1
|
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.
Collapse
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
| |
Collapse
|
2
|
Bang MJ, Lee S, Lee JW, Kim W, Sung KW, Seo JM. Sarcopenia with decreased total psoas muscle area in children with high-risk neuroblastoma. Asian J Surg 2024; 47:2584-2588. [PMID: 38519312 DOI: 10.1016/j.asjsur.2024.03.009] [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: 12/04/2023] [Revised: 02/25/2024] [Accepted: 03/01/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND We calculated psoas muscle area (PMA) z-scores in high-risk neuroblastoma patients undergoing treatment to examine the clinical significance of sarcopenia in this cohort. METHODS We analyzed retrospective data from patients aged 0-18 who were diagnosed with abdominal neuroblastoma between 2005 and 2019 at Samsung Medical Center. Patients categorized as high-risk undergone induction chemotherapy, neuroblastoma excision, and tandem high-dose chemotherapy with autologous stem cell transplantation (HDCT/auto-SCT) were selected. L3-4 lumbar levels on axial CT images were identified and we measured the areas of the left and right psoas muscles to determine tPMA. Total PMA z-scores were calculated using an open online tool. RESULTS There were 45 boys and 25 girls with a mean age of 3.86 years. CT images taken at initial diagnosis and after tandem HDCT/auto-SCT were selected to calculate tPMA z-scores. Mean elapsed time between the two measurements was 12.91 ± 1.73 months. Mean tPMA z-score significantly decreased from -0.21 ± 1.29 to -0.66 ± 0.97 (p = 0.022). Length of hospital stay was significantly longer in the group of patients whose tPMA z-scores decreased by more than .45 (177.62 ± 28.82 days vs. 165.75 ± 21.34 days, p = 0.049). Presence of sarcopenia at initial diagnosis was a significant risk factor for bacterial infection during neuroblastoma treatment. CONCLUSION tPMA z-scores in high-risk neuroblastoma patients decreased significantly following a treatment regimen that included induction chemotherapy, tumor resection surgery, and HDCT/auto-SCT. A greater decrease in tPMA z-score was associated with longer hospital stay during treatment.
Collapse
Affiliation(s)
- Min-Jung Bang
- Division of Pediatric Surgery, Ajou Medical Center, University of Ajou College of Medicine, Suwon, South Korea
| | - Sanghoon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Wontae Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong-Meen Seo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
3
|
da Silva RC, Chaves GV, Bergmann A, Frajacomo FTT. Assessment of myosteatosis and functionality in pretreatment gynecological cancer patients. Support Care Cancer 2024; 32:339. [PMID: 38733544 DOI: 10.1007/s00520-024-08558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE We aimed to investigate the relationship between pretreatment gynecologic cancer survival and the physical function of patients with myosteatosis. Understanding this relationship prior to treatment would help healthcare providers identify and refer patients with poor muscle quality to an exercise program prior to treatment. METHODS We conducted a cross-sectional analysis of 73 GC patients. Physical function was quantified using handgrip strength and an adapted version of the Senior Fitness Test (aerobic endurance not included). The EORTC QLC-C30 was used to evaluate general health quality. Myosteatosis (values below the median muscle radiodensity), muscle mass, and adipose tissue variables were calculated from the computed tomography (CT) scan at the third lumbar vertebra using specific software. RESULTS Seventy patients (50.9 ± 15.2) were included; 41.5% had stage III or IV disease, and 61.4% had cervical cancer. The myosteatosis group was 11.9 years older and showed reduced functioning compared to the normal-radiodensity group. Age and Timed Up and Go (TUG) test results were shown to be the most reliable predictors of muscle radiodensity in pretreatment gynecological patients according to multivariate regression analysis (R2 = 0.314). CONCLUSION Gynecological healthcare professionals should be aware that prompt exercise programs might be especially beneficial for older patients with reduced TUG performance to preserve muscle function and quality.
