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Brath MSG, Sahakyan M, Mark EB, Rasmussen HH, Østergaard LR, Frøkjær JB, Weinreich UM, Jørgensen ME. Ethnic differences in CT derived abdominal body composition measures: a comparative retrospect pilot study between European and Inuit study population. Int J Circumpolar Health 2024; 83:2312663. [PMID: 38314517 PMCID: PMC10846476 DOI: 10.1080/22423982.2024.2312663] [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: 11/09/2023] [Accepted: 01/28/2024] [Indexed: 02/06/2024] Open
Abstract
Understanding ethnic variations in body composition is crucial for assessing health risks. Universal models may not suit all ethnicities, and there is limited data on the Inuit population. This study aimed to compare body composition between Inuit and European adults using computed tomography (CT) scans and to investigate the influence of demographics on these measurements. A retrospective analysis was conducted on 50 adults (29 Inuit and 21 European) who underwent standard trauma CT scans. Measurements focused on skeletal muscle index (SMI), various fat indices, and densities at the third lumbar vertebra level, analyzed using the Wilcoxon-Mann-Whitney test and multiple linear regression. Inuit women showed larger fat tissue indices and lower muscle and fat densities than European women. Differences in men were less pronouncehd, with only Intramuscular fat density being lower among Inuit men. Regression indicated that SMI was higher among men, and skeletal muscle density decreased with Inuit ethnicity and age, while visceral fat index was positively associated with age. This study suggests ethnic differences in body composition measures particularly among women, and indicates the need for Inuit-specific body composition models. It higlights the importance of further research into Inuit-specific body composition measurements for better health risk assessment.
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Affiliation(s)
- Mia Solholt Godthaab Brath
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
- Respiratory Research Aalborg, Reaal, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marina Sahakyan
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Esben Bolvig Mark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department. of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Højgaard Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Danish Nutrition Science Center, Department. of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Center for Nutrition and Intestinal Failure, Department. of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Lasse Riis Østergaard
- Medical Informatics group, Department. of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
- Respiratory Research Aalborg, Reaal, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
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Brath MSG, Kristensen SV, Sahakyan M, Mark EB, Rasmussen HH, Østergaard LR, Frøkjær JB, Weinreich UM. Influence of weight-adjusted contrast enhancement on computed tomography-derived skeletal muscle measures: a retrospective proof-of-concept comparative study between Danish females and males. Am J Clin Nutr 2024:S0002-9165(24)00578-1. [PMID: 38936776 DOI: 10.1016/j.ajcnut.2024.06.009] [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: 09/15/2023] [Revised: 05/31/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Computed tomography (CT) has an underutilized potential for evaluating body composition in clinical settings. Often conducted with intravenous contrast (IVC), CT scans yield unused body composition data due to unclear effects on skeletal muscle area (SMA), skeletal muscle index (SMI), and muscle density (SMD). OBJECTIVES This study investigates whether weight-adjusted IVC influences SMA, SMI, and SMD differently in females and males compared with noncontrast abdominal CT. In addition, the study explores associations between contrast and noncontrast-assessed SMA, SMI, SMD, and demographic factors. METHODS A comparative observational retrospective study was conducted on Danish patients who underwent consecutive 4-phased contrast-enhanced abdominal CT scans (noncontrast, arterial, venous, and late venous phases). Muscle measures were evaluated using validated semiautomated threshold-based software by 3 independent raters. RESULTS The study included 72 patients (51 males and 21 females) with a mean age of 59 (55 and 62) y. Weight-adjusted IVC increased SMA by ≤3.28 cm2 (95% confidence interval [CI]: 2.58, 3.98) corresponding to 2.4% (1.8, 2.9) in the late venous phase compared with noncontrast CT. Analysis between sexes showed no difference in the effects of IVC on SMA and SMI between females and males. However, females exhibited a higher increase in SMD during the venous by a mean of 1.7 HU (0.9; 2.5) and late venous phases with a mean HU of 1.80 (1.0; 2.6) compared with males. Multivariate regression analysis indicated an association between the differences in SMD and sex during venous (-1.38, 95% CI: -2.48, -0.48) and late venous phases (-1.23, 95% CI: -2.27, -0.19). CONCLUSIONS Weight-adjusted IVC leads to increased SMA, SMI, and SMD. Although SMA and SMI differences were consistent across the sexes, females exhibited a significantly higher SMD increase than males in the venous and late venous phases. Further investigations are necessary to determine the applicability of SMD as a muscle quality proxy in IVC CT scans.
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Affiliation(s)
- Mia Solholt Godthaab Brath
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark; Research Unit of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Sebastian Villesen Kristensen
- Institute of Regional Health Research, Southern Danish University, Odense, Denmark; Department of Radiology, Lillebaelt Hospital, University Hospitals of Southern Denmark, Kolding, Denmark
| | - Marina Sahakyan
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Esben Bolvig Mark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Højgaard Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Danish Nutrition Science Center, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Center for Nutrition and Intestinal Failure, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Lasse Riis Østergaard
- Medical Informatics Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark; Research Unit of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Wang S, Wang M, Jiang L, Zhao X. Low skeletal muscle quality extracted from CT is associated with poor outcomes in severe acute pancreatitis patients. Eur J Radiol 2024; 170:111215. [PMID: 38091663 DOI: 10.1016/j.ejrad.2023.111215] [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: 08/14/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To evaluate the association between body composition parameters derived from computed tomography (CT) scans and clinical outcomes in patients with severe acute pancreatitis (AP). METHODS Patients who have been diagnosed AP with a CT scan at ICU admission were included. Body composition parameters were measured on a single slice at L2-3 of the unenhanced CT scans. The intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), skeletal muscle area (SMA) and skeletal muscle density (SMD) were assessed using HUs by image analysis software. Univariable and multivariable analyses were performed to analyze the association between body composition parameters and clinical outcomes including all-cause mortality or prolonged ICU stay. The area under the curve (AUC) of a receiver operating characteristic curve was used to explore the predictive value of the body composition on treatment clinical outcomes. RESULTS A total of 158 patients were included. The IMAT (8.3 cm2 vs 6.0 cm2, P = 0.001) and VAT (190.3 cm2 vs 143.7 cm2, P < 0.001) were significantly higher in the severe AP group than in the moderately severe group, but were notassociatedwithoutcomes. For 1 HU of SMD increased, the risk of poor clinical outcomes decresed 11 % (adjusted OR 0.892, 95 %CI 0.806-0.987, P = 0.026), while an SMD below the median value (32.1 HU for males and 28.5 HU for females) was independently associated with worse outcomes in the multivariable analysis (adjusted OR 8.868, 95 % CI 2.146-36.650, P = 0.003). The SMD had a good predictive ability for clinical outcomes, AUC was 0.824 (95 % CI, 0.715-0.933) for males and 0.803 (95 % CI, 0.639-0.967) for females. CONCLUSION Low SMD was associated with poor outcomes in patients with severe and moderately severe AP and might be used as a novel marker to predict outcomes in patients suffering from severe and moderately severe AP.
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Affiliation(s)
- Shengqi Wang
- Department of Emergency Medicine, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Meiping Wang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, PR China.
| | - Xin Zhao
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, PR China
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Bot D, Klerks S, Leistra E, Tushuizen ME, van Hoek B. Association between skeletal muscle index prior to liver transplantation and 1-year mortality posttransplant. JPEN J Parenter Enteral Nutr 2023; 47:867-877. [PMID: 37070816 DOI: 10.1002/jpen.2508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 03/27/2023] [Accepted: 04/17/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Liver transplantation is the only curative therapy for end-stage liver disease (ESLD). Sarcopenia is often defined as the loss of muscle quantity (skeletal muscle index [SMI]), but muscle attenuation (MA), a surrogate marker of muscle quality, is also decreased in ESLD. We assessed pre-liver transplant SMI and MA and their association with posttransplant mortality, complications, and length of intensive care unit (ICU) and hospital stay. METHODS In 169 consecutive patients with ESLD who underwent a liver transplantation between 2007 and 2014, SMI and MA were measured on computed tomography scans at time of placement on the waiting list for liver transplantation. The primary outcome of interest was 1-year posttransplant mortality. Secondary posttransplantation outcomes of interest were complications within 30 days and length of stay in the ICU > 3 days and in the hospital >3 weeks. Logistic and Cox regression analyses were performed. RESULTS MA was associated with 1-year posttransplant mortality rate (hazard ratio=0.656, 95% CI=0.464-0.921, P = 0.015). The highest quartile of SMI had a lower odds for the total length of stay in the hospital lasting >3 weeks (odds ratio=0.211, 95% CI=0.061-0.733, P = 0.014). MA was associated with a prolonged ICU stay; this was, however, not statistically significant after adjustment for age, sex, and Model for ESLD score. CONCLUSION Lower MA is associated with a longer length of ICU stay and 1-year mortality after liver transplantation, whereas low SMI was associated with a total length of hospital stay.
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Affiliation(s)
- Daphne Bot
- Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzanne Klerks
- Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Eva Leistra
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, LUMC Transplantation Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, LUMC Transplantation Center, Leiden University Medical Center, Leiden, the Netherlands
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Wan SHT, Guldeniz O, Yeung MHY, Cheung JPY, Kwan KYH, Cheung KMC. Inter-screw index as a novel diagnostic indicator of tether breakage. Spine Deform 2023; 11:887-895. [PMID: 37014574 PMCID: PMC10261206 DOI: 10.1007/s43390-023-00679-w] [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: 12/07/2022] [Accepted: 03/11/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Tether breakage is the most common complication of Vertebral Body Tethering (VBT) occurring in up to 52% of Adolescent Idiopathic Scoliosis (AIS) patients and risks continued progression and revision. Radiographical diagnosis of tether breakage is commonly defined by a 5° increase in inter-screw angle and associates breakage with loss of correction. However, the sensitivity of this method was 56% only, suggesting that tethers can break without an increase in angulation, which was supported by other studies. To our knowledge, current literature lacks a method merely focusing on the diagnosis of tether breakage radiographically that does not associate the breakages with loss of correction. METHODS This was a retrospective review of prospectively collected data of AIS patients who underwent VBT. The "inter-screw index" is defined as the percentage increase in inter-screw distance since post-op, with ≥ 13% increase defined as tether breakage as suggested by our mechanical tests. CTs were reviewed to identify the breakages and compared with inter-screw angle and inter-screw index. RESULTS 94 segments from 13 CTs were reviewed, and 15 tether breakages were identified. Use of inter-screw index correctly identified 14 breakages (93%), whereas ≥ 5° increase in inter-screw angle only identified 12 breakages (80%). CONCLUSION Use of inter-screw index is proven to be more sensitive than inter-screw angle in identifying tether breakages. Therefore, we propose the use of inter-screw index to diagnose tether breakages radiographically. Tether breakages were not necessarily accompanied by a loss of segmental correction leading to an increase in inter-screw angle, especially after skeletal maturity. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Sandra H T Wan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ogulcan Guldeniz
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Matthew H Y Yeung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kenny Y H Kwan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kenneth M C Cheung
- Department of Orthopaedic Surgery, HKU-Shenzhen Hospital, Shenzhen, China.
