes relevant to the patient's viewpoints and perspective may ultimately impact on cancer-related and overall survival, such as body mass composition, nutritional biomarkers, chemotherapy tolerance and patient-reported quality of life. The aim of this review is to provide an overview of potential key outcomes that should be explored in future comparative research around mGOO treatment options.
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Affiliation(s)
- Filipe Vilas-Boas
- Department of Gastroenterology, São João University Hospital, Porto 4200, Portugal
| | - Giacomo Emanuele Maria Rizzo
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Scientific Institute for Research, Hospitalization and Healthcare - The Mediterranean Institute for Transplantation and Highly Specialized Therapies, Palermo 90127, Sicilia, Italy
| | - Charles De Ponthaud
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtriere, Sorbonne Université, Paris 75013, Île-de-France, France
| | - Stuart Robinson
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle NE7 7DN, Newcastle upon Tyne, United Kingdom
| | - Sebastien Gaujoux
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtriere, Sorbonne Université, Paris 75013, Île-de-France, France
| | - Gabriele Capurso
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano 20132, Italy
| | - Giuseppe Vanella
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano 20132, Italy
| | - Bahadır Bozkırlı
- Department of General Surgery, HPB-Unit, Acıbadem Maslak Hospital, Istanbul 34398, Türkiye
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Gehlen M, Schwarz-Eywill M, Mahn K, Pfeiffer A, Bauer JM, Maier A. [Sonography of muscles : Rheumatology-Neurology-Geriatrics-Sports medicine-Orthopedics]. Z Rheumatol 2024:10.1007/s00393-024-01541-8. [PMID: 39143255 DOI: 10.1007/s00393-024-01541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 08/16/2024]
Abstract
Muscle sonography is used in rheumatology, neurology, geriatrics, sports medicine and orthopedics. Muscular atrophy with fatty and connective tissue degeneration can be visualized and must be interpreted in conjunction with the sonographic findings of the supplying nerves. Sonography is becoming increasingly more important for the early diagnosis of sarcopenia in rheumatology, geriatrics and osteology. Even if its significance has not yet been conclusively clarified, many publications confirm the high reliability of the method. Sonography can ideally be used in addition to magnetic resonance imaging (MRI) in the diagnostics of myositis as it can speed up the diagnosis, muscle groups that were not imaged by MRI can also be assessed sonographically and all muscle groups can be examined during the course of the procedure. Sonography also helps to make a quick and uncomplicated diagnosis of many sports injuries in addition to MRI and is therefore the basis for a targeted therapeutic approach.
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Affiliation(s)
- Martin Gehlen
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Ausbildungsabteilung Sonographie DEGUM, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland.
| | - Michael Schwarz-Eywill
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Ausbildungsabteilung Sonographie DEGUM, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| | - Karin Mahn
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Ausbildungsabteilung Sonographie DEGUM, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| | - Andreas Pfeiffer
- Abteilung für Neurologie, St. Josefs-Hospital Cloppenburg, Cloppenburg, Deutschland
| | - Jürgen M Bauer
- Abteilung für Akutgeriatrie, Mitglied der EWGSOP2, Bethanien Krankenhaus Heidelberg, Heidelberg, Deutschland
| | - Anna Maier
- Abteilung für Rheumatologie, Interdisziplinäres Ultraschallzentrum & Ausbildungsabteilung Sonographie DEGUM, Nordwestdeutsches Rheumazentrum, St. Josef Stift, Sendenhorst, Deutschland
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Dong B, Yu D, Zhang H, Li P, Li Y, Li C, Li J. Association between preoperative sarcopenia and postoperative delirium in older patients undergoing gastrointestinal cancer surgery. Front Aging Neurosci 2024; 16:1416569. [PMID: 39144259 PMCID: PMC11322050 DOI: 10.3389/fnagi.2024.1416569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/19/2024] [Indexed: 08/16/2024] Open
Abstract
Background Postoperative delirium (POD) is a usual neurological complication, often leading to poor prognoses. Early identification of high-risk patients is crucial for preventing POD. Sarcopenia is an age-related geriatric syndrome characterized by the loss of skeletal muscle mass and function, and previous studies indicated that preoperative low muscle mass might be a predictor for POD. However, the association between preoperative sarcopenia and POD remains to be fully elucidated. This study was to explore the correlation between preoperative sarcopenia and POD following gastrointestinal cancer surgery in older patients. Methods Older patients (≥60 years) undergoing gastrointestinal cancer surgery were enrolled. Sarcopenia was defined based on the Special Interest Group on sarcopenia of the International Society of