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Kim HS, Kim H, Kim S, Cha Y, Kim JT, Kim JW, Ha YC, Yoo JI. Precise individual muscle segmentation in whole thigh CT scans for sarcopenia assessment using U-net transformer. Sci Rep 2024; 14:3301. [PMID: 38331977 PMCID: PMC10853213 DOI: 10.1038/s41598-024-53707-8] [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: 07/19/2023] [Accepted: 02/04/2024] [Indexed: 02/10/2024] Open
Abstract
The study aims to develop a deep learning based automatic segmentation approach using the UNETR(U-net Transformer) architecture to quantify the volume of individual thigh muscles(27 muscles in 5 groups) for Sarcopenia assessment. By automating the segmentation process, this approach improves the efficiency and accuracy of muscle volume calculation, facilitating a comprehensive understanding of muscle composition and its relationship to Sarcopenia. The study utilized a dataset of 72 whole thigh CT scans from hip fracture patients, annotated by two radiologists. The UNETR model was trained to perform precise voxel-level segmentation and various metrics such as dice score, average symmetric surface distance, volume correlation, relative absolute volume difference and Hausdorff distance were employed to evaluate the model's performance. Additionally, the correlation between Sarcopenia and individual thigh muscle volumes was examined. The proposed model demonstrated superior segmentation performance compared to the baseline model, achieving higher dice scores (DC = 0.84) and lower average symmetric surface distances (ASSD = 1.4191 ± 0.91). The volume correlation between Sarcopenia and individual thigh muscles in the male group. Furthermore, the correlation analysis of grouped thigh muscles also showed negative associations with Sarcopenia in the male participants. This thesis presents a deep learning based automatic segmentation approach for quantifying individual thigh muscle volume in sarcopenia assessment. The results highlights the associations between Sarcopenia and specific individual muscles as well as grouped thigh muscle regions, particularly in males. The proposed method improves the efficiency and accuracy of muscle volume calculation, contributing to a comprehensive evaluation of Sarcopenia. This research enhances our understanding of muscle composition and performance, providing valuable insights for effective interventions in Sarcopenia management.
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Affiliation(s)
- Hyeon Su Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon, South Korea.
| | - Hyunbin Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon, South Korea
| | - Shinjune Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Daejeon, South Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Seoul, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, South Korea
| | - Jun-Il Yoo
- Department of Orthopedic Surgery, School of Medicine, Inha University Hospital, Incheon, South Korea.
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Noda M, Takahara S, Inui A, Oe K, Osawa S, Matsushita T. Comparative Study of Different Entry Spots on Postoperative Gluteus Medius Muscle Cross-Sectional Area in Patients With Intertrochanteric Fractures Nailing. Cureus 2023; 15:e36103. [PMID: 37065393 PMCID: PMC10097852 DOI: 10.7759/cureus.36103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/15/2023] Open
Abstract
Introduction In a preliminary study of cephalo-medullary (CM) nailing in patients with femoral intertrochanteric fractures, the authors of this study found a 25% to 30% decrease in muscle strength, especially abduction force, during the postoperative follow-up period. This decline was partially attributed to the entry point for the nail insertion causing damage to the gluteus medius tendon at the junction of the greater trochanter after reaming. Therefore, we assumed that changing the position of nail insertion to a "bald spot (BS)" could mitigate postoperative functional impairment. Automated computed tomography (CT) imaging of skeletal muscle cross-sectional area (CSA) and adipose tissue ratio (ATR) can show pathological changes on the operated side compared with the non-operated side. In this study, the authors quantified the difference in postoperative CSA and ATR of the gluteus medius muscle after bald spot nailing versus nail insertion through the conventional tip of the greater trochanter. It was hypothesized that bald spot nailing could avoid significant injury to the gluteus medius muscle. Materials and methods Patients with femoral intertrochanteric fractures were grouped according to the site of cephalo-medullary nailing: greater trochanteric tip (TIP) in 27 patients (8 men and 19 women, mean age 84.9±5.1 years) and BS in 16 patients (3 men and 13 women, mean age 86.9±6.2 years). The CSA and ATR of the gluteus medius muscles were assessed in three slices (A, B, and C from proximal to distal). Each slice was manually traced and automatically calculated based on its contour. Adipose tissue (-100 to -50 in Hounsfield units) in the designated area was distinguished by a bimodal image histogram resulting from the distribution of CT numbers of adipose tissue and muscle. The body mass index (BMI) was used to correct the CSA in each patient. Results In the TIP group, the mean CSA values (mm2) from the non-operated/operated sides were as follows: slice A, 2180.2 ± 616.5/1976.3 ± 421.2; slice B, 2112.3 ± 535.7/1857.7 ± 386.7; and slice C: 1671.8 ± 460.0/1404.1 ± 404.3 (p<0.01 in slices A, B, and C). In the BS group, slice A was 2044.1 ± 473.0/2016.9 ± 388.4; slice B was 2073.2 ± 540.7/1848.3 ± 411.1; and slice C was 1659.1 ± 477.2/1468.5 ± 341.7 (p=0.34 in slice A, and p<0.05 in slices B and C, respectively). The mean CSA values (mm2) of the non-operated minus operated side between the TIP/BS groups were as follows: slice A, 241.3 ± 424.3/-11.8 ± 285.6; slice B, 290.3 ± 313.0/211.8 ± 333.2; and slice C, 276.4 ± 270.4/162.8 ± 319.3 (p < 0.05 in slice A, 0.45, 0.24 in slices B, C, respectively). The mean adjusted CSA per BMI values (mm2) of the non-operated minus the operated side between the TIP/BS groups were slice A, 10.6 ± 19.7/-0.4 ± 14.8; slice B, 13.3 ± 15.0/10.1 ± 16.3; and slice C, 13.1 ± 13.4/ 8.7 ± 15.3 (p < 0.05 in slice A and 0.54 and 0.36 in slices B and C, respectively). Conclusion Nail insertion at the bald spot resulted in a significantly smaller decrease in the CSA of the gluteus medius muscle compared with the conventional tip entry. In addition, an examination of BMI-adjusted CSA showed that CSA was maintained in some image slices. These results suggest that nailing from the BS of the greater trochanter can reduce damage to the gluteus medius muscle and highlight the importance of imaging beyond the usual assessment of skeletal changes.
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Eastlack M, Miller RR, Hicks GE, Gruber-Baldini A, Orwig DL, Magaziner J, Ryan AS. Thigh Muscle Composition and Its Relationship to Functional Recovery Post Hip Fracture Over Time and Between Sexes. J Gerontol A Biol Sci Med Sci 2022; 77:2445-2452. [PMID: 35580856 PMCID: PMC9799201 DOI: 10.1093/gerona/glac112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Computed tomography (CT)-scan measures of muscle composition may be associated with recovery post hip fracture. METHODS In an ancillary study to Baltimore Hip Studies Seventh cohort, older adults were evaluated at 2 and 6 months post hip fracture. CT-scan measures of muscle were acquired at 2 months. Short Physical Performance Battery (SPPB) was measured at 2 and 6 months. Generalized estimating equations were used to model the association of muscle measures and physical function, adjusting for age, sex, body mass index, and time postfracture. RESULTS Seventy-one older adults (52% males, age 79.6 ± 7.3 years) were included. At 2-months, males had greater thigh cross-sectional area (CSA, p < .0001) and less low-density muscle (p = .047), and intermuscular adipose tissue (p = .007) than females on the side of the fracture, while females performed better on the SPPB (p = .05). Muscle measures on the fractured side were associated with function at 2 months in both sexes. Participants with the lowest tertile of muscle CSA difference at 2-months, indicating greater symmetry in CSA between limbs, performed better than the other 2 tertiles at 6-months. Males performed worse in functional measures at baseline and did not recover as well as females (p = .02). CONCLUSION CT-scan measures of muscle CSA and fatty infiltration were associated with function at 2-months post hip fracture and with improvement in function by 6 months. Observed sex differences in these associations suggest that rehabilitation strategies may need to be adapted by sex after hip fracture.
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Affiliation(s)
- Marty Eastlack
- Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Ram R Miller
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - Gregory E Hicks
- STAR Health Sciences Complex Campus, University of Delaware, Newark, Delaware, USA
| | - Ann Gruber-Baldini
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Denise L Orwig
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jay Magaziner
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alice S Ryan
- Division of Gerontology and Palliative Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Takahiro F, Shigeharu T. Skeletal muscle tissue composition ratio in patients with hip fracture: Comparison of fractured side and non-fractured side. J Back Musculoskelet Rehabil 2022; 36:669-676. [PMID: 36530078 DOI: 10.3233/bmr-220083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The extent of asymmetry in the muscle tissue composition ratios with hip fractures has not been clarified. OBJECTIVE To determine whether there is a difference in the muscle tissue composition ratios between the fractured and non-fractured sides of the trunk and thighs immediate measurement. METHODS Forty-four patients (84.6 ± 7.0 years) were included. Computed tomography images were used for measurements. The muscle tissue composition ratio was measured using muscle cross-sectional area (CSA) and attenuation coefficient (Hounsfield units; HU). Defined each HU attenuation range as follows: low-density muscle (LDM), low-quality muscle tissue with fat infiltration, normal-density muscle (NDM), muscle contractor tissue, and intramuscular adipose tissue (IMAT), fat infiltration tissue. The CSA of each muscle tissue was expressed as a percentage: %LDM, %NDM, and %IMAT. A paired t-test was performed for comparison. RESULTS The %LDM on the fractured side was higher in the thigh and erector spinae. The %NDM on the fractured side was lower in the thigh. There was no significant difference in the %IMAT for all muscles. CONCLUSION The thigh on the fractured side showed asymmetry with low %NDM and high %LDM. This characteristic captures a characteristic of muscle tissue that may have importance in hip fracture etiology.
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Affiliation(s)
| | - Tanaka Shigeharu
- Division of Physical Therapy, School of Rehabilitation, Kanagawa University of Human Services, Kanagawa, Japan
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Overgaard JA, Kallemose T, Mangione KK, Kristensen MT. Six Versus 12 Weeks of Outpatient Physical Therapy Including Progressive Resistance Training in Cognitively Intact Older Adults After Hip Fracture: A Multicenter Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2021; 77:1455-1462. [PMID: 34460897 DOI: 10.1093/gerona/glab256] [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: 01/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recovery of function and regaining muscle strength is challenging after hip fracture. We compared the effectiveness of a 12 versus 6-weeks outpatient physical therapy program with progressive resistive training (PRT) to increase strength and physical performance. METHODS This parallel, superiority, 2-group randomized controlled trial was conducted in 4 clinics enrolled community-dwelling, cognitively intact older adults (+60 years) with a surgical repair of a hip fracture and no major medical conditions. Participants received 12 or 6-weeks of PRT and standardized physical therapy, twice weekly. Pain was monitored throughout. Primary outcome was the change in the 6-minute walk test (6MWT) from baseline to 12-weeks follow-up. Randomization via a computer-generated allocation sequence was implemented using sealed, sequentially numbered opaque envelopes and assessors were blinded to group assignment. RESULTS Participants (81% women) with a mean (SD) age of 77 (8.1) years were enrolled at an average of 18 days post-hip fracture surgery and randomized into a 12-week group (n=50) or a 6-week group (n=50). A mean (SD) change score in the 6MWT of 143.8 (81.1) and 161.5 (84.1) meters found in the 12 and 6-week group, respectively (both exceeding the minimal clinically important difference of 55 meters). The mean between-group difference was -17.7 (95%CI -50.1, 14.8) meter. Pain during training did not exceed moderate levels nor increase as training intensity increased. CONCLUSION Twelve weeks of physical therapy with PRT was not superior to 6-weeks in improving walking distance. Hip fracture-related pain was relatively low and indicated strength testing and training was well tolerated.
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Affiliation(s)
- Jan Arnholtz Overgaard
- Department of Rehabilitation, Lolland Municipality, Maribo, Denmark.,Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Amager-Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | | | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen, Denmark.,Departments of Physical Therapy and Orthopedic Surgery, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Noda M, Saegusa Y, Takahashi M, Takada Y, Fujita M, Shinohara I. Decreased postoperative gluteus medius muscle cross-sectional area measured by computed tomography scan in patients with intertrochanteric fractures nailing. J Orthop Surg (Hong Kong) 2018; 25:2309499017727943. [PMID: 28920547 DOI: 10.1177/2309499017727943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In patients with femoral intertrochanteric fractures treated by cephalomedullary (CM) nailing, abduction force reportedly decreased by 25-30% during the postoperative follow-up period. The purpose of the current study is to evaluate the cross-sectional area (CSA) and adipose tissue ratio (ATR) of the gluteus medius muscle on the postoperative computed tomography (CT) view, expecting this graphic study will support clinical results. MATERIALS AND METHODS A total of 27 patients with femoral intertrochanteric fractures treated by CM femoral nail implants completed the study. The mean age at osteosynthesis was 83 years (range: 72-94 years). The mean postoperative follow-up period was 23 months. The three CT axial slice views were defined as slices A, B, and C corresponding to proximal, midway, and distal part of gluteus medius, respectively. The CSA and ATR were assessed bilaterally. RESULTS The mean and standard deviation of CSA values (mm2) between the nonoperated/ operated side were as follows: slice A: 2225.8 ± 621.2/1984.5 ± 425.8; slice B: 2145.1 ± 538.3/1854.9 ± 383.9; and slice C: 1711.0 ± 459.0/1434.5 ± 396.9 ( p < 0.01 in slices A, B, and C). The mean and standard deviation of ATR values (%) from the nonoperative/ operative side were as follows: slice A: 2.8 ± 1.7/5.2 ± 3.5; slice B: 2.7 ± 1.9/4.6 ± 3.2; and slice C: 3.6 ± 3.0/4.8 ± 3.2 ( p < 0.01 in slices A and B and p < 0.05 in slice C). CONCLUSION Our image findings documented that gluteus medius is significantly changed in CSA and ATR. The damage possibly triggers decrease in muscular strength of hip abduction in the postoperative follow-up period. This measurement is objective, and needed no patient's endurance and cooperation.
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Affiliation(s)
- Mitsuaki Noda
- Department of Orthopedics, Konan Hospital, Kobe City, Japan
| | | | | | - Yuma Takada
- Department of Orthopedics, Konan Hospital, Kobe City, Japan
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Foresto CS, Paula-Gomes S, Silveira WA, Graça FA, Kettelhut IDC, Gonçalves DAP, Mattiello-Sverzut AC. Morphological and molecular aspects of immobilization-induced muscle atrophy in rats at different stages of postnatal development: the role of autophagy. J Appl Physiol (1985) 2016; 121:646-60. [PMID: 27445301 DOI: 10.1152/japplphysiol.00687.2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 07/19/2016] [Indexed: 01/07/2023] Open
Abstract
Muscle loss occurs following injury and immobilization in adulthood and childhood, which impairs the rehabilitation process; however, far fewer studies have been conducted analyzing atrophic response in infants. This work investigated first the morphological and molecular mechanisms involved in immobilization-induced atrophy in soleus muscles from rats at different stages of postnatal development [i.e., weanling (WR) and adult (AR) rats] and, second, the role of autophagy in regulating muscle plasticity during immobilization. Hindlimb immobilization for 10 days reduced muscle mass and fiber cross-sectional area, with more pronounced atrophy in WR, and induced slow-to-fast fiber switching. These effects were accompanied by a decrease in markers of protein synthesis and an increase in autophagy. The ubiquitin (Ub)-ligase MuRF1 and the ubiquitinated proteins were upregulated by immobilization in AR while the autolyzed form of μ-calpain was increased in WR. To further explore the role of autophagy in muscle abnormalities, AR were concomitantly immobilized and treated with colchicine, which blocks autophagosome-lysosome fusion. Colchicine-treated immobilized muscles had exacerbated atrophy and presented degenerative features. Despite Igf1/Akt signaling was downregulated in immobilized muscles from both age groups, Foxo1 and 4 phosphorylation was increased in WR. In the same group of animals, Foxo1 acetylation and Foxo1 and 4 content was increased and decreased, respectively. Our data show that muscle disorders induced by 10-day-immobilization occur in both age-dependent and -independent manners, an understanding that may optimize treatment outcomes in infants. We also provide further evidence that the strong inhibition of autophagy may be ineffective for treating muscle atrophy.
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Affiliation(s)
- Camila Silva Foresto
- Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Sílvia Paula-Gomes
- Department of Biochemistry/Immunology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Wilian Assis Silveira
- Department of Physiology Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; and
| | - Flávia Aparecida Graça
- Department of Physiology Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; and
| | - Isis do Carmo Kettelhut
- Department of Physiology Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; and Department of Biochemistry/Immunology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Dawit Albieiro Pinheiro Gonçalves
- Department of Physiology Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; and Department of Biochemistry/Immunology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ana Claudia Mattiello-Sverzut
- Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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