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
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Janiszewski R, Law N, Walters R, DenOtter T. Diagnosing sarcopenia with semi-automated skeletal muscle computed tomography cutoff values and the association of these muscle metrics with long-term physical exercise. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2023; 6:100026. [PMID: 39077548 PMCID: PMC11265184 DOI: 10.1016/j.redii.2023.100026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/13/2023] [Indexed: 07/31/2024]
Affiliation(s)
- Robert Janiszewski
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, 68124, USA
| | - Nathan Law
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, 68124, USA
| | - Ryan Walters
- Creighton University School of Medicine, Department of Clinical Research and Public Health, 2500 California Plaza, Omaha, NE 68178, USA
| | - Tami DenOtter
- Creighton University School of Medicine, Department of Radiology, 7500 Mercy Rd, Omaha, NE 68124, USA
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Brath MSG, Sahakyan M, Mark EB, Frøkjær JB, Rasmussen HH, Østergaard LR, Weinreich UM. Association between thoracic and third lumbar CT-derived muscle mass and density in Caucasian patients without chronic disease: a proof-of-concept study. Eur Radiol Exp 2023; 7:26. [PMID: 37246199 DOI: 10.1186/s41747-023-00340-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/24/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Computed tomography (CT) is increasingly used in the clinical workup, and existing scan contains unused body composition data, potentially useful in a clinical setting. However, there is no healthy reference for contrast-enhanced thoracic CT-derived muscle measures. Therefore, we aimed at investigating whether there is a correlation between each of the thoracic and third lumbar vertebra level (L3) skeletal muscle area (SMA), skeletal muscle index (SMI), and skeletal muscle density (SMD) at contrast-enhanced CT in patients without chronic disease. METHODS A proof-of-concept retrospective observational study was based on Caucasian patients without chronic disease, who received CT for trauma between 2012 and 2014. Muscle measures were assessed using a semiautomated threshold-based software by two raters independently. Pearson's correlation between each thoracic level and third lumbar and intraclass correlation between two raters and test-retest with SMA as proxy parameters were used. RESULTS Twenty-one patients (11 males, 10 females; median age 29 years) were included. The second thoracic vertebra (T2) had the highest median of cumulated SMA (males 314.7 cm2, females 118.5 cm2) and SMI (97.8 cm2/m2 and 70.4 cm2/m2, respectively). The strongest SMA correlation was observed between T5 and L3 (r = 0.970), the SMI between T11 and L3 (r = 0.938), and the SMD between the T10 and L3 (r = 0.890). CONCLUSIONS This study suggests that any of the thoracic levels can be valid to assess skeletal muscle mass. However, the T5 may be most favourable for measuring SMA, the T11 for SMI, and T10 for SMD when using contrast-enhanced thoracic CT. RELEVANCE STATEMENT In COPD patients, a CT-derived thoracic muscle mass assessment may help identify who would benefit from focused pulmonary rehabilitation: thoracic contrast-enhanced CT conducted as part of the standard clinical workup can be used for this evaluation. KEY POINTS • Any thoracic level can be used to assess thoracic muscle mass. • Thoracic level 5 is strongly associated with the 3rd lumbar muscle area. • A strong correlation between the thoracic level 11 and the 3rd lumbar muscle index. • Thoracic level 10 is strongly associated with the 3rd lumbar muscle density.
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Affiliation(s)
- Mia Solholt Godthaab Brath
- Research Unit of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, 9000, Denmark.
| | - Marina Sahakyan
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Esben Bolvig Mark
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Højgaard Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology & Hepatology, Danish Nutrition Science Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Gastroenterology & Hepatology, Center of Nutritional and Intestinal Failure, Aalborg University Hospital, Aalborg, Denmark
| | - Lasse Riis Østergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Medical Informatics Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Research Unit of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, 9000, Denmark
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Ono S, Furuhashi H, Kisaki S, Horiuchi H, Matsui H, Dobashi A, Ojiri H, Sumiyama K. Sarcopenia Is a Prognostic Factor in Patients Undergoing Percutaneous Endoscopic Gastrostomy. J Clin Med 2023; 12:jcm12103360. [PMID: 37240466 DOI: 10.3390/jcm12103360] [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: 02/14/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Percutaneous endoscopic gastrostomy (PEG) is a widely used long-term enteral nutrition method, but little is known about the associated prognostic factors in patients with PEG. Sarcopenia, a condition characterized by a loss of skeletal muscle mass, increases the risk of developing various gastrointestinal disorders. Yet, the relationship between sarcopenia and the prognosis after PEG remains unclear. (2) Methods: We conducted a retrospective study of patients who underwent PEG consecutively from March 2008 to April 2020. We analyzed preoperative sarcopenia and the prognosis of patients after PEG. We defined sarcopenia as a skeletal muscle index at the level of the third lumbar vertebra of ≤29.6 cm2/m2 for women and ≤36.2 cm2/m2 for men. Cross-sectional computed tomography images of skeletal muscle at the level of the third lumbar vertebra were evaluated using DICOM image analysis software (OsiriX). The primary outcome was the difference in overall survival after PEG based on the status of sarcopenia. We also performed a covariate balancing propensity score matching analysis. (3) Results: Of 127 patients (99 men, 28 women), 71 (56%) were diagnosed with sarcopenia, and 64 patients died during the observation period. The median follow-up period did not differ between patients with and without sarcopenia (p = 0.5). The median survival time after PEG was 273 days in patients with sarcopenia and 1133 days in those without (p < 0.001). Cox proportional hazard model analyses identified three factors that were significantly associated with overall survival: sarcopenia (adjusted hazard ratio [HR]: 2.9, 95% confidence interval [CI]: 1.6-5.4, p < 0.001), serum albumin level (adjusted HR: 0.34, 95% CI: 0.21-0.55, p < 0.001) and male sex (adjusted HR: 2.0, 95% CI: 1.1-3.7, p = 0.03). Propensity score-matched analysis (n = 37 vs. 37) showed that the survival rate was lower in the sarcopenia group than in the non-sarcopenia group (at 90 days: 77% (95% CI, 59-88) vs. 92% (76-97), at 180 days: 56% (38-71) vs. 92% (76-97), and at one year: 35% (19-51) vs. 81% (63-91), p = 0.0014). (4) Conclusions: Sarcopenia was associated with poor prognosis in patients having undergone PEG.
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Affiliation(s)
- Shingo Ono
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroto Furuhashi
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Shunsuke Kisaki
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hideka Horiuchi
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroaki Matsui
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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Tsai PS, Lin DC, Jan YT, Liu YP, Wu TH, Huang SC. Lower-extremity muscle wasting in patients with peripheral arterial disease: quantitative measurement and evaluation with CT. Eur Radiol 2022; 33:4063-4072. [PMID: 36580096 DOI: 10.1007/s00330-022-09356-4] [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: 09/07/2022] [Revised: 11/11/2022] [Accepted: 11/30/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Lower-extremity peripheral arterial disease (PAD) results in limb ischemia and is strongly associated with sarcopenia. This study aimed to retrospectively evaluate the association between the quantity of muscle mass in the lower extremities and the severity of vascular stenosis in PAD patients. METHODS Between January 2018 and August 2021, 128 patients with PAD and 53 individuals without PAD, diagnosed by computed tomography, were enrolled. The severity of stenosis of lower-extremity arteries was measured using a grading system. The muscle and fat mass areas were calculated in the abdomen at the L3 or L4 level, mid-thigh, and lower leg. Multivariable logistic regression was conducted to clarify the risk associated with low muscle mass. The difference in muscle mass between PAD and non-PAD patients was evaluated by using propensity score matching. RESULTS A strong positive correlation between the abdomen muscle area and leg muscle area was observed. The muscle area and muscle index of the leg were lower in PAD patients. These changes occurred earlier than in the abdomen muscle area. The group with more severe artery stenosis had more muscle wasting in the lower extremities. Greater age, female, lower BMI, and PAD were associated with low muscle mass. After propensity score matching, the leg muscle area was still lower in PAD patients. CONCLUSIONS There is a direct association between PAD and regional muscle wasting. This occurs earlier regionally in the lower extremities than in central muscles. Early diagnosis of PAD might prevent progressive muscle loss, improving disease outcome and quality of life. KEY POINTS • Peripheral arterial disease is strongly associated with sarcopenia. • Muscle wasting in the lower extremities is earlier and more prominent than that in the abdomen. • More severe arterial stenoses are associated with higher muscle wasting in the lower extremities.
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Affiliation(s)
- Pei-Shan Tsai
- Department of Radiology, MacKay Memorial Hospital, 104217, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, 112304, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, 252005, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, 252005, New Taipei City, Taiwan
| | - Dao-Chen Lin
- Department of Radiology, Taipei Veterans General Hospital, 112201, Taipei, Taiwan.,Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, 112201, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, 112304
| | - Ya-Ting Jan
- Department of Radiology, MacKay Memorial Hospital, 104217, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, 112304, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, 252005, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, 252005, New Taipei City, Taiwan
| | - Yu-Peng Liu
- Mackay Junior College of Medicine, Nursing and Management, 252005, New Taipei City, Taiwan.,Department of Radiology, Hsinchu Mackay Memorial Hospital, 300044, Hsinchu City, Taiwan
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, 112304, Taipei, Taiwan.
| | - Shih-Chieh Huang
- Department of Radiology, MacKay Memorial Hospital, 104217, Taipei, Taiwan.