Collapse
Affiliation(s)
- Regielly Candido da Silva
- Program of Molecular Carcinogenesis, Brazilian National Cancer Institute, Andre Cavalcanti Av. 37, Rio de Janeiro, 20231050, Brazil
| | - Gabriela Villaça Chaves
- Department of Nutrition and Dietetics, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Anke Bergmann
- Program of Molecular Carcinogenesis, Brazilian National Cancer Institute, Andre Cavalcanti Av. 37, Rio de Janeiro, 20231050, Brazil
| | - Fernando Tadeu Trevisan Frajacomo
- Program of Molecular Carcinogenesis, Brazilian National Cancer Institute, Andre Cavalcanti Av. 37, Rio de Janeiro, 20231050, Brazil.
| |
Collapse
|
4
|
Jang MK, Park S, Raszewski R, Park CG, Doorenbos AZ, Kim S. Prevalence and clinical implications of sarcopenia in breast cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:328. [PMID: 38702479 DOI: 10.1007/s00520-024-08532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 04/27/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE The impact of sarcopenia in oncology is increasingly recognized, yet little is known about its clinical implications in breast cancer. This systematic review and meta-analysis estimates the overall prevalence of sarcopenia in breast cancer, quantifies skeletal muscle index (SMI), and comprehensively evaluates sarcopenia's impact on clinical outcomes. METHODS We systematically searched primary original research published before June 2023 in four databases: the Cochrane Library via Wiley, CINAHL Plus with Full Text, Embase via Elsevier Excerpta Medica, and Medline via Ovid. Standardized mean SMI and 95% confidence interval (CI) were calculated by applying the random-effects model. The methodological quality of the included studies was assessed using the National Institutes of Health quality assessment checklist. RESULTS The systematic review included 17 studies with a total of 9863 patients; the meta-analysis included 12 of these studies. The mean prevalence of sarcopenia in breast cancer (stages I-III) was 32.5%. The mean SMI assessed by CT was 43.94 cm2/m2 (95% CI 42.87, 45.01; p < .01). Overall, low muscle mass was associated with chemotherapy toxicities, dose reductions, dose delays, or treatment discontinuation. Low muscle mass was generally associated with poor survival, but in some studies, this association was not significant or reversed direction. CONCLUSION Sarcopenia is not just a state of muscle mass loss, but an influencing factor on therapeutic effects and survival rates in oncology. It is thus necessary to recognize the risk of sarcopenia throughout the trajectory of cancer treatment, identify low muscle mass early, and manage it from a prehabilitation perspective.
Collapse
Affiliation(s)
- Min Kyeong Jang
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea.
| | - Sungwon Park
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca Raszewski
- Library of the Health Sciences-Chicago, University of Illinois Chicago, Chicago, IL, USA
| | - Chang Gi Park
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Ardith Z Doorenbos
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Sue Kim
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| |
Collapse
|
5
|
Kawano T, Nankaku M, Murao M, Yuri T, Kitamura G, Goto K, Kuroda Y, Kawai T, Okuzu Y, Ikeguchi R, Matsuda S. Association of physical activity with fatty infiltration of muscles after total hip arthroplasty. Skeletal Radiol 2024; 53:967-974. [PMID: 37999749 DOI: 10.1007/s00256-023-04516-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE This study aimed to investigate the association between muscle density as an indicator of fatty infiltration of lower extremity muscles and physical activity (PA) after total hip arthroplasty (THA) and identify the patient characteristics with high postoperative PA. METHODS This study included 62 female patients who underwent THA for unilateral hip osteoarthritis. Muscle density of the gluteus maximus, gluteus medius, iliopsoas, and quadriceps muscles was measured using computed tomography (CT). PA was assessed using University of California, Los Angeles (UCLA) activity scores. CT and UCLA activity score were obtained before and 1 year after THA. The patients were divided into two groups, sufficient (score ≥ 6) and insufficient (score < 6) activity groups, based on their level of PA as determined by their UCLA activity score 1 year after THA. The association of PA with the amount of changes in muscle density was examined with Spearman's rank correlation coefficient. Logistic regression analysis was performed to identify postoperative factors determining PA at 1 year after THA. RESULTS Spearman's rank correlation coefficient showed a significantly positive association between recovery in PA and an increase in muscle density of the gluteus maximus, gluteus medius, iliopsoas, and quadriceps muscles. Additionally, logistic regression analysis confirmed that postoperative muscle densities of the gluteus maximus and quadriceps muscles were variables determining the PA 1 year after THA. CONCLUSION The findings of this study indicated that the improvement of fatty infiltration in lower limb muscles, especially in the gluteus maximus and quadriceps, is likely to promote the increase in postoperative PA.