Physical and Rehabilitation Medicine (ISarcoPRM), which combined the loss of muscle mass (evaluated by ultrasound) and function (assessed by chair stand test and handgrip strength) before surgery. POD assessment was performed using the Confusion Assessment Method (CAM) or CAM for the intensive care unit (CAM-ICU) during the first 7 days after surgery or before discharge. Multivariate logistic regression analysis examined the correlation between preoperative sarcopenia and POD. Moreover, the receiver operator characteristic (ROC) curve was applied to analyze the predictive effect of the preoperative sarcopenia in POD. Results One hundred and thirty patients were finally included, of which 43 patients presented with sarcopenia before surgery. Twenty-four patients ultimately developed POD, and the incidence was 18.5%. The results of the multivariate analyses demonstrated that preoperative sarcopenia was still independently associated with POD after adjusting for age ≥70 years, preoperative Mini-Mental State Examination score, and intraoperative blood transfusion. The area under the ROC curve of preoperative sarcopenia in predicting POD was 0.680 (95% confidence interval 0.557-0.804). Conclusion Preoperative sarcopenia defined by ISarcoPRM criteria was independently associated with POD in geriatric patients after gastrointestinal cancer surgery.
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Affiliation(s)
- Bo Dong
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Graduate Faculty, Hebei North University, Zhangjiakou, China
| | - Dongdong Yu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Pan Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yi Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Chong Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
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Qu G, Zhou C, Zhang Y, Lyu SC, Lang R. Influence of sarcopenia on postoperative complications and long-term survival in pancreatic cancer patients undergone pancreaticoduodenectomy. Front Nutr 2024; 11:1434630. [PMID: 39027658 PMCID: PMC11254807 DOI: 10.3389/fnut.2024.1434630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Background Sarcopenia has the potential to impact the postoperative results and extended prognosis of various types of tumors. Nevertheless, the specific impact of sarcopenia on the postoperative results and long-term survival of pancreatic cancer (PC) following pancreaticoduodenectomy (PD) remains inadequately elucidated. This study investigates the significance of sarcopenia according to various Asian standards on postoperative complications and long-term prognosis in PC patients who have undergone PD. Methods This retrospective study systematically analyzed patients with PC who underwent PD from January 2015 to December 2022. Sarcopenia was diagnosed by the skeletal muscle index (SMI) obtained by the skeletal muscle area normalized for height squared on the third lumbar vertebra on computed tomography (CT) images. Univariate and multivariate logistic regression analysis were performed to analyze the correlation between sarcopenia and postoperative complications, while Cox regression analysis was utilized to explore the influence of sarcopenia on overall survival (OS) and recurrence-free survival (RFS) in PC patients after PD. Results We enrolled 162 patients with PC after PD (92 males and 70 females, mean age: 63.78 ± 10.27 years), including 83 and 79 patients with sarcopenia and non-sarcopenia, respectively. Compared with non-sarcopenia patients, sarcopenia exhibited higher rates of recurrence rate (75% versus 59%, p = 0.039). Univariate and multivariate logistic regression analysis showed that sarcopenia did not affect the incidence of complications in patients with PC after PD in three Asian sarcopenia criteria. Multivariate Cox regression analysis indicated that sarcopenia was an independent risk factor for OS (hazard ratio [HR]: 2.49, 95% confidence interval [CI]: 1.73-3.60, p < 0.001) and RFS(hazard ratio [HR]: 1.70, 95%confidence interval [CI]: 1.12-2.50, p = 0.012) of PC patients with PD in Japanese Society of Hepatology criteria. Meanwhile, according to the Asian pancreatic cancer population standard, sarcopenia is an independent risk factor affecting the long-term OS (hazard ratio [HR]: 2.59, 95% confidence interval [CI]: 1.80-3.70, p < 0.001) and RFS (hazard ratio [HR]: 2.00, 95% confidence interval [CI]: 1.36-3.00, p < 0.001) of PC after PD. While sarcopenia is recognized as a risk factor for OS (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.08-3.10, p = 0.025) in PC patients based on the Fujiwara criteria, it is not found to be associated with RFS (hazard ratio [HR]: 1.60, 95% confidence interval [CI]: 0.90-3.00, p = 0.10). The model based on sarcopenia and clinical characteristics has high predictive ability for OS and RFS. Conclusion Various Asian diagnostic criteria do not link sarcopenia with postoperative complications in PC patients after PD. Nevertheless, sarcopenia remains a significant independent risk factor for long-term survival, and its combination with clinical characteristics can aid clinicians in predicting long-term survival outcomes.
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Affiliation(s)
- Guangzhen Qu
- Department of Interventional Radiology, Beijing Chao-Yang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Chuanguo Zhou
- Department of Interventional Radiology, Beijing Chao-Yang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Yong Zhang
- Department of Interventional Radiology, Beijing Chao-Yang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Shao-Cheng Lyu
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Ren Lang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing, China
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Pecchi A, Valoriani F, Cuoghi Costantini R, Squecco D, Spallanzani A, D’Amico R, Dominici M, Di Benedetto F, Torricelli P, Menozzi R. Role of Body Composition in Patients with Resectable Pancreatic Cancer. Nutrients 2024; 16:1834. [PMID: 38931189 PMCID: PMC11206463 DOI: 10.3390/nu16121834] [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: 05/03/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
This study investigates the role of body composition parameters in patients with pancreatic cancer undergoing surgical treatment. The research involved 88 patients diagnosed with pancreatic cancer who underwent surgery at the Modena Cancer Center between June 2015 and October 2023. Body composition parameters were obtained from CT scans performed before and after surgery. The percentage of sarcopenic patients at the time of diagnosis of pancreatic cancer is 56.82%. Of the patients who died between the first and second CT evaluated, 58% were sarcopenic, thus confirming the role of sarcopenia on outcome. The study found that all body composition parameters (TAMA, SMI, VFI, and SFI) demonstrated a trend towards reduction between two examinations, indicating an overall depletion in muscle and adipose tissue. We then evaluated the relationships between fat-related parameters (VFI, SFI and VSR) and survival outcomes: overall survival and progression-free survival. Cox univariate regression model show significant parameter related to outcomes was adipose tissue, specifically VFI. The study found that higher VFI levels were associated with greater survival rates. This research holds promise for advancing our understanding of the link between body composition and the prognosis of pancreatic cancer patients.
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Affiliation(s)
- Annarita Pecchi
- Radiology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (D.S.); (P.T.)
| | - Filippo Valoriani
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, Modena University Hospital, 41124 Modena, Italy; (F.V.); (R.M.)
| | | | - Denise Squecco
- Radiology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (D.S.); (P.T.)
| | - Andrea Spallanzani
- Oncology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.S.); (M.D.)
| | - Roberto D’Amico
- Unit of Clinical Statistics, University Hospital of Modena, 41124 Modena, Italy; (R.C.C.); (R.D.)
| | - Massimo Dominici
- Oncology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.S.); (M.D.)
| | - Fabrizio Di Benedetto
- Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Pietro Torricelli
- Radiology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (D.S.); (P.T.)
| | - Renata Menozzi
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, Modena University Hospital, 41124 Modena, Italy; (F.V.); (R.M.)
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Praveen AD, Sollmann N, Baum T, Ferguson SJ, Benedikt H. CT image-based biomarkers for opportunistic screening of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 2024; 35:971-996. [PMID: 38353706 PMCID: PMC11136833 DOI: 10.1007/s00198-024-07029-0] [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: 09/17/2023] [Accepted: 01/19/2024] [Indexed: 05/30/2024]
Abstract
The use of opportunistic computed tomography (CT) image-based biomarkers may be a low-cost strategy for screening older individuals at high risk for osteoporotic fractures and populations that are not sufficiently targeted. This review aimed to assess the discriminative ability of image-based biomarkers derived from existing clinical routine CT scans for hip, vertebral, and major osteoporotic fracture prediction. A systematic search in PubMed MEDLINE, Embase, Cochrane, and Web of Science was conducted from the earliest indexing date until July 2023. The evaluation of study quality was carried out using a modified Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) checklist. The primary outcome of interest was the area under the curve (AUC) and its corresponding 95% confidence intervals (CIs) obtained for four main categories of biomarkers: areal bone mineral density (BMD), image attenuation, volumetric BMD, and finite element (FE)-derived biomarkers. The meta-analyses were performed using random effects models. Sixty-one studies were included in this review, among which 35 were synthesized in a meta-analysis and the remaining articles were qualitatively synthesized. In comparison to the pooled AUC of areal BMD (0.73 [95% CI 0.71-0.75]), the pooled AUC values for predicting osteoporotic fractures for FE-derived parameters (0.77 [95% CI 0.72-0.81]; p < 0.01) and volumetric BMD (0.76 [95% CI 0.71-0.81]; p < 0.01) were significantly higher, but there was no significant difference with the pooled AUC for image attenuation (0.73 [95% CI 0.66-0.79]; p = 0.93). Compared to areal BMD, volumetric BMD and FE-derived parameters may provide a significant improvement in the discrimination of osteoporotic fractures using opportunistic CT assessments.
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Affiliation(s)
- Anitha D Praveen
- Early Detection of Health Risks and Prevention, Future Health Technologies, Singapore-ETH Centre (SEC), Campus for Research Excellence and Technological Enterprise (CREATE), 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore.
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephen J Ferguson
- Early Detection of Health Risks and Prevention, Future Health Technologies, Singapore-ETH Centre (SEC), Campus for Research Excellence and Technological Enterprise (CREATE), 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore
- Institute for Biomechanics, ETH-Zurich, Zurich, Switzerland
| | - Helgason Benedikt
- Early Detection of Health Risks and Prevention, Future Health Technologies, Singapore-ETH Centre (SEC), Campus for Research Excellence and Technological Enterprise (CREATE), 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore
- Institute for Biomechanics, ETH-Zurich, Zurich, Switzerland
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Akar B, Calik BB, Kabul EG, Akbaş ANB, Cobankara V. Examining the presence of sarcopenia in women with rheumatoid arthritis: Case-control study. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:150-159. [PMID: 38153879 DOI: 10.2478/rjim-2023-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION The aim of this study was to compare the frequency of sarcopenia, functional status, fear-avoidance behaviors, biopsychosocial status and quality of life in RA women with healthy controls. METHODS 25 RA women and 25 healthy women were included in the study. Definition of sarcopenia was assessed using parameters recommended by the European Working Group on Sarcopenia (EWGSOP): Bioimpedance analysis for muscle mass (body fat ratio, skeletal muscle mass, skeletal muscle mass index); grip and knee extension strength for muscle strength and 4-m course gait speed test for physical performance was applied. Functional status was evaluated with the Health Assessment Questionnaire (HAQ), fear-avoidance behaviors with the Tampa Kinesiophobia Scale (TKS), biopsychosocial status with the Biopsychosocial Questionnaire (BETY-BQ), and quality of life with Short Form-36 (SF-36). RESULTS While none of the healthy women had sarcopenia, severe sarcopenia was detected in 7 (28%) of the women with RA. When RA and healthy groups were compared; skeletal muscle mass (p: 0,004); skeletal muscle mass index (p: 0,011); grip strength-right (p:0.001) and left (p:0.001); knee extension strength-right (p:0.001) and left (p:0.001), 4-m course gait speed test (p:0.001), HAQ (p:0.001), TKS (p:0.001), BETY-BQ (p:0.001), SF-36 physical (p:0.001) ve mental component (p:0.001) results were significant in favor of the healthy group while there was no difference in body fat ratio (p>0.05). CONCLUSION In women with RA, the frequency of sarcopenia is higher, and functional status, fear-avoidance behaviors, biopsychosocial status and quality of life are worse than healthy.
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Affiliation(s)
- Begum Akar
- 1Faculty of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Bilge Basakci Calik
- 1Faculty of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Elif Gur Kabul
- 2Faculty of Health Sciences, Physiotherapy and Rehabilitation, Usak University, Usak, Turkey
| | | | - Veli Cobankara
- 3Department of Rheumatology, Medical Faculty, Pamukkale University, Denizli, Turkey
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Phillips ME, Robertson MD, Bennett-Eastley K, Rowe L, Frampton AE, Hart KH. Standard Nutritional Assessment Tools Are Unable to Predict Loss of Muscle Mass in Patients Due to Undergo Pancreatico-Duodenectomy: Highlighting the Need for Detailed Nutritional Assessment. Nutrients 2024; 16:1269. [PMID: 38732516 PMCID: PMC11085118 DOI: 10.3390/nu16091269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND AND METHODS Pancreatico-duodenectomy (PD) carries significant morbidity and mortality, with very few modifiable risk factors. Radiological evidence of sarcopenia is associated with poor outcomes. This retrospective study aimed to analyse the relationship between easy-to-use bedside nutritional assessment techniques and radiological markers of muscle loss to identify those patients most likely to benefit from prehabilitation. RESULTS Data were available in 184 consecutive patients undergoing PD. Malnutrition was present in 33-71%, and 48% had a high visceral fat-to-skeletal muscle ratio, suggestive of sarcopenic obesity (SO). Surgical risk was higher in patients with obesity (OR 1.07, 95%CI 1.01-1.14, p = 0.031), and length of stay was 5 days longer in those with SO (p = 0.006). There was no correlation between skeletal muscle and malnutrition using percentage weight loss or the malnutrition universal screening tool (MUST), but a weak correlation between the highest hand grip strength (HGS; 0.468, p < 0.001) and the Global Leadership in Malnutrition (GLIM) criteria (-0.379, p < 0.001). CONCLUSIONS Nutritional assessment tools give widely variable results. Further research is needed to identify patients at significant nutritional risk prior to PD. In the meantime, those with malnutrition (according to the GLIM criteria), obesity or low HGS should be referred to prehabilitation.
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Affiliation(s)
- Mary E. Phillips
- Department of Nutrition and Dietetics, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - M. Denise Robertson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Kate Bennett-Eastley
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Lily Rowe
- Department of Nutrition and Dietetics, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
| | - Adam E. Frampton
- Department of Nutrition and Dietetics, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
- HPB Surgical Unit, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
- Section of Oncology, Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford GU2 7XH, UK
| | - Kathryn H. Hart
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
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Linder N, Denecke T, Busse H. Body composition analysis by radiological imaging - methods, applications, and prospects. ROFO-FORTSCHR RONTG 2024. [PMID: 38569516 DOI: 10.1055/a-2263-1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND This review discusses the quantitative assessment of tissue composition in the human body (body composition, BC) using radiological methods. Such analyses are gaining importance, in particular, for oncological and metabolic problems. The aim is to present the different methods and definitions in this field to a radiological readership in order to facilitate application and dissemination of BC methods. The main focus is on radiological cross-sectional imaging. METHODS The review is based on a recent literature search in the US National Library of Medicine catalog (pubmed.gov) using appropriate search terms (body composition, obesity, sarcopenia, osteopenia in conjunction with imaging and radiology, respectively), as well as our own work and experience, particularly with MRI- and CT-based analyses of abdominal fat compartments and muscle groups. RESULTS AND CONCLUSION Key post-processing methods such as segmentation of tomographic datasets are now well established and used in numerous clinical disciplines, including bariatric surgery. Validated reference values are required for a reliable assessment of radiological measures, such as fatty liver or muscle. Artificial intelligence approaches (deep learning) already enable the automated segmentation of different tissues and compartments so that the extensive datasets can be processed in a time-efficient manner - in the case of so-called opportunistic screening, even retrospectively from diagnostic examinations. The availability of analysis tools and suitable datasets for AI training is considered a limitation. KEY POINTS · Radiological imaging methods are increasingly used to determine body composition (BC).. · BC parameters are usually quantitative and well reproducible.. · CT image data from routine clinical examinations can be used retrospectively for BC analysis.. · Prospectively, MRI examinations can be used to determine organ-specific BC parameters.. · Automated and in-depth analysis methods (deep learning or radiomics) appear to become important in the future.. CITATION FORMAT · Linder N, Denecke T, Busse H. Body composition analysis by radiological imaging - methods, applications, and prospects. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2263-1501.
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Affiliation(s)
- Nicolas Linder
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Leipzig, Germany
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Sankt Gallen, Switzerland
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Leipzig, Germany
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Voulgaridou G, Tyrovolas S, Detopoulou P, Tsoumana D, Drakaki M, Apostolou T, Chatziprodromidou IP, Papandreou D, Giaginis C, Papadopoulou SK. Diagnostic Criteria and Measurement Techniques of Sarcopenia: A Critical Evaluation of the Up-to-Date Evidence. Nutrients 2024; 16:436. [PMID: 38337720 PMCID: PMC10856900 DOI: 10.3390/nu16030436] [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: 01/02/2024] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Sarcopenia, a geriatric syndrome characterized by progressive skeletal muscle mass and function decline, poses a significant health risk among the elderly, contributing to frailty, falls, hospitalization, loss of independence and mortality. The prevalence of sarcopenia varies significantly based on various factors, such as living status, demographics, measurement techniques and diagnostic criteria. Although the overall prevalence is reported at 10% in individuals aged 60 and above, disparities exist across settings, with higher rates in nursing homes and hospitals. Additionally, the differences in prevalence between Asian and non-Asian countries highlight the impact of cultural and ethnic factors, and variations in diagnostic criteria, cut-off values and assessment methods contribute to the observed heterogeneity in reported rates. This review outlines diverse diagnostic criteria and several measurement techniques supporting decision making in clinical practice. Moreover, it facilitates the selection of appropriate tools to assess sarcopenia, emphasizing its multifactorial nature. Various scientific groups, including the European Working Group of Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS), the Asian Working Group on Sarcopenia (AWGS), the American Foundation for the National Institutes of Health (FNIH) and the Sarcopenia Definition and Outcomes Consortium (SDOC), have published consensus papers outlining diverse definitions of sarcopenia. The choice of diagnostic criteria should be aligned with the specific objectives of the study or clinical practice, considering the characteristics of the study population and available resources.
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Affiliation(s)
- Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (G.V.); (D.T.); (M.D.)
| | - Stefanos Tyrovolas
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA;
- WHOCC Centre for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
| | - Paraskevi Detopoulou
- Department of Clinical Nutrition, General Hospital Korgialenio Benakio, Athanassaki 2, 11526 Athens, Greece
| | - Despoina Tsoumana
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (G.V.); (D.T.); (M.D.)
| | - Mariella Drakaki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (G.V.); (D.T.); (M.D.)
| | - Thomas Apostolou
- Department of Physiotherapy, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece;
| | | | - Dimitrios Papandreou
- Department of Clinical Nutrition & Dietetics, College of Health, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates;
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece;
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (G.V.); (D.T.); (M.D.)
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Rahal L. Skeletal muscle mass or appendicular muscle mass? That is the question. Eur J Clin Nutr 2024:10.1038/s41430-023-01397-2. [PMID: 38182753 DOI: 10.1038/s41430-023-01397-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Lotfi Rahal
- Faculty of Medicine, Tahri Mohamed University, Bechar, 08000, Algeria.
- Department of clinical physiology and functional explorations, Public Hospital Establishment, Bechar, 08000, Algeria.
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