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10
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Lortie J, Gage G, Rush B, Heymsfield SB, Szczykutowicz TP, Kuchnia AJ. The effect of computed tomography parameters on sarcopenia and myosteatosis assessment: a scoping review. J Cachexia Sarcopenia Muscle 2022; 13:2807-2819. [PMID: 36065509 PMCID: PMC9745495 DOI: 10.1002/jcsm.13068] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/21/2022] [Accepted: 07/20/2022] [Indexed: 12/15/2022] Open
Abstract
Computed tomography (CT) is a valuable assessment method for muscle pathologies such as sarcopenia, cachexia, and myosteatosis. However, several key underappreciated scan imaging parameters need consideration for both research and clinical use, specifically CT kilovoltage and the use of contrast material. We conducted a scoping review to assess these effects on CT muscle measures. We reviewed articles from PubMed, Scopus, and Web of Science from 1970 to 2020 on the effect of intravenous contrast material and variation in CT kilovoltage on muscle mass and density. We identified 971 articles on contrast and 277 articles on kilovoltage. The number of articles that met inclusion criteria for contrast and kilovoltage was 11 and 7, respectively. Ten studies evaluated the effect of contrast on muscle density of which nine found that contrast significantly increases CT muscle density (arterial phase 6-23% increase, venous phase 19-57% increase, and delayed phase 23-43% increase). Seven out of 10 studies evaluating the effect of contrast on muscle area found significant increases in area due to contrast (≤2.58%). Six studies evaluating kilovoltage on muscle density found that lower kilovoltage resulted in a higher muscle density (14-40% increase). One study reported a significant decrease in muscle area when reducing kilovoltage (2.9%). The use of contrast and kilovoltage variations can have dramatic effects on skeletal muscle analysis and should be considered and reported in CT muscle analysis research. These significant factors in CT skeletal muscle analysis can alter clinical and research outcomes and are therefore a barrier to clinical application unless better appreciated.
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Affiliation(s)
- Jevin Lortie
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Grace Gage
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Benjamin Rush
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | | | - Adam J Kuchnia
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
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11
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De Marco D, Mamane S, Choo W, Mullie L, Xue X, Afilalo M, Afilalo J. Muscle Area and Density Assessed by Abdominal Computed Tomography in Healthy Adults: Effect of Normal Aging and Derivation of Reference Values. J Nutr Health Aging 2022; 26:243-246. [PMID: 35297466 DOI: 10.1007/s12603-022-1746-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND A growing body of evidence has demonstrated the prognostic value of skeletal muscle area and quality measured by computed tomography (CT) as biomarkers of sarcopenia and frailty. However, there exists little data in normal healthy subjects to inform reference values and determine the effects of advancing age and sex on CT muscle parameters. METHODS Abdominal CT images of patients (20-80 years of age) presenting to the emergency department with benign abdominal symptoms and no significant medical comorbidities were retrospectively collected from 2014 to 2017. Psoas and abdominal wall muscle area (PMA, WMA) and density (PMD, WMD) at the level of the L4 vertebrae were measured with the CoreSlicer.com web app. The normal reference range was computed by non-parameteric 2.5th and 97.5th percentiles stratified by sex and restricted by age to the younger subgroup (20-39 years of age). RESULTS The cohort consisted of 390 otherwise healthy patients (162 males, 228 females). The lower reference range for PMA was <22.0 cm2 in males and <11.1 cm2 in females, and for WMA was <112.2 cm2 in males and <75.6 cm2 in females. There was a graded decline observed in PMA and WMA among older compared to younger adults (especially ≥60 years of age) (P<0.001) and among females compared to males (P<0.001). There was also a graded decline observed in PMD and WMD among older compared to younger adults (P<0.001), irrespective of sex. CONCLUSION This study has defined the normal reference values and age-associated down-trend for CT muscle parameters at L4 in a healthy population using an accessible web-based software, which help contextualize and interpret these imaging biomarkers of sarcopenia in clinical care.
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Affiliation(s)
- D De Marco
- Jonathan Afilalo, MD, MSc, FACC, FRCPC, Associate Professor, McGill University, Co-Director, McGill Integrated Cardiac Imaging Fellowship Program, Division of Cardiology and Centre for Clinical Epidemiology, Jewish General Hospital, 3755 Cote Ste Catherine Rd, E-222, Montreal, QC H3T 1E2, Phone: (514) 340-8222 | Fax: (514) 221-3785 |
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12
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Honda S, Ota S, Yamashita S, Yasuda T. Inverse association between sarcopenia and displacement in the early phase of fragility fractures of the pelvis. Osteoporos Sarcopenia 2022; 8:24-29. [PMID: 35415276 PMCID: PMC8987323 DOI: 10.1016/j.afos.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/21/2022] [Accepted: 03/13/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives Fragility fractures of the pelvis (FFP) commonly occur in the frail elderly. Displacement in the posterior pelvic ring is recognized as the key sign of instability. This study aims to elucidate the relationship between computer tomography (CT)-based frailty markers and displacement of the posterior pelvic ring within 7 days after injury. Methods This retrospective study included 49 patients (42 females, 7 males) with FFP (type I 10, type II 24, type III 12, type IV 3). On a CT slice at the level of the third lumbar vertebra, skeletal muscle area, skeletal muscle radiation attenuation, and skeletal muscle index (SMI) were calculated as sarcopenia markers. Osteopenia was measured with trabecular region of interest attenuation technique on the same CT slice. Results There was no difference in the demographics between non-displaced and displaced FFP. CT-based data showed that patients with FFP had osteopenia. However, no difference was found between non-displaced and displaced FFP. SMI was higher in FFP types III/IV than non-displaced FFP when CT-based data on sarcopenia were compared among all patients. Female patients with FFP demonstrated similar results. Logistic regression analysis using the demographics and CT-based markers on sarcopenia and osteopenia revealed that SMI was a potential determinant of displacement of the posterior pelvic ring fractures. Conclusions There was inverse association between sarcopenia and displacement of the posterior pelvic ring in the early phase of FFP. Relatively preserved muscle may develop displacement in the elderly with osteopenia.
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13
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Linge J, Petersson M, Forsgren MF, Sanyal AJ, Dahlqvist Leinhard O. Adverse muscle composition predicts all-cause mortality in the UK Biobank imaging study. J Cachexia Sarcopenia Muscle 2021; 12:1513-1526. [PMID: 34713982 PMCID: PMC8718078 DOI: 10.1002/jcsm.12834] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/06/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Adverse muscle composition (MC) as measured by magnetic resonance imaging has previously been linked to poor function, comorbidity, and increased hospitalization. The aim of this study was to investigate if adverse MC predicts all-cause mortality using data from UK Biobank. METHODS There were 40 178 participants scanned using a 6 min magnetic resonance imaging protocol. Images were analysed for thigh fat-tissue free muscle volume and muscle fat infiltration (MFI) using AMRA® Researcher (AMRA Medical, Linköping, Sweden). For each participant, a sex, weight, and height invariant muscle volume z-score was calculated. Participants were partitioned into four MC groups: (i) normal MC, (ii) only low muscle volume [<25th percentile for muscle volume z-score (population wide)], (iii) only high MFI [>75th percentile (population wide, sex-specific)], and (iv) adverse MC (low muscle volume z-score and high MFI). Association of MC groups with mortality was investigated using Cox proportional-hazard modelling with normal MC as referent (unadjusted and adjusted for low hand grip strength, sex, age, body mass index, previous diagnosis of disease (cancer, type 2 diabetes and coronary heart disease), lifestyle, and socioeconomic factors (smoking, alcohol consumption, physical activity, and Townsend deprivation index). RESULTS Muscle composition measurements were complete for 39 804 participants [52% female, mean (SD) age 64.2 (7.6) years and body mass index 26.4 (4.4) kg/m2 ]. Three hundred twenty-eight deaths were recorded during a follow-up period of 2.9 (1.4) years after imaging. At imaging, adverse MC was detected in 10.5% of participants. The risk of death from any cause in adverse MC compared with normal MC was 3.71 (95% confidence interval 2.81-4.91, P < 0.001). Only low muscle volume and only high MFI were independently associated with all-cause mortality [1.58 (1.13-2.21), P = 0.007, and 2.02 (1.51-2.71), P < 0.001, respectively]. Adjustment of low hand grip strength [1.77 (1.28-2.44), P < 0.001] did not attenuate the associations with any of the MC groups. In the fully adjusted model, adverse MC and only high MFI remained significant (P < 0.001 and P = 0.020) while the association with only low muscle volume was attenuated to non-significance (P = 0.560). The predictive performance of adverse MC [1.96 (1.42-2.71), P < 0.001] was comparable with that of previous cancer diagnosis [1.93 (1.47-2.53), P < 0.001] and smoking [1.71 (1.02-2.84), P = 0.040]. Low hand grip strength was borderline non-significant [1.34 (0.96-1.88), P = 0.090]. CONCLUSIONS Adverse MC was a strong and independent predictor of all-cause mortality. Sarcopenia guidelines can be strengthened by including cut-offs for myosteatosis enabling detection of adverse MC.
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Affiliation(s)
- Jennifer Linge
- AMRA Medical, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Mikael F Forsgren
- AMRA Medical, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Arun J Sanyal
- Department of Internal Medicine and Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
| | - Olof Dahlqvist Leinhard
- AMRA Medical, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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14
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van Heusden HC, Swartz JE, Chargi N, de Jong PA, van Baal MCPM, Wegner I, de Bree R. Feasibility of assessment of skeletal muscle mass on a single cross-sectional image at the level of the fourth thoracic vertebra. Eur J Radiol 2021; 142:109879. [PMID: 34343845 DOI: 10.1016/j.ejrad.2021.109879] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/18/2021] [Accepted: 07/22/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Skeletal muscle mass (SMM) determined on computed tomography (CT) is emerging as a novel imaging biomarker. Cross-sectional area (CSA) of SMM at the level of the third lumbar vertebra (L3) on abdominal imaging is considered the clinical reference standard for measuring SMM. In certain patient groups, such as those with oncological or non-oncological lung disease like COVID-19, a chest CT may be available while an abdominal CT is not. The purpose of this study was to investigate whether determining SMM on a chest CT is a feasible alternative to abdominal CT. RESEARCH QUESTION What is the correlation between SMM measurements at the level of L3 and the level of the fourth thoracic vertebra (Th4)? STUDY DESIGN AND METHODS In this study we retrospectively analyzed abdominal and thoracic series of whole-body CT-scans of trauma patients (N = 47) and head and neck cancer patients (N = 194). All abdominal muscles were delineated on a single axial slice at the level of L3. The erector spinae, levator scapulae, rhomboideus minor and major and pectoralis minor and major muscles were delineated on a single axial slice at the level of Th4. CSA of the muscles at Th4 and the L3 level were compared using linear regression, and a multivariate linear regression model was established. RESULTS Muscle CSA at level Th4 strongly correlates with L3 muscle CSA (r = 0.791, p < 0.05). A multivariate model incorporating the patient characteristics arm positioning, age, sex, and weight achieved a stronger correlation (r = 0.856, p < 0.05). INTERPRETATION Skeletal muscle CSA measured at the level of Th4 is a feasible alternative to measurements at L3. This allows diagnosing low SMM using clinically available thoracic CT-scans. SMM measurements at the level of Th4 may become a prognostic or triage tool when faced with mechanical ventilator shortage.
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Affiliation(s)
- Hugo C van Heusden
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Justin E Swartz
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Najiba Chargi
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Mark C P M van Baal
- Department of Surgery, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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15
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Albano D, Camoni L, Rinaldi R, Tucci A, Zilioli VR, Muzi C, Ravanelli M, Farina D, Coppola A, Camalori M, Giubbini R, Bertagna F. Comparison between skeletal muscle and adipose tissue measurements with high-dose CT and low-dose attenuation correction CT of 18F-FDG PET/CT in elderly Hodgkin lymphoma patients: a two-centre validation. Br J Radiol 2021; 94:20200672. [PMID: 34106736 PMCID: PMC8248212 DOI: 10.1259/bjr.20200672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives: High-dose CT (HDCT) is considered the gold-standard imaging for the measurements of skeletal muscle area (SMA), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and intramuscular adipose tissue (IMAT) areas in the abdomen. These parameters may reflect sarcopenia, which can have a prognostic impact in several oncological diseases. The aim of this study was to compare the agreement of measurements of SMA, VAT, SAT and IMAT areas between HDCT and low-dose CT (LDCT) of 18-fludeoxyglucose positron emission tomography (18F-FDG PET)/CT in elderly patients affected by Hodgkin lymphoma (HL). Methods: We retrospectively included 90 patients affected by HL who underwent baseline 18F-FDG-PET/CT and HDCT within a mean interval of 7 days. HDCT and LDCT images were analysed by two blinded observers using segmentation software (Slice-O-Matic, Tomovision) to quantify the areas. HDCT and LDCT measurements were compared using Bland–Altman plots and Passing-Bablock regression analyses. Pearson correlation coefficient (r) was used to correlate measurements from the two imaging modalities. Results: Comparison of HDCT and LDCT data demonstrated a strong correlation for measurement of VAT(r = 0.942, p < 0.0001), SAT (r = 0.894, p < 0.0001) and SMA (r = 0.934, p < 0.0001). Instead considering IMAT, correlation was good but less significant (r = 0.742). The mean difference between the two methods was found to be very small, with a difference of 1% for SAT,+6.1% for VAT,+2.5% for SMA and −1.9% for IMAT. Conclusion: LDCT of PET/CT is a safe, accurate and precise method for the measurements of skeletal muscle area, visceral and subcutaneous adipose tissue. Their measurements are reproducible and correlate closely with HDCT. Advances in knowledge: LLDCT of PET/CT is a safe and accurate method for the measurements of SMA, VAT and SAT; their measurements are closely correlated with HDCT. LDCT can be considered an accurate alternative tool for measuring abdominal fat and muscles in the clinical practice.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Luca Camoni
- Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, Italy
| | - Roberto Rinaldi
- Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, Italy
| | - Alessandra Tucci
- Hematology Division, ASST Spedali Civili Brescia, Brescia, Italy
| | | | - Cristina Muzi
- Haematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Ravanelli
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Davide Farina
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Alessandra Coppola
- Department of Radiology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Manuela Camalori
- Department of Radiology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
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16
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The effect of sirolimus on angiomyolipoma is determined by decrease of fat-poor compartments and includes striking reduction of vascular structures. Sci Rep 2021; 11:8493. [PMID: 33875750 PMCID: PMC8055687 DOI: 10.1038/s41598-021-87930-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 04/01/2021] [Indexed: 02/02/2023] Open
Abstract
Renal angiomyolipomas hemorrhage is associated with their size and vascular constitution. The effects of sirolimus on different components of angiomyolipomas was analyzed in patients with tuberous sclerosis complex, sporadic lymphangioleiomyomatosis and multiple sporadic angiomyolipomas. Thirty angiomyolipomas from 14 patients treated with sirolimus were retrospectively evaluated. A Hounsfield-unit threshold was used to classify angiomyolipomas in fat-rich, fat-poor and intermediate-fat tumors, and to categorize tumor compartments in fat rich, fat poor, intermediate fat and highly vascularized. Diameter variations were measured to assess the effects on aneurysmatic/ectatic vascular formations. Volume reduction following treatment with sirolimus was higher in fat-poor than fat-rich angiomyolipomas. Tumor reduction was mainly determined by decrease of the fat-poor and highly-vascularized compartments while the volume of the fat-rich compartment increased. Broad liposubstitution was observed in some tumors. A median reduction of 100% (75 to 100) in the diameter of aneurysmatic/ectatic vascular structures was observed. Our study showed that sirolimus reduces the size of angiomyolipomas by decreasing primarily their highly-vascularized and fat-poor compartments. This effect is associated with a remarkable reduction of tumoral aneurysms/ectatic vessels, revealing the likely mechanism responsible for the risk-decreasing effect of mTOR inhibitors on angiomyolipoma bleeding. These findings support the role of mTOR in the development of angiomyolipoma blood vessels.
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17
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Significance of Acquisition Parameters for Adipose Tissue Segmentation on CT Images. AJR Am J Roentgenol 2021; 217:177-185. [PMID: 33729886 DOI: 10.2214/ajr.20.23280] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. CT-based body composition analysis quantifies skeletal muscle and adipose tissue. However, acquisition parameters and quality can vary between CT images obtained for clinical care, which may lead to unreliable measurements and systematic error. The purpose of this study was to estimate the influence of IV contrast medium, tube current-exposure time product, tube potential, and slice thickness on cross-sectional area (CSA) and mean attenuation of subcutaneous (SAT), visceral (VAT), and inter-muscular adipose tissue (IMAT). MATERIALS AND METHODS. We retrospectively analyzed 244 images from 105 patients. We applied semiautomated threshold-based segmentation to CTA, dual-energy CT, and CT images acquired as part of PET examinations. An axial image at the level of the third lumbar vertebral body was extracted from each examination to generate 139 image pairs. Images from each pair were obtained with the same scanner, from the same patient, and during the same examination. Each image pair varied in only one acquisition parameter, which allowed us to estimate the effect of the parameter using one-sample t or median tests and Bland-Altman plots. RESULTS. IV contrast medium application reduced CSA in each adipose tissue compartment, with percentage change ranging from -0.4% (p = .03) to -9.3% (p < .001). Higher tube potential reduced SAT CSA (median percentage change, -4.2%; p < .001) and VAT CSA (median percentage change, -2.8%; p = .001) and increased IMAT CSA (median percentage change, -5.4%; p = .001). Thinner slices increased CSA in the VAT (mean percentage change, 3.0%; p = .005) and IMAT (median percentage change, 17.3%; p < .001) compartments. Lower tube current-exposure time product had a variable effect on CSA (median percentage change, -3.2% for SAT [p < .001], -12.6% for VAT [p = .001], and 58.8% for IMAT [p < .001]). IV contrast medium and higher tube potential increased mean attenuation, with percentage change ranging from 0.8% to 1.7% (p < .05) and from 6.2% to 20.8% (p < .001), respectively. Conversely, thinner slice and lower tube current-exposure time product reduced mean attenuation, with percentage change ranging from -5.4% to -1.0% (p < .001) and from -8.7% to -1.8% (p < .001), respectively. CONCLUSION. Acquisition parameters significantly affect CSA and mean attenuation of adipose tissue. Details of acquisition parameters used for CT-based body composition analysis need to be scrutinized and reported to facilitate interpretation of research studies.
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18
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Baggerman MR, van Dijk DPJ, Winkens B, Schnabel RM, van Gassel RJJ, Bol ME, Bakers FC, Olde Damink SWM, van de Poll MCG. Edema in critically ill patients leads to overestimation of skeletal muscle mass measurements using computed tomography scans. Nutrition 2021; 89:111238. [PMID: 33895558 DOI: 10.1016/j.nut.2021.111238] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/28/2021] [Accepted: 02/28/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Changes in muscle mass and quality are important targets for nutritional intervention in critical illness. Effects of such interventions may be assessed using sequential computed tomography (CT) scans. However, fluid and lipid infiltration potentially affects muscle area measurements. The aim of this study was to evaluate changes in muscle mass and quality in critical illness with special emphasis on the influence of edema on this assessment. METHODS Changes in skeletal muscle area index (SMI) and radiation attenuation (RA) at the level of vertebra L3 were analyzed using sequential CT scans of 77 patients with abdominal sepsis. Additionally, the relation between these changes and disease severity using the maximum Sequential Organ Failure Assessment (SOFA) score and change in edema were studied. RESULTS SMI declined on average 0.35%/d (±1.22%; P = 0.013). However, SMI increased in 41.6% of the study population. Increasing edema formation was significantly associated with increased SMI and with a higher SOFA score. Muscle RA decreased during critical illness, but was not significantly associated with changes in SMI or changes in edema. CONCLUSION In critically ill patients, edema affects skeletal muscle area measurements, which leads to an overestimation of skeletal muscle area. A higher SOFA score was associated with edema formation. Because both edema and fat infiltration may affect muscle RA, the separate effects of these on muscle quality are difficult to distinguish. When using abdominal CT scans to changes in muscle mass and quality in critically ill patients, researchers must be aware and careful with the interpretation of the results.
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Affiliation(s)
- Michelle R Baggerman
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Intensive Care Medicine, Laurentius hospital, Roermond, the Netherlands.
| | - David P J van Dijk
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Ronny M Schnabel
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Rob J J van Gassel
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Martine E Bol
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - Frans C Bakers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Steven W M Olde Damink
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Marcel C G van de Poll
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
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19
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Kim DW, Ha J, Ko Y, Kim KW, Park T, Lee J, You MW, Yoon KH, Park JY, Kee YJ, Kim HK. Reliability of Skeletal Muscle Area Measurement on CT with Different Parameters: A Phantom Study. Korean J Radiol 2021; 22:624-633. [PMID: 33569929 PMCID: PMC8005347 DOI: 10.3348/kjr.2020.0914] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/18/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023] Open
Abstract
Objective To evaluate the reliability of CT measurements of muscle quantity and quality using variable CT parameters. Materials and Methods A phantom, simulating the L2–4 vertebral levels, was used for this study. CT images were repeatedly acquired with modulation of tube voltage, tube current, slice thickness, and the image reconstruction algorithm. Reference standard muscle compartments were obtained from the reference maps of the phantom. Cross-sectional area based on the Hounsfield unit (HU) thresholds of muscle and its components, and the mean density of the reference standard muscle compartment, were used to measure the muscle quantity and quality using different CT protocols. Signal-to-noise ratios (SNRs) were calculated in the images acquired with different settings. Results The skeletal muscle area (threshold, −29 to 150 HU) was constant, regardless of the protocol, occupying at least 91.7% of the reference standard muscle compartment. Conversely, normal attenuation muscle area (30–150 HU) was not constant in the different protocols, varying between 59.7% and 81.7% of the reference standard muscle compartment. The mean density was lower than the target density stated by the manufacturer (45 HU) in all cases (range, 39.0–44.9 HU). The SNR decreased with low tube voltage, low tube current, and in sections with thin slices, whereas it increased when the iterative reconstruction algorithm was used. Conclusion Measurement of muscle quantity using HU threshold was reliable, regardless of the CT protocol used. Conversely, the measurement of muscle quality using the mean density and narrow HU thresholds were inconsistent and inaccurate across different CT protocols. Therefore, further studies are warranted in future to determine the optimal CT protocols for reliable measurements of muscle quality.
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Affiliation(s)
- Dong Wook Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jiyeon Ha
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yousun Ko
- Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Taeyong Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeongjin Lee
- School of Computer Science and Engineering, Soongsil University, Seoul, Korea
| | - Myung Won You
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Kwon Ha Yoon
- Department of Radiology, Wonkwang University College of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Ji Yong Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jin Kee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hong Kyu Kim
- Health Screening & Promotion Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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20
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Derstine BA, Holcombe SA, Ross BE, Wang NC, Su GL, Wang SC. Optimal body size adjustment of L3 CT skeletal muscle area for sarcopenia assessment. Sci Rep 2021; 11:279. [PMID: 33431971 PMCID: PMC7801425 DOI: 10.1038/s41598-020-79471-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/09/2020] [Indexed: 12/16/2022] Open
Abstract
Measurements of skeletal muscle cross-sectional area (SMA) at the level of the third lumbar (L3) vertebra derived from clinical computed tomography (CT) scans are commonly used in assessments of sarcopenia, the loss of skeletal muscle mass and function associated with aging. As SMA is correlated with height and Body Mass Index (BMI), body size adjustment is necessary to fairly assess sarcopenic low muscle mass in individuals of different height and BMI. The skeletal muscle index, a widely used measure, adjusts for height as [Formula: see text] but uses no BMI adjustment. There is no agreed upon standard for body size adjustment. We extracted L3 SMA using non-contrast-enhanced CT scans from healthy adults, split into 'Under-40' and 'Over-40' cohorts. Sex-specific allometric analysis showed that height to the power of one was the optimal integer coefficient for height adjusted SMA in both males and females. We computed two height-adjusted measures [Formula: see text] and [Formula: see text], comparing their Pearson correlations versus age, height, weight, and BMI separately by sex and cohort. Finally, in the 'Under-40' cohort, we used linear regression to convert each height-adjusted measure into a z-score ([Formula: see text], [Formula: see text]) adjusted for BMI. [Formula: see text] was less correlated with height in both males and females ([Formula: see text], [Formula: see text] and [Formula: see text], [Formula: see text]) than [Formula: see text] ([Formula: see text] and [Formula: see text], [Formula: see text]). [Formula: see text] was uncorrelated with BMI and weight, and minimally correlated with height in males and females ([Formula: see text], [Formula: see text] and [Formula: see text], [Formula: see text]). The final [Formula: see text] equation was: [Formula: see text], where [Formula: see text], [Formula: see text], [Formula: see text], and sex = 1 if male, 0 if female. We propose [Formula: see text] for optimal height adjustment and the [Formula: see text] score for optimal height and BMI adjustment. By minimizing correlations with height and BMI, the [Formula: see text] score produces unbiased assessments of relative L3 skeletal muscle area across the full range of body sizes.
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21
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Navin PJ, Moynagh MR, Atkinson EJ, Tirumanisetty P, LeBrasseur NK, Kumar A, Khosla S, Takahashi N. Establishment of normative biometric data for body composition based on computed tomography in a North American cohort. Clin Nutr 2020; 40:2435-2442. [PMID: 33176926 DOI: 10.1016/j.clnu.2020.10.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Accurate and reproducible biomarkers are required to allow a more personalized approach to patient care. Body composition is one such biomarker affecting outcomes in a range of surgical and oncological conditions. The aim of this study is to determine the age and sex specific distribution of body composition data, based on information gathered from computed tomography (CT). METHODS This prospective study used healthy subjects from the medical records linkage of the Rochester Epidemiology Project, based in Minnesota, USA. Each patient had a CT scan without intravenous contrast performed between 1999 and 2001. Quantification was performed using previously validated semi-automated in-house developed software for body composition analysis. Subcutaneous adipose tissue area, visceral adipose tissue area, intermuscular adipose tissue area and skeletal muscle area were measured and indexed to subject height. Generalized Additive Models for Location, Scale and Shape were used to assess the location, scale, and shape of each variable across age, stratified by sex. Z-scores specific to sex were assessed for each of the parameters analyzed. Age-specific z-scores were calculated using the formula: Z = (Index Variable - μ)/σ or Z = (√ (Index Variable) - μ)/σ. RESULTS There were 692 subjects enrolled in the study. The fitted model equation was offered for each variable with values presented for μ and σ. Modelling with penalized splines was performed for VAT index, IMAT index and total adipose tissue index. Scatterplots of each variable were produced with lines of Z-scores as a visual representation. CONCLUSION This study offers comparative data to allow comparison amongst multiple populations. This will form an important reference for future research and clinical practice.
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Affiliation(s)
- P J Navin
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - M R Moynagh
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - E J Atkinson
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - P Tirumanisetty
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
| | - N K LeBrasseur
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, USA
| | - A Kumar
- Department of Gynecological Surgery, Mayo Clinic, Rochester, USA
| | - S Khosla
- Department of Endocrinology, Mayo Clinic, Rochester, USA
| | - N Takahashi
- Department of Radiology, Mayo Clinic, Rochester, USA.
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22
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Patients triaged to neoadjuvant chemotherapy have higher rates of sarcopenia: An opportunity for prehabilitation. Gynecol Oncol 2020; 160:40-44. [PMID: 33109391 DOI: 10.1016/j.ygyno.2020.10.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare baseline body composition measures (BCM), including sarcopenia, between patients with advanced epithelial ovarian cancer (EOC) undergoing primary cytoreductive surgery (PCS) versus neoadjuvant chemotherapy/interval cytoreductive surgery (NACT/ICS) and evaluate changes in BCM pre-NACT versus pre-ICS. METHODS Patients with stage IIIC/IV EOC who underwent PCS or NACT with curative intent between 1/1/2012 and 7/31/2016 were included. Computed tomography scans were evaluated via a semi-automated program to determine BCM. Measures evaluated include skeletal muscle area (SMA), skeletal muscle density (SMD), skeletal muscle index (SMI), and skeletal muscle gauge (SMG). Sarcopenia was defined as SMI <39.0 cm2/m2. RESULTS The study included 200 PCS patients and 85 NACT/ICS patients, of which 76 had both pre-NACT and pre-ICS scans. NACT patients were significantly more likely to be sarcopenic compared to PCS patients (40.0% vs 27.5%, p = 0.04). Mean SMA (107.3 vs 113.4 cm2, p = 0.004) and mean SMG (1344.6 vs. 1456.9 (cm2 x HU)/m2, p = 0.06) were lower in NACT patients. Among NACT/ICS patients, mean SMI significantly decreased -1.4 cm2/m2 (p = 0.005) at the time of surgery, resulting in a non-statistically significant increase in the percentage of sarcopenic patients from baseline (40.8% vs. 50.0%, p = 0.09). CONCLUSIONS Sarcopenia is more common in patients with advanced EOC undergoing NACT compared to PCS when using an evidence-based triage system for triage decisions. Body composition changes significantly over the course of NACT. Sarcopenia may be an indicator of debility and another factor for consideration in treatment planning. Further research into body composition's effects on prognosis and altering sarcopenia is necessary.
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23
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Value-Added Opportunistic CT: Insights Into Osteoporosis and Sarcopenia. AJR Am J Roentgenol 2020; 215:582-594. [DOI: 10.2214/ajr.20.22874] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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24
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Singhrao K, Fu J, Gao Y, Wu HH, Yang Y, Hu P, Lewis JH. A generalized system of tissue-mimicking materials for computed tomography and magnetic resonance imaging. ACTA ACUST UNITED AC 2020; 65:13NT01. [DOI: 10.1088/1361-6560/ab86d4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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25
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Poltronieri TS, de Paula NS, Chaves GV. Assessing skeletal muscle radiodensity by computed tomography: An integrative review of the applied methodologies. Clin Physiol Funct Imaging 2020; 40:207-223. [PMID: 32196914 DOI: 10.1111/cpf.12629] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/04/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
Abstract
Low-radiodensity skeletal muscle has been related to the degree of muscle fat infiltration and seems to be associated with worse outcomes. The aim of this study was to summarize the methodologies used to appraise skeletal muscle radiodensity by computed tomography, to describe the terms used in the literature to define muscle radiodensity and to give recommendations for its measurement standardization. An integrative bibliographic review in four databases included studies published until August 2019 in Portuguese, English or Spanish and performed in humans, adults and/or the elderly, of both sex, which investigated skeletal muscle radiodensity through computed tomography (CT) of the region between the third and fifth lumbar vertebrae and evaluated at least two muscular groups. One hundred and seventeen studies were selected. We observed a trend towards selecting all abdominal region muscle. A significant methodological variation in terms of contrast use, selection of skeletal muscle areas, radiodensity ranges delimitation and their cut-off points, as well as the terminologies used, was also found. The methodological differences detected are probably due to the lack of more precise information about the correlation between skeletal muscle radiodensity by CT and its molecular composition, among others. Therefore, until the gaps are addressed in future studies, authors should avoid arbitrary approaches when reporting skeletal muscle radiodensity, especially when it comes to prognosis inference. Studies using both CT and direct methods of muscle composition evaluation are encouraged, to enable the definition and validation of the best approach to classify fat-infiltrated muscle tissue, which will favour the nomenclature uniformization.
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Affiliation(s)
- Taiara Scopel Poltronieri
- Department of Nutrition, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Nathália Silva de Paula
- Department of Nutrition, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Gabriela Villaça Chaves
- Department of Nutrition, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
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26
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Singhrao K, Fu J, Wu HH, Hu P, Kishan AU, Chin RK, Lewis JH. A novel anthropomorphic multimodality phantom for MRI‐based radiotherapy quality assurance testing. Med Phys 2020; 47:1443-1451. [DOI: 10.1002/mp.14027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Kamal Singhrao
- Department of Radiation Oncology University of California Los Angeles Los Angeles CA 90095USA
| | - Jie Fu
- Department of Radiation Oncology University of California Los Angeles Los Angeles CA 90095USA
| | - Holden H. Wu
- Department of Radiology University of California Los Angeles Los Angeles CA 90095USA
| | - Peng Hu
- Department of Radiology University of California Los Angeles Los Angeles CA 90095USA
| | - Amar U. Kishan
- Department of Radiation Oncology University of California Los Angeles Los Angeles CA 90095USA
| | - Robert K. Chin
- Department of Radiation Oncology University of California Los Angeles Los Angeles CA 90095USA
| | - John H. Lewis
- Department of Radiation Oncology Cedars‐Sinai Medical Center Los Angeles CA 90048USA
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27
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van der Werf A, Langius JAE, Beeker A, Ten Tije AJ, Vulink AJ, Haringhuizen A, Berkhof J, van der Vliet HJ, Verheul HMW, de van der Schueren MAE. The effect of nutritional counseling on muscle mass and treatment outcome in patients with metastatic colorectal cancer undergoing chemotherapy: A randomized controlled trial. Clin Nutr 2020; 39:3005-3013. [PMID: 32037284 DOI: 10.1016/j.clnu.2020.01.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS A low muscle mass before start of treatment and loss of muscle mass during chemotherapy is related to adverse outcomes in patients with cancer. In this randomized controlled trial, the effect of nutritional counseling on change in muscle mass and treatment outcome in patients with metastatic colorectal cancer during first-line chemotherapy was studied. METHODS Patients scheduled for first-line chemotherapy (n = 107) were randomly assigned to individualized nutritional counseling by a dietitian (NC) or usual care (UC). NC was aimed at sufficient protein- and energy intake, supported by oral supplements or enteral feeding if indicated. Furthermore, physical activity was encouraged. Outcomes were assessed at baseline (T0) and the time of the first (T1) and second (T2) regular follow-up computed tomography scans. The proportion of patients with a clinically relevant decrease in skeletal muscle area of ≥6.0 cm2, measured by computed tomography, was the primary outcome. Secondary outcomes included body weight, quality of life, treatment toxicity and progression free and overall survival. RESULTS A total of 107 patients were enrolled (mean age, 65 years (SD, 11 years), 63% male). Mean change in skeletal muscle area from T0 till T1 was -2.5 (SD, 9.5) cm2, with no difference between NC versus UC (p = 0.891). The proportion of patients with a clinically relevant decrease in skeletal muscle area of ≥6.0 cm2 did not differ (NC 30% versus UC 31%, p = 0.467). NC compared with UC had a significant positive effect on body weight (B coefficient 1.7, p = 0.045), progression free survival (p = 0.039) and overall survival (p = 0.046). CONCLUSIONS NC of patients undergoing chemotherapy for metastatic colorectal cancer had no effect on muscle mass. However, we found that NC may increase body weight and improve progression free survival and overall survival compared to UC in this group of patients. These findings need further evaluation in future clinical trials. CLINICAL TRIAL INFORMATION ClinicalTrials.gov NCT01998152; Netherlands Trial Register NTR4223.
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Affiliation(s)
- A van der Werf
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Internal Medicine, Amsterdam UMC, Vrije Universiteit, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands.
| | - J A E Langius
- Department of Nutrition and Dietetics, Internal Medicine, Amsterdam UMC, Vrije Universiteit, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, P.O. Box 13336, 2501 EH, The Hague, the Netherlands
| | - A Beeker
- Department of Medical Oncology, Spaarne Gasthuis, P.O. Box 417, 2000 AK, Haarlem, the Netherlands
| | - A J Ten Tije
- Department of Medical Oncology, Amphia Ziekenhuis, P.O. Box 90157, 4800 RL, Breda, the Netherlands
| | - A J Vulink
- Department of Medical Oncology, Reinier de Graaf Gasthuis, P.O. Box 5011, 2600 GA, Delft, the Netherlands
| | - A Haringhuizen
- Department of Medical Oncology, Ziekenhuis Gelderse Vallei, P.O. Box 9025, 6710 HN, Ede, the Netherlands
| | - J Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands
| | - H J van der Vliet
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands
| | - H M W Verheul
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands
| | - M A E de van der Schueren
- Department of Nutrition and Dietetics, Internal Medicine, Amsterdam UMC, Vrije Universiteit, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands; Department of Nutrition and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL, Nijmegen, the Netherlands
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28
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Grønberg BH, Valan CD, Halvorsen T, Sjøblom B, Jordhøy MS. Associations between severe co-morbidity and muscle measures in advanced non-small cell lung cancer patients. J Cachexia Sarcopenia Muscle 2019; 10:1347-1355. [PMID: 31385663 PMCID: PMC6903441 DOI: 10.1002/jcsm.12469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/15/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Studies show that low skeletal muscle index (SMI) and low skeletal muscle density (SMD) are negative prognostic factors and associated with more toxicity from systemic therapy in cancer patients. However, muscle depletion can be caused by a range of diseases, and many cancer patients have significant co-morbidity. The aim of this study was to investigate whether there were associations between co-morbidity and muscle measures in patients with advanced non-small cell lung cancer. METHODS Patients in a Phase III trial comparing two chemotherapy regimens in advanced non-small cell lung cancer were analysed (n = 436). Co-morbidity was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), which rates co-morbidity from 0 to 4 on 14 different organ scales. Severe co-morbidity was defined as having any grades 3 and 4 CIRS-G score. Muscle measures were assessed from baseline computed tomography slides at the L3 level using the SliceOMatic software. RESULTS Complete data were available for 263 patients (60%). Median age was 66, 57.0% were men, 78.7% had performance status 0-1, 25.9% Stage IIIB, 11.4% appetite loss, 92.4% were current/former smokers, 22.8% were underweight, 43.7% had normal weight, 26.6% were overweight, and 6.8% obese. The median total CIRS-G score was 7 (range: 0-16), and 48.2% had severe co-morbidity. Mean SMI was 44.7 cm2 /m2 (range: 27-71), and the mean SMD was 37.3 Hounsfield units (HU) (range: 16-60). When comparing patients with and without severe co-morbidity, there were no significant differences in median SMI (44.5 vs. 44.1 cm2 /m2 ; 0.70), but patients with severe co-morbidity had a significantly lower median SMD (36 HU vs. 39 HU; 0.001), mainly due to a significant difference in SMD between those with severe heart disease and those without (32.5 vs. 37.9 HU; 0.002). Linear regression analyses confirmed the association between severe co-morbidity and SMD both in the simple analysis (0.001) and the multiple analysis (0.037) adjusting for baseline characteristics. Stage of disease, gender, and body mass index (BMI) were significantly associated with SMI in both the simple and multiple analyses. Age and BMI were significantly associated with SMD in the simple analysis; and age, gender, and BMI were significantly associated in the multiple analysis. CONCLUSIONS There were no significant differences in SMI between patients with and patients without severe co-morbidity, but patients with severe co-morbidity had lower SMD than other patients, mainly due to severe heart disease. Co-morbidity might be a confounder in studies of the clinical role of SMD in cancer patients.
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Affiliation(s)
- Bjørn H Grønberg
- Department of Clinical and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Christine Damgaard Valan
- Department of Clinical and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tarje Halvorsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bjørg Sjøblom
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Marit S Jordhøy
- Department of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Internal Medicine, Innlandet Hospital Trust, Hamar, Norway
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29
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Baggerman MR, van Dijk DPJ, Winkens B, van Gassel RJJ, Bol ME, Schnabel RM, Bakers FC, Olde Damink SWM, van de Poll MCG. Muscle wasting associated co-morbidities, rather than sarcopenia are risk factors for hospital mortality in critical illness. J Crit Care 2019; 56:31-36. [PMID: 31805466 DOI: 10.1016/j.jcrc.2019.11.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/18/2019] [Accepted: 11/25/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Low skeletal muscle mass on intensive care unit admission is related to increased mortality. It is however unknown whether this association is influenced by co-morbidities that are associated with skeletal muscle loss. The aim of this study was to investigate whether sarcopenia is an independent risk factor for hospital mortality in critical illness in the presence of co-morbidities associated with muscle wasting. METHODS Data of 155 patients with abdominal sepsis were retrospectively analyzed. Skeletal muscle area was assessed using CT-scans at the level of vertebra L3. Demographic and clinical data were retrieved from electronic patient files. Sarcopenia was defined as a muscle area index below the 5th percentile of the general population. Uni- and multivariable analyses were performed to assess the association between sarcopenia and hospital mortality, correcting for age and comorbidities. RESULTS The prevalence of sarcopenia was higher in patients that did not survive until hospital discharge. However, it appeared that this relation was confounded by the presence of chronic renal insufficiency and cancer. These were independent risk factors for hospital mortality, whereas sarcopenia was not. CONCLUSION In critically ill patients with abdominal sepsis, muscle wasting associated co-morbidities rather than sarcopenia were risk factors for hospital mortality.
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Affiliation(s)
- Michelle R Baggerman
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands.
| | - David P J van Dijk
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Rob J J van Gassel
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Martine E Bol
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - Ronny M Schnabel
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Frans C Bakers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Steven W M Olde Damink
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Marcel C G van de Poll
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
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30
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Hopkins JJ, Reif R, Bigam D, Baracos VE, Eurich DT, Sawyer MM. Change in Skeletal Muscle Following Resection of Stage I-III Colorectal Cancer is Predictive of Poor Survival: A Cohort Study. World J Surg 2019; 43:2518-2526. [PMID: 31222643 DOI: 10.1007/s00268-019-05054-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sarcopenia at time of diagnosis predicts worse survival outcomes. It is currently unknown how changes in muscle mass over time interact with sarcopenia in colorectal patients treated with curative intent. Objectives of this study were to quantify sarcopenia and skeletal muscle loss from time of diagnosis to end of surveillance and determine its effect on survival outcomes after completion of 2 years of surveillance. METHODS Retrospective cohort study of stage I-III colorectal cancer patients from 2007-2009, who underwent resection and had preoperative and 2-year surveillance computed tomography scans, without recurrence during that time. Body composition analysis was done at both time points to determine lumbar skeletal muscle index, radiodensity and adiposity. Change over time was standardized as a percentage per year. Cox proportional hazard regression modeling was used for survival analysis. RESULTS Of 667 patients included, median survival from surgery was 7.96 years, with 75 recurrences occurring after 2 years. On average patients lost muscle mass (-0.415%/year; CI -0.789, -0.042) and radiodensity (-5.76 HU/year; CI -6.74, -4.80), but gained total adipose tissue (7.06%/year; CI 4.34, 9.79). Patients with sarcopenia at diagnosis (HR 1.80; CI 1.13, 2.85) or muscle loss over time (HR 1.55; CI 1.01, 2.37) had worse overall survival, with significantly worse joint effect (HR 2.73; CI 1.32, 5.65). CONCLUSIONS Sarcopenia at diagnosis combined with ongoing skeletal muscle loss over time resulted in significantly worse survival. Patients with these features who are recurrence-free at 2 years are more likely to have a non-colorectal cancer cause of death.
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Affiliation(s)
- Jessica J Hopkins
- Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of Alberta, 2D4.1 WMC, 8440 -112 St., Edmonton, AB, T6G 2B7, Canada.
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | | | - David Bigam
- Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of Alberta, 2D4.1 WMC, 8440 -112 St., Edmonton, AB, T6G 2B7, Canada
| | - Vickie E Baracos
- Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Michael M Sawyer
- Division of Medical Oncology, Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Chargi N, Bril SI, de Jong PA, Emmelot-Vonk MH, de Bree R. Reply to comment on “Sarcopenia is a prognostic factor for overall survival in elderly patients with head and neck cancer”. Eur Arch Otorhinolaryngol 2019; 276:2631-2633. [DOI: 10.1007/s00405-019-05541-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
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Morsbach F, Zhang YH, Martin L, Lindqvist C, Brismar T. Body composition evaluation with computed tomography: Contrast media and slice thickness cause methodological errors. Nutrition 2019; 59:50-55. [DOI: 10.1016/j.nut.2018.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/11/2018] [Accepted: 08/03/2018] [Indexed: 12/22/2022]
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Feng Z, Rong P, Luo M, Sun X, Wang W. Influence of Methods Used to Establish Sarcopenia Cutoff Values for Skeletal Muscle Measures Using Unenhanced and Contrast-Enhanced Computed Tomography Images. JPEN J Parenter Enteral Nutr 2019; 43:1028-1036. [PMID: 30741436 DOI: 10.1002/jpen.1519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/24/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Multiple cutoff values of computed tomography (CT)-based skeletal muscle measures have been proposed, but there is currently no consensus used to identify sarcopenia. We aimed to evaluate the influence of statistical methods used to establish sarcopenia cutoff values and to examine the impact of contrast enhancement on the skeletal muscle measures. METHODS The skeletal muscle area (SMA) and muscle radiation attenuation (MRA) of 316 healthy individuals were measured on unenhanced CT images at the third lumbar vertebra level, and the skeletal muscle index (SMI) was SMA divided by height squared. Possible cutoff values were established using 2 methods: 5th percentile of individuals aged 20-60 years or mean - 2 × SD of individuals aged 20-50 years. The concordance was assessed using Cohen's κ coefficients and McNemar test. The skeletal muscle parameters on 3 phases from 30 CT examinations were compared. RESULTS The concordance between the 2 methods was almost perfect (κ coefficients: 0.830-0.849) for low MRA but slight to moderate (κ coefficients: 0.189-0.591) for low SMI, especially in the men (P < 0.01). Compared with the unenhanced images, the mean SMA, SMI, and MRA on the contrast-enhanced images increased by 0.8%-1.7%, 0.8%-1.8%, and 14.8%-21.6% (all P < 0.001), respectively, and only the changes in MRA were clinically significant. CONCLUSIONS The methods for establishing cutoff values and contrast enhancement influence the identification of low SMI and low MRA, respectively. Thus, the definition of sarcopenia should include the standardized method for establishing cutoff values and the phase of CT for analysis.
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Affiliation(s)
- Zhichao Feng
- Department of Radiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Pengfei Rong
- Department of Radiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Muqing Luo
- Department of Radiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xianxi Sun
- School of Mathematics and Statistics of Central South University, Changsha, China
| | - Wei Wang
- Department of Radiology, Third Xiangya Hospital of Central South University, Changsha, China
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Dijksterhuis WPM, Pruijt MJ, van der Woude SO, Klaassen R, Kurk SA, van Oijen MGH, van Laarhoven HWM. Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy. J Cachexia Sarcopenia Muscle 2019; 10:199-206. [PMID: 30666831 PMCID: PMC6438339 DOI: 10.1002/jcsm.12371] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/05/2018] [Accepted: 11/03/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Palliative systemic treatment in patients with advanced or metastatic esophagogastric cancer may result in improved overall survival and quality of life but can also lead to considerable toxicity. In various cancer types, severe muscle mass depletion (sarcopenia) and poor muscle strength are associated with decreased survival and increased chemotherapy-related toxicity. The aim of this study is to determine the impact of body composition on survival and chemotherapy toxicity in esophagogastric cancer patients treated with first-line palliative chemotherapy. METHODS A total of 88 patients with advanced esophagogastric cancer treated with standard first-line palliative systemic therapy consisting of capecitabine and oxaliplatin (CapOx) between January 2010 and February 2017 were included. Skeletal muscle index (SMI), reflecting muscle mass, and skeletal muscle density (SMD), associated with muscle strength, were measured using pre-treatment of all patients and evaluation computed tomography scans after three treatment cycles of 65 patients and were used to determine sarcopenia and sarcopenic obesity (i.e. sarcopenia and body mass index >25 kg/m2 ). The associations between body composition (SMI, SMD, sarcopenia, and sarcopenic obesity) and survival and toxicity were assessed using univariable and multivariable Cox and logistic regression analyses, respectively. RESULTS Of 88 patients, 75% was male, and median age was 63 (interquartile range 56-69) years. The majority of patients had an adenocarcinoma (83%). Before start of treatment, 49% of the patients were sarcopenic, and 20% had sarcopenic obesity. Low SMD was observed in 50% of patients. During three cycles CapOx, SMI significantly decreased, with a median decrease of 4% (interquartile range -8.6--0.4). Median progression-free and overall survival were 6.9 and 10.1 months. SMI, SMD, sarcopenia, and sarcopenic obesity (both pre-treatment and after three cycles) were neither associated with progression-free nor overall survival. Pre-treatment SMD was independently associated with grade 3-4 toxicity (odds ratio 0.94; 95% confidence interval 0.89-1.00) and sarcopenic obesity with grade 2-4 neuropathy (odds ratio 3.82; 95% confidence interval 1.20-12.18). CONCLUSIONS Sarcopenia was not associated with survival or treatment-related toxicity in advanced esophagogastric cancer patients treated with CapOx. Pre-treatment sarcopenic obesity was independently associated with the occurrence of grade 2-4 neurotoxicity and skeletal muscle density with grade 3-4 toxicity.
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Affiliation(s)
- Willemieke P M Dijksterhuis
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten J Pruijt
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephanie O van der Woude
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Remy Klaassen
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophie A Kurk
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Martijn G H van Oijen
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Derstine BA, Holcombe SA, Ross BE, Wang NC, Su GL, Wang SC. Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population. Sci Rep 2018; 8:11369. [PMID: 30054580 PMCID: PMC6063941 DOI: 10.1038/s41598-018-29825-5] [Citation(s) in RCA: 268] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/19/2018] [Indexed: 12/13/2022] Open
Abstract
Measurements of skeletal muscle cross-sectional area, index, and radiation attenuation utilizing clinical computed tomography (CT) scans are used in assessments of sarcopenia, the loss of skeletal muscle mass and function associated with aging. To classify individuals as sarcopenic, sex-specific cutoffs for 'low' values are used. Conventionally, cutoffs for skeletal muscle measurements at the level of the third lumbar (L3) vertebra are used, however L3 is not included in several clinical CT protocols. Non-contrast-enhanced CT scans from healthy kidney donor candidates (age 18-40) at Michigan Medicine were utilized. Skeletal muscle area (SMA), index (SMI), and mean attenuation (SMRA) were measured at each vertebral level between the tenth thoracic (T10) and the fifth lumbar (L5) vertebra. Sex-specific means, standard deviations (s.d.), and sarcopenia cutoffs (mean-2 s.d.) at each vertebral level were computed. Associations between vertebral levels were assessed using Pearson correlations and Tukey's difference test. Classification agreement between different vertebral level cutoffs was assessed using overall accuracy, specificity, and sensitivity. SMA, SMI, and SMRA L3 cutoffs for sarcopenia were 92.2 cm2, 34.4 cm2/m2, and 34.3 HU in females, and 144.3 cm2, 45.4 cm2/m2, and 38.5 HU in males, consistent with previously reported cutoffs. Correlations between all level pairs were statistically significant and high, ranging from 0.65 to 0.95 (SMA), 0.64 to 0.95 (SMI), and 0.63 to 0.95 (SMRA). SMA peaks at L3, supporting its use as the primary site for CT sarcopenia measurements. However, when L3 is not available alternative levels (in order of preference) are L2, L4, L5, L1, T12, T11, and T10. Healthy reference values reported here enable sarcopenia assessment and sex-specific standardization of SMA, SMI, and SMRA in clinical populations, including those whose CT protocols do not include L3.
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Affiliation(s)
- Brian A Derstine
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Sven A Holcombe
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Brian E Ross
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas C Wang
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Grace L Su
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Stewart C Wang
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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Martin L, Hopkins J, Malietzis G, Jenkins JT, Sawyer MB, Brisebois R, MacLean A, Nelson G, Gramlich L, Baracos VE. Assessment of Computed Tomography (CT)-Defined Muscle and Adipose Tissue Features in Relation to Short-Term Outcomes After Elective Surgery for Colorectal Cancer: A Multicenter Approach. Ann Surg Oncol 2018; 25:2669-2680. [PMID: 30006691 DOI: 10.1245/s10434-018-6652-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sarcopenia, visceral obesity (VO), and reduced muscle radiodensity (myosteatosis) are suggested risk factors for postoperative morbidity in colorectal cancer (CRC), but usually are not concurrently assessed. Published thresholds used to define these features are not CRC-specific and are defined in relation to mortality, not postoperative outcomes. This study aimed to evaluate body composition in relation to length of hospital stay (LOS) and postoperative outcomes. METHODS Pre-surgical computed tomography (CT) images were assessed for total area and radiodensity of skeletal muscle and visceral adipose tissue in a pooled Canadian and UK cohort (n = 2100). Sex- and age-specific values for these features were calculated. For 1139 of 2100 patients, LOS data were available, and sex- and age-specific thresholds for sarcopenia, myosteatosis, and VO were defined on the basis of LOS. Association of CT-defined features with LOS and readmissions was explored using negative binomial and logistic regression models, respectively. RESULTS In the multivariable analysis, the predictors of LOS (P < 0.001) were age, surgical approach, major complications (incidence rate ratio [IRR] 2.42; 95% confidence interval [CI] 2.18-2.68), study cohort, and three body composition profiles characterized by myosteatosis combined with either sarcopenia (IRR, 1.27; 95% CI 1.12-1.43) or VO (IRR, 1.25; 95% CI 1.10-1.42), and myosteatosis combined with both sarcopenia and VO (IRR, 1.58; 95% CI 1.29-1.93). In the multivariable analysis, risk of readmission was associated with VO alone (odds ratio [OR] 2.66; 95% CI 1.18-6.00); P = 0.018), VO combined with myosteatosis (OR, 2.72; 95% CI 1.36-5.46; P = 0.005), or VO combined with myosteatosis and sarcopenia (OR, 2.98; 95% CI 1.06-5.46; P = 0.038). Importantly, the effect of body composition profiles on LOS and readmission was independent of major complications. CONCLUSION The findings showed that CT-defined multidimensional body habitus is independently associated with LOS and hospital readmission.
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Affiliation(s)
- Lisa Martin
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Jessica Hopkins
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.,Department of Oncology, 4023 Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Georgios Malietzis
- Department of Surgery, St. Mark's Hospital, Harrow, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - J T Jenkins
- Department of Surgery, St. Mark's Hospital, Harrow, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Michael B Sawyer
- Department of Oncology, 4023 Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Ron Brisebois
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Anthony MacLean
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Gregg Nelson
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Vickie E Baracos
- Department of Oncology, 4023 Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
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Hopkins JJ, Skubleny D, Bigam DL, Baracos VE, Eurich DT, Sawyer MB. Barriers to the Interpretation of Body Composition in Colorectal Cancer: A Review of the Methodological Inconsistency and Complexity of the CT-Defined Body Habitus. Ann Surg Oncol 2018; 25:1381-1394. [PMID: 29488190 DOI: 10.1245/s10434-018-6395-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Measurement of body composition by computed tomography (CT) is an advancing field. Sarcopenia, myosteatosis, and visceral obesity (VO) have been identified as predictive of survival in colorectal cancer (CRC). We performed a systematic review of contemporary studies to characterize this association and highlight methodological inconsistencies. METHODS MEDLINE and PubMed were queried for articles published from January 2000 on, with populations of resectable CRC and with CT-measured body composition and survival data. The study quality was assessed by two independent reviewers using the Newcastle-Ottawa Scale. RESULTS Twenty studies met inclusion criteria, with a total of 8895 patients. Only two of the studies scored as high quality and nine as moderate quality. The remaining nine studies scored as low quality. Ten studies considered sarcopenia and 12 considered visceral obesity (VO). Cutoff points to define sarcopenia, myosteatosis, and VO were identified by optimal stratification, quartiles, or median values. The prevalence of sarcopenia varied from 15 to 60%, which based on study population and cutoff value used. Sarcopenia was associated with worse overall and disease-free survival in eight of the included studies. Myosteatosis was considered in three studies with a prevalence of 19-78%. It was significantly predictive of worse overall and disease-free survival in all three studies. VO had a prevalence of 14-70% and was inconsistently predictive of survival outcomes. CONCLUSIONS There is a lack of methodological consistency within the currently published literature. Despite this, sarcopenia and myosteatosis, but not VO, are consistently associated with worse survival outcomes, when population and cancer-specific cutoffs are utilized.
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Affiliation(s)
- Jessica J Hopkins
- Department of Surgery, University of Alberta, Edmonton, AB, Canada. .,School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Daniel Skubleny
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - David L Bigam
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Vickie E Baracos
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Michael B Sawyer
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
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Paris MT, Furberg HF, Petruzella S, Akin O, Hötker AM, Mourtzakis M. Influence of Contrast Administration on Computed Tomography-Based Analysis of Visceral Adipose and Skeletal Muscle Tissue in Clear Cell Renal Cell Carcinoma. JPEN J Parenter Enteral Nutr 2018; 42:1148-1155. [PMID: 29350403 DOI: 10.1002/jpen.1067] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/24/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Computed tomography (CT) scans are being utilized to examine the influence of skeletal muscle and visceral adipose quantity and quality on health-related outcomes in clinical populations. However, little is known about the influence of contrast administration on these parameters. METHODS Precontrast, arterial, and 3-minute postcontrast CT images of 45 patients with clear cell renal cell carcinoma were downloaded from The Cancer Imaging Archive and retrospectively analyzed for visceral adipose cross-sectional area (CSA) and density, and muscle CSA and density at the third lumbar vertebrae. Low muscle CSA index was defined as ≤38.9 cm2 /m2 for women and ≤55.4 cm2 /m2 for men. Low muscle density was defined as <41 Hounsfield units (HU) for body mass index (BMI) <24.9 kg/m2 and <33 HU for BMI ≥25.0 kg/m2 . RESULTS In both the arterial and 3-minute phases, contrast administration decreased visceral adipose CSA (-20.9 and -20.9 cm2 ; P < .001) and increased visceral adipose density (4.8 and 5.8 HU; P < .001), relative to precontrast images. Muscle CSA index marginally increased in the arterial (0.6 cm2 /m2 ; P = .007) and 3-minute phases (0.8 cm2 /m2 ; P < .001). This likely represents clinically insignificant changes because it does not alter the identification of low muscle CSA (44.4% vs 42.2%; P = 1.00). Skeletal muscle density increased in the arterial (6.4 HU; P < .001) and 3-minute phases (8.7 HU; P < .001), which altered the identification of low muscle density (6.7% vs 31.1%; P < .001). CONCLUSIONS Future analyses should consider the phase of contrast during CT imaging because it may alter the interpretations of several parameters.
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Affiliation(s)
- Michael T Paris
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Helena F Furberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stacey Petruzella
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andreas M Hötker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marina Mourtzakis
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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Percentiles for skeletal muscle index, area and radiation attenuation based on computed tomography imaging in a healthy Caucasian population. Eur J Clin Nutr 2017; 72:288-296. [PMID: 29242526 PMCID: PMC5842880 DOI: 10.1038/s41430-017-0034-5] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/14/2017] [Accepted: 10/04/2017] [Indexed: 12/18/2022]
Abstract
Background/objectives Muscle mass is a key determinant of nutritional status and associated with outcomes in several patient groups. Computed tomography (CT) analysis is increasingly used to assess skeletal muscle area (SMA), skeletal muscle index (SMI) and muscle radiation attenuation (MRA). However, interpretation of these muscle parameters is difficult since values in a healthy population are lacking. The aim of this study was to provide sex specific percentiles for SMA, SMA and MRA in a healthy Caucasian population and to examine the association with age and BMI in order to define age- and BMI specific percentiles. Subjects/methods In this retrospective cross-sectional study CT scans of potential kidney donors were used to assess SMA, SMI and MRA at the level of the third lumbar vertebra. Sex specific distributions were described and, based on the association between age/BMI and muscle parameters, age, and BMI specific predicted percentiles were computed. The 5th percentile was considered as cut-off. Results CT scans of 420 Individuals were included (age range 20–82 years and BMI range 17.5–40.7 kg/m2). Sex specific cut-offs of SMA, SMI and MRA were 134.0 cm2, 41.6 cm2/m2 and 29.3 HU in men and 89.2 cm2, 32.0 cm2/m2 and 22.0 HU in women, respectively. Correlations were negative between age and all three muscle parameters, positive between BMI and SMA/SMI and negative between BMI and MRA, resulting in age- and BMI specific percentiles. Conclusions This study provides sex specific percentiles for SMA, SMI, and MRA. In addition, age- and BMI specific percentiles have been established.
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Derstine BA, Holcombe SA, Goulson RL, Ross BE, Wang NC, Sullivan JA, Su GL, Wang SC. Quantifying Sarcopenia Reference Values Using Lumbar and Thoracic Muscle Areas in a Healthy Population. J Nutr Health Aging 2017; 21:180-185. [PMID: 29300439 DOI: 10.1007/s12603-017-0983-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sarcopenia is defined as the loss of skeletal muscle mass and function associated with aging. Muscle mass can be reliably and accurately quantified using clinical CT scans but reference measurements are lacking, particularly in healthy US populations. METHODS Two-phase CT scans from healthy kidney donors (age 18-40) at the University of Michigan between 1999-2010 were utilized. Muscle mass was quantified using two thoracic and two lumbar muscle cross-sectional area (CSA) measures. Indexed measurements were computed as area divided by height-squared. Paired analyses of non-contrast and contrast phases and different Hounsfield Unit (HU) ranges for muscle were conducted to determine their effect on CSA muscle measures. We report the means, standard deviations, and 2SD sarcopenia cutoffs from this population. RESULTS Healthy population CSA (cm2) cutoffs for N=604 males/females respectively were: 34.7/20.9 (T12 Dorsal Muscle), 91.5/55.9 (T12 Skeletal Muscle), 141.7/91.2 (L3 Skeletal Muscle), 23.5/14.3 (L4 Total Psoas Area), and 23.4/14.3 (L4 Psoas Muscle Area). Height-indexed CSA (cm2/m2) cutoffs for males/females respectively were: 10.9/7.8 (T12 Dorsal Muscle), 28.7/20.6 (T12 Skeletal Muscle), 44.6/34.0 (L3 Skeletal Muscle), 7.5/5.2 (L4 Total Psoas Area), and 7.4/5.2 (L4 Psoas Muscle Area). We confirmed that a mask of -29 to 150 HU is optimal and shows no significant difference between contrast-enhanced and non-contrast CT scan CSA measurements. CONCLUSIONS We quantified reference values for lumbar and thoracic muscle CSA measures in a healthy US population. We defined the effect of IV contrast and different HU ranges for muscle. Combined, these results facilitate the extraction of clinically valuable data from the large numbers of existing scans performed for medical indications.
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Affiliation(s)
- B A Derstine
- S.C. Wang, Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA,
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