Collapse
Affiliation(s)
- Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masanobu Murao
- Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Takuma Yuri
- Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Gakuto Kitamura
- Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yaichiro Okuzu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
6
|
Wu M, Liu C, Sun D. Glucocorticoid-Induced Myopathy: Typology, Pathogenesis, Diagnosis, and Treatment. Horm Metab Res 2024; 56:341-349. [PMID: 38224966 DOI: 10.1055/a-2246-2900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Glucocorticoid-induced myopathy is a non-inflammatory toxic myopathy typified by proximal muscle weakness, muscle atrophy, fatigue, and easy fatigability. These vague symptoms coupled with underlying disorders may mask the signs of glucocorticoid-induced myopathy, leading to an underestimation of the disease's impact. This review briefly summarizes the classification, pathogenesis, and treatment options for glucocorticoid-induced muscle wasting. Additionally, we discuss current diagnostic measures in clinical research and routine care used for diagnosing and monitoring glucocorticoid-induced myopathy, which includes gait speed tests, muscle strength tests, hematologic tests, bioelectrical impedance analysis (BIA), dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI), electromyography, quantitative muscle ultrasound, histological examination, and genetic analysis. Continuous monitoring of patients receiving glucocorticoid therapy plays an important role in enabling early detection of glucocorticoid-induced myopathy, allowing physicians to modify treatment plans before significant clinical weakness arises.
Collapse
Affiliation(s)
- Mengmeng Wu
- Department of Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
- Graduate School, Xuzhou Medical University, Xuzhou, China
| | - Caixia Liu
- Department of Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | - Dong Sun
- Department of Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
- Department of Internal Medicine and Diagnostics, Xuzhou Medical University, Xuzhou, China
| |
Collapse
|
7
|
Yang D, Su L, Zhang L, Zhang Y, Li Y, Huang T, Huang X. Sarcopenia predicts postoperative complications in head and neck cancer: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08577-1. [PMID: 38647686 DOI: 10.1007/s00405-024-08577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/19/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE We performed this systematic review and meta-analysis to explore the impact of preoperative sarcopenia on postoperative complication risks after head and neck cancer (HNC) surgery. METHODS We identified eligible studies by searching Ovid-MEDLINE, Ovid-Embase, EBM Reviews-Cochrane Central Register of Controlled Trials, Web of Science Core Collection, and Scopus. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. RESULTS Twenty-one studies with a total of 3480 patients met our inclusion criteria. The presence of sarcopenia significantly increased the incidence of overall postoperative complications (OR = 1.72, 95% CI 1.23, 2.41; P = 0.002; I2 = 59%). Subgroup analyses showed a higher risk of postoperative complications in the populations in which sarcopenia was diagnosed with low L3-skeletal muscle index (L3-SMI) or low cross-sectional area of the rectus femoris, but not in the group that sarcopenia was diagnosed with low C3-SMI. Preoperative sarcopenia also substantially increased the risk of severe postoperative complications (OR = 2.26), pharyngocutaneous fistulas (OR = 2.15), free flap-related complications (OR = 1.63), and surgical site infections (OR = 1.84). We also found a tendency toward a higher incidence of wound complications and 30-day mortality in patients with sarcopenia. CONCLUSION Preoperative sarcopenia is a negative prognostic indicator for postoperative complications in patients with HNC after surgery. To reduce the incidence of postoperative complications and improve poor prognosis, further attention needs to be paid to the evaluation and management of preoperative sarcopenia.
Collapse
Affiliation(s)
- Dan Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lin Su
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Liying Zhang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yu Zhang
- Department of Biomedical Engineering, Sichuan University Library, Chengdu, 610041, Sichuan, China
| | - Yina Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tingxuan Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiaoli Huang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
8
|
Chen J, Li Y, Li C, Song T. Myosteatosis is associated with poor survival after kidney transplantation: a large retrospective cohort validation. Abdom Radiol (NY) 2024; 49:1210-1222. [PMID: 38326665 DOI: 10.1007/s00261-023-04180-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] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE We aim to establish diagnostic thresholds of sarcopenia and myosteatosis based on CT measurements, and to validate their prognostic value in a large cohort of kidney transplant recipients. METHODS Local healthy population with abdominal CT between 2010 and 2022, and patients underwent kidney transplantation between 2015 and 2019 at our center were retrospectively included. The skeletal muscle index and muscle attenuation of abdominal muscles were calculated based on CT image at the middle of the third lumbar vertebra. Primary endpoints included all-cause mortality and death censored allograft survival. RESULTS Age- and sex-specific thresholds for sarcopenia and myosteatosis were established based on 1598 healthy local population. The final patient cohort consisted of 992 kidney transplant recipients (median age 34 years, interquartile range 28-44 years; 694 males), including 33 (3.3%) with sarcopenia and 95 (9.5%) with myosteatosis. Multivariate analysis revealed myosteatosis (adjusted hazard ratio = 3.08, p = 0.022) was an independent baseline risk factor of mortality after adjusting for age, the history of cancer, and the history of cardiovascular event. Multivariate analysis found preemptive transplantation (adjusted hazard ratio = 0.36, p = 0.037) was an independent protective factor of allograft loss. No difference was found in the prognosis between kidney transplant recipients with and without sarcopenia. CONCLUSION Myosteatosis was an independent risk factor of mortality after kidney transplantation, but sarcopenia was not. Neither sarcopenia nor myosteatosis was associated with graft loss.
Collapse
Affiliation(s)
- Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Yue Li
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
- Transplant Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Chengjie Li
- Department of Radiology, Chongqing Southeast Hospital, No. 98, Tongjiang Avenue, Nan'an District, Chongqing, China
| | - Turun Song
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
- Transplant Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
| |
Collapse
|
9
|
Liu FP, Guo MJ, Yang Q, Li YY, Wang YG, Zhang M. Myosteatosis is associated with coronary artery calcification in patients with type 2 diabetes. World J Diabetes 2024; 15:429-439. [PMID: 38591084 PMCID: PMC10999038 DOI: 10.4239/wjd.v15.i3.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/19/2023] [Accepted: 02/20/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Myosteatosis, rather than low muscle mass, is the primary etiologic factor of sarcopenia in patients with type 2 diabetes mellitus (T2DM). Myosteatosis may lead to a series of metabolic dysfunctions, such as insulin resistance, systematic inflammation, and oxidative stress, and all these dysfunctions are closely associated with the acceleration of T2DM and atherosclerosis. AIM To investigate the association between myosteatosis and coronary artery calcification (CAC) in patients with T2DM. METHODS Patients with T2DM, who had not experienced major cardiovascular events and had undergone both abdominal and thoracic computed tomography (CT) scans, were included. The mean skeletal muscle attenuation was assessed using abdominal CT images at the L3 level. The CAC score was determined from thoracic CT images using the Agatston scoring method. Myosteatosis was diagnosed according to Martin's criteria. Severe CAC (SCAC) was defined when the CAC score exceeded 300. Logistic regression and decision tree analyses were performed. RESULTS A total of 652 patients with T2DM were enrolled. Among them, 167 (25.6%) patients had SCAC. Logistic regression analysis demonstrated that myosteatosis, age, duration of diabetes, cigarette smoking, and alcohol consumption were independent risk factors of SCAC. Myosteatosis was significantly associated with an increased risk of SCAC (OR = 2.381, P = 0.003). The association between myosteatosis and SCAC was significant in the younger patients (OR = 2.672, 95%CI: 1.477-4.834, P = 0.002), but not the older patients (OR = 1.456, 95%CI: 0.863-2.455, P = 0.188), and was more prominent in the population with lower risks of atherosclerosis. The decision tree analyses prioritized older age as the primary variable for SCAC. In older patients, cigarette smoking was the main contributing factor for SCAC, while in younger patients, it was myosteatosis. CONCLUSION Myosteatosis is a novel risk factor for atherosclerosis in patients with T2DM, especially in the population with younger ages and fewer traditional risk factors.
Collapse
Affiliation(s)
- Fu-Peng Liu
- The Affiliated Hospital of Medical College Qingdao University, Qingdao University, Qingdao 266071, Shandong Province, China
- Department of Endocrinology, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| | - Mu-Jie Guo
- Department of Medical Imaging, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| | - Qing Yang
- Department of Clinical Nutrition, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| | - Yan-Ying Li
- Department of Endocrinology, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| | - Yan-Gang Wang
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Mei Zhang
- Department of Endocrinology, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| |
Collapse
|
10
|
Iida H, Takegami Y, Osawa Y, Funahashi H, Ozawa Y, Ido H, Asamoto T, Otaka K, Tanaka S, Imagama S. Association of mid-thigh quadriceps muscle quality with postoperative outcomes in patients with hip osteoarthritis undergoing total hip arthroplasty: a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06142-3. [PMID: 38472467 DOI: 10.1007/s00264-024-06142-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Muscle quality is more important than muscle mass for assessing physical function. Computed tomography (CT) is used to evaluate intramuscular fatty infiltration. The mid-thigh quadriceps CT attenuation values (CTV) expressed in Hounsfield units (HU) negatively correlate with physical function. Patients with hip osteoarthritis (HOA) have lower extremity muscle atrophy, including decreased cross-sectional area (CSA), CTV, and muscle strength. Using preoperative CT images, we investigated the association between mid-thigh quadriceps CSA, CTV, and postoperative outcomes in patients with HOA. METHODS This study included 62 patients who had unilateral HOA (62 hips) and underwent total hip arthroplasty (THA). We investigated the association between preoperative and postoperative Japanese Orthopaedic Association (JOA) hip scores, 12-item Short Form survey (SF-12), mid-thigh quadriceps CSA, and CTV. RESULTS The mean age was 64.7 ± 10.1 years, with 15 men (24.2%), and the mean body mass index was 24.3 ± 4.3 kg/m2. Secondary HOA was present in 79.0% of patients. The mean CSA and CTV of the mid-thigh quadriceps on the operative side were 38.8 ± 9.8 cm2 and 40.3 ± 7.8 HU, respectively. Multiple regression analyses adjusted for age and sex showed that preoperative mid-thigh quadriceps CSA was not associated with preoperative and postoperative JOA hip scores or SF-12. The preoperative mid-thigh quadriceps CTV was associated with the postoperative JOA hip score in the gait ability domain and SF-12 in the physical component summary domain. CONCLUSION Preoperative muscle quality is associated with postoperative outcomes in patients who have HOA regardless of age and sex.
Collapse
Affiliation(s)
- Hiroki Iida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8560, Japan
| | - Yasuhiko Takegami
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8560, Japan.
| | - Yusuke Osawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8560, Japan
| | - Hiroto Funahashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8560, Japan
| | - Yuto Ozawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8560, Japan
| | - Hiroaki Ido
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8560, Japan
| | - Takamune Asamoto
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8560, Japan
| | - Keiji Otaka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8560, Japan
| | - Shinya Tanaka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8560, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8560, Japan
| |
Collapse
|
11
|
Yao L, Petrosyan A, Chaudhari AJ, Lenchik L, Boutin RD. Clinical, functional, and opportunistic CT metrics of sarcopenia at the point of imaging care: analysis of all-cause mortality. Skeletal Radiol 2024; 53:515-524. [PMID: 37684434 PMCID: PMC10841085 DOI: 10.1007/s00256-023-04438-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: 05/28/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE This study examines clinical, functional, and CT metrics of sarcopenia and all-cause mortality in older adults undergoing outpatient imaging. METHODS The study included outpatients ≥ 65 years of age undergoing CT or PET/CT at a tertiary care institution. Assessments included screening questionnaires for sarcopenia (SARC-F) and frailty (FRAIL scale), and measurements of grip strength and usual gait speed (6 m course). Skeletal muscle area (SMA), index (SMI, area/height2) and density (SMD) were measured on CT at T12 and L3. A modified SMI was also examined (SMI-m, area/height). Mortality risk was studied with Cox proportional hazard analysis. RESULTS The study included 416 patients; mean age 73.8 years [sd 6.2]; mean follow-up 2.9 years (sd 1.34). Abnormal grip, SARC-F, and FRAIL scale assessments were associated with higher mortality risk (HR [95%CI] = 2.0 [1.4-2.9], 1.6 [1.1-2.3], 2.0 [1.4-2.8]). Adjusting for age, higher L3-SMA, T12-SMA, T12-SMI and T12-SMI-m were associated with lower mortality risk (HR [95%CI] = 0.80 [0.65-0.90], 0.76 [0.64-0.90], 0.84 [0.70-1.00], and 0.80 [0.67-0.90], respectively). T12-SMD and L3-SMD were not predictive of mortality. After adjusting for abnormal grip strength and FRAIL scale assessments, T12-SMA and T12-SMI-m remained predictive of mortality risk (HR [95%CI] = 0.83 [0.70-1.00] and 0.80 [0.67-0.97], respectively). CONCLUSION CT areal metrics were weaker predictors of all-cause mortality than clinical and functional metrics of sarcopenia in our older patient cohort; a CT density metric (SMD) was not predictive. Of areal CT metrics, SMI (area/height2) appeared to be less effective than non-normalized SMA or SMA normalized by height1.
Collapse
Affiliation(s)
- Lawrence Yao
- Radiology and Imaging Sciences/CC/NIH, 10 Center Drive, Bethesda, MD, 20892, USA.
| | | | - Abhijit J Chaudhari
- University of California, Davis 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Leon Lenchik
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Robert D Boutin
- Stanford University School of Medicine, 300 Pasteur Drive, MC-5105, Stanford, CA, 94305, USA
| |
Collapse
|
12
|
Sabatino A, Sola KH, Brismar TB, Lindholm B, Stenvinkel P, Avesani CM. Making the invisible visible: imaging techniques for assessing muscle mass and muscle quality in chronic kidney disease. Clin Kidney J 2024; 17:sfae028. [PMID: 38444750 PMCID: PMC10913944 DOI: 10.1093/ckj/sfae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Indexed: 03/07/2024] Open
Abstract
Muscle wasting and low muscle mass are prominent features of protein energy wasting (PEW), sarcopenia and sarcopenic obesity in patients with chronic kidney disease (CKD). In addition, muscle wasting is associated with low muscle strength, impaired muscle function and adverse clinical outcomes such as low quality of life, hospitalizations and increased mortality. While assessment of muscle mass is well justified, the assessment of skeletal muscle should go beyond quantity. Imaging techniques provide the means for non-invasive, comprehensive, in-depth assessment of the quality of the muscle such as the infiltration of ectopic fat. These techniques include computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Dual energy X-ray absorptiometry is also an imaging technique, but one that only provides quantitative and not qualitative data on muscle. The main advantage of imaging techniques compared with other methods such as bioelectrical impedance analysis and anthropometry is that they offer higher precision and accuracy. On the other hand, the higher cost for acquiring and maintaining the imaging equipment, especially CT and MRI, makes these less-used options and available mostly for research purposes. In the field of CKD and end-stage kidney disease (ESKD), imaging techniques are gaining attention for evaluating muscle quantity and more recently muscle fat infiltration. This review describes the potential of these techniques in CKD and ESKD settings for muscle assessment beyond that of muscle quantity.
Collapse
Affiliation(s)
- Alice Sabatino
- Department of Nephrology, Parma University Hospital, Parma, Italy
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institute, Stockholm, Sweden
| | - Kristoffer Huitfeldt Sola
- Unit of Radiology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, and Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Torkel B Brismar
- Unit of Radiology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, and Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institute, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institute, Stockholm, Sweden
| | - Carla Maria Avesani
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
13
|
Nachit M, Dioguardi Burgio M, Abyzov A, Garteiser P, Paradis V, Vilgrain V, Leclercq I, Van Beers BE. Hepatocellular carcinoma in patients with non-alcoholic fatty liver disease is associated with heterogeneous pattern of fat infiltration in skeletal muscles. Eur Radiol 2024; 34:1461-1470. [PMID: 37658893 DOI: 10.1007/s00330-023-10131-2] [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: 07/13/2022] [Revised: 05/20/2023] [Accepted: 07/04/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES To evaluate the association between fat infiltration in skeletal muscles (myosteatosis) and hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). METHODS In a cross-sectional cohort of 72 histologically proven NAFLD patients (n = 38 with non-alcoholic steatohepatitis; NASH), among which 20 had HCC diagnosed on biopsy, we used proton density fat fraction (PDFF) at MRI to evaluate myosteatosis in skeletal muscles (mean fat fraction and first order radiomic-based pattern) at the third lumbar level, namely in erector spinae (ES), quadratus lumborum (QL), psoas, oblique, and rectus muscles. RESULTS PDFFES was 70% higher in patients with HCC when compared to those without HCC (9.6 ± 5.5% versus 5.7 ± 3.0%, respectively, p < 0.001). In multivariate logistic regression, PDFFES was a significant predictor of the presence of HCC (AUC = 0.72, 95% CI 0.57-0.86, p = 0.002) independently from age, sex, visceral fat area, and liver fibrosis stage (all p < 0.05). The relationship between PDFFES and HCC was exacerbated in patients with NASH (AUC = 0.79, 95% CI 0.63-0.86, p = 0.006). In patients with NASH, radiomics features of heterogeneity such as energy and entropy in any of the paraspinal muscles (i.e., ES, QL, or psoas) were independent predictors of HCC. EnergyES identified patients with HCC (n = 13) in the NASH population with AUC = 0.92 (95% CI 0.82-1.00, p < 0.001). CONCLUSION In patients with NAFLD, and more specifically in those with NASH, the degree and heterogeneity of myosteatosis is independently associated with HCC irrespective of liver fibrosis stage. CLINICAL RELEVANCE STATEMENT Our data suggest that myosteatosis could be used as a biomarker of HCC in the ever-expanding NAFLD population and pave the way for further investigation in longitudinal studies. KEY POINTS • HCC in patients with non-alcoholic fatty liver disease, and more specifically in those with non-alcoholic steatohepatitis, is independently associated with severe fatty infiltration (myosteatosis) of paravertebral skeletal muscles. • Association between myosteatosis and HCC is independent from liver fibrosis stage. • Histogram-based radiomics features of myosteatosis predicts the risk of HCC in patients with non-alcoholic steatohepatitis.
Collapse
Affiliation(s)
- Maxime Nachit
- Laboratory of Hepato-Gastroenterology, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium.
- Department of Imaging and Pathology, KU Leuven, Louvain, Belgium.
| | - Marco Dioguardi Burgio
- Laboratory of Imaging Biomarkers, Center of Research On Inflammation, Université Paris Cité, Inserm, Paris, France
- Department of Radiology, Beaujon University Hospital Paris Nord, AP-HP, Clichy, France
| | - Anton Abyzov
- Laboratory of Imaging Biomarkers, Center of Research On Inflammation, Université Paris Cité, Inserm, Paris, France
| | - Philippe Garteiser
- Laboratory of Imaging Biomarkers, Center of Research On Inflammation, Université Paris Cité, Inserm, Paris, France
| | - Valérie Paradis
- Team "From Inflammation to Cancer in Digestive Disease", Center of Research on Inflammation, Université Paris Cité, Inserm, Paris, France
- Department of Pathology, Beaujon University Hospital Paris Nord, AP-HP, Clichy, France
| | - Valérie Vilgrain
- Laboratory of Imaging Biomarkers, Center of Research On Inflammation, Université Paris Cité, Inserm, Paris, France
- Department of Radiology, Beaujon University Hospital Paris Nord, AP-HP, Clichy, France
| | - Isabelle Leclercq
- Laboratory of Hepato-Gastroenterology, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Bernard E Van Beers
- Laboratory of Imaging Biomarkers, Center of Research On Inflammation, Université Paris Cité, Inserm, Paris, France
- Department of Radiology, Beaujon University Hospital Paris Nord, AP-HP, Clichy, France
| |
Collapse
|
14
|
Bellone F, Sardella A, Muscianisi M, Basile G. Fatigue, sarcopenia, and frailty in older adults with inflammatory bowel disease. Minerva Gastroenterol (Torino) 2024; 70:79-88. [PMID: 33988010 DOI: 10.23736/s2724-5985.21.02886-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inflammatory bowel diseases (IBDs) are characterized by a multifactorial clinical picture, in which age-related physical, functional and psychological symptoms may coexist. The accurate evaluation and identification of such symptomatology acquires considerable importance in the context of older adults, since those core factors typical of IBD may also expose older patients to an increased risk for age-related negative outcomes, such as frailty and disability. The purpose of the present review was to provide an updated overview on the evaluation and management of IBD in the elderly population, with regard to fatigue, sarcopenia, and frailty. The assessment of fatigue might contribute to the identification of early symptoms of IBD, such as pain and mood disorders, which should be treated timely to offer elderly patient a better quality of life. Similarly, an accurate evaluation of sarcopenia might represent a useful Prognostic Index to identify those patients at risk of developing physical frailty. Frailty in IBD should be evaluated not only in relation to the occurrence of negative outcomes, but also should be considered itself as an outcome itself in IBD. A recommendation for future research on this topic might be the implementation of randomized trials, which include older adults and evaluate fatigue, sarcopenia, and frailty. Similarly, the development of tailored intervention programs, based on both physical and psychological outcomes, with the purpose of improving patients' adaptation to the disease, and monitoring the evolution of symptoms and the response to therapies over time, should be encouraged.
Collapse
Affiliation(s)
- Federica Bellone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marco Muscianisi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giorgio Basile
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy -
| |
Collapse
|
15
|
Medici F, Ferioli M, Cammelli S, Forlani L, Laghi V, Ma J, Cilla S, Buwenge M, Macchia G, Deodato F, Vadalà M, Malizia C, Tagliaferri L, Perrone AM, De Iaco P, Strigari L, Bazzocchi A, Rizzo S, Arcelli A, Morganti AG. Sarcopenic Obesity in Cervical Carcinoma: A Strong and Independent Prognostic Factor beyond the Conventional Predictors (ESTHER Study-AFRAID Project). Cancers (Basel) 2024; 16:929. [PMID: 38473291 DOI: 10.3390/cancers16050929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Locally advanced cervical cancer represents a significant treatment challenge. Body composition parameters such as body mass index, sarcopenia, and sarcopenic obesity, defined by sarcopenia and BMI ≥ 30 kg/m2, have been identified as potential prognostic factors, yet their overall impact remains underexplored. This study assessed the relationship between these anthropometric parameters alongside clinical prognostic factors on the prognosis of 173 cervical cancer patients. Survival outcomes in terms of local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were analyzed using Kaplan regression methods-Meier and Cox. Older age, lower hemoglobin levels, higher FIGO (International Federation of Gynecology and Obstetrics) stages, and lower total radiation doses were significantly associated with worse outcomes. Univariate analysis showed a significant correlation between BMI and the outcomes examined, revealing that normal-weight patients show higher survival rates, which was not confirmed by the multivariate analysis. Sarcopenia was not correlated with any of the outcomes considered, while sarcopenