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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; 120:696-706. [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] [MESH Headings] [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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Thai ST, Lund JL, Poole C, Buse JB, Stürmer T, Harmon CA, Al-Obaidi M, Williams GR. Skeletal muscle density performance for screening frailty in older adults with cancer and the impact of diabetes: The CARE Registry. J Geriatr Oncol 2024; 15:101815. [PMID: 38896951 PMCID: PMC11346769 DOI: 10.1016/j.jgo.2024.101815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 05/30/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Skeletal muscle density (SMD) measurements from imaging scans identify myosteatosis and could screen patients for geriatric assessment. We assessed SMD performance as a screening tool to identify older adults with cancer likely to be frail and who could benefit from in-depth assessment; we compared performance by sex and diabetes status. MATERIALS AND METHODS We analyzed patients in the Cancer & Aging Resilience Evaluation (CARE) Registry. Frailty and diabetes were captured using a patient-reported geriatric assessment (CARE tool). Frailty was defined using CARE frailty index (CARE-FI) based on principles of deficit accumulation. SMD was calculated from computed tomography scans (L3 vertebrae). Analyses were conducted by sex and diabetes status. Scatterplots and linear regression described crude associations between SMD and frailty score. Classification performance (frail vs. non-frail) was analyzed with (1) area under the receiver operating characteristic curves (AUC) and confidence intervals (CIs); and (2) sensitivity/specificity for sex-specific SMD quartile cut-offs (Q1, median, Q3). Performance was compared between patients with and without diabetes using differences and estimated CIs (2000 bootstrap replicates). We additionally calculated positive and negative likelihood ratios (LR+, LR-). RESULTS The analytic cohort included 872 patients (39% female, median age 68 years, 27% with diabetes) with predominately stage III/IV gastrointestinal cancer; >60% planning to initiate first-line chemotherapy. SMD was negatively associated with frailty score; models were best fit in male patients with diabetes. AUC estimates for female (range: 0.58-0.62) and male (0.58-0.68) patients were low. Q3 cut-offs had high sensitivity (range: 0.76-0.89), but poor specificity (0.25-0.34). Diabetes did not impact estimates for female patients. Male patients with diabetes had greater sensitivity estimates compared to those without (sensitivity differences: 0.23 [0.07, 0.38], 0.08 [-0.07, 0.24], and 0.11 [0.00, 0.22] for Q1, median, Q3, respectively). LR estimates were most notable for male patients with diabetes (LR+ = 2.92, Q1 cut-off; LR- = 0.46, Q3 cut-off). DISCUSSION Using SMD alone to screen older patients for geriatric assessment requires improvement. High-sensitivity cut-off points could miss 11-24% of patients with frailty, and many non-frail patients may be flagged. Screening with SMD is practical but work is needed to understand clinical andresource impacts of different cut-off points. Future research should evaluate performance with additional clinical data and in subgroups.
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Affiliation(s)
- Sydney T Thai
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charles Poole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John B Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christian A Harmon
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
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Kim M, Lee SM, Son IT, Park T, Oh BY. Prognostic Value of Artificial Intelligence-Driven, Computed Tomography-Based, Volumetric Assessment of the Volume and Density of Muscle in Patients With Colon Cancer. Korean J Radiol 2023; 24:849-859. [PMID: 37634640 PMCID: PMC10462901 DOI: 10.3348/kjr.2023.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/03/2023] [Accepted: 06/28/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE The prognostic value of the volume and density of skeletal muscles in the abdominal waist of patients with colon cancer remains unclear. This study aimed to investigate the association between the automated computed tomography (CT)-based volume and density of the muscle in the abdominal waist and survival outcomes in patients with colon cancer. MATERIALS AND METHODS We retrospectively evaluated 474 patients with colon cancer who underwent surgery with curative intent between January 2010 and October 2017. Volumetric skeletal muscle index and muscular density were measured at the abdominal waist using artificial intelligence (AI)-based volumetric segmentation of body composition on preoperative pre-contrast CT images. Patients were grouped based on their skeletal muscle index (sarcopenia vs. not) and muscular density (myosteatosis vs. not) values and combinations (normal, sarcopenia alone, myosteatosis alone, and combined sarcopenia and myosteatosis). Postsurgical disease-free survival (DFS) and overall survival (OS) were analyzed using univariable and multivariable analyses, including multivariable Cox proportional hazard regression. RESULTS Univariable analysis showed that DFS and OS were significantly worse for the sarcopenia group than for the non-sarcopenia group (P = 0.044 and P = 0.003, respectively, by log-rank test) and for the myosteatosis group than for the non-myosteatosis group (P < 0.001 by log-rank test for all). In the multivariable analysis, the myosteatotic muscle type was associated with worse DFS (adjusted hazard ratio [aHR], 1.89 [95% confidence interval, 1.25-2.86]; P = 0.003) and OS (aHR, 1.90 [95% confidence interval, 1.84-3.04]; P = 0.008) than the normal muscle type. The combined muscle type showed worse OS than the normal muscle type (aHR, 1.95 [95% confidence interval, 1.08-3.54]; P = 0.027). CONCLUSION Preoperative volumetric sarcopenia and myosteatosis, automatically assessed from pre-contrast CT scans using AI-based software, adversely affect survival outcomes in patients with colon cancer.
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Affiliation(s)
- Minsung Kim
- Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, CHA University Gangnam Medical Center, Seoul, Republic of Korea
| | - Il Tae Son
- Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Taeyong Park
- Medical Artificial Intelligence Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Bo Young Oh
- Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
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Park SH. Looking Ahead to 2022 for the Korean Journal of Radiology. Korean J Radiol 2022; 23:6-9. [PMID: 34983089 PMCID: PMC8743157 DOI: 10.3348/kjr.2021.0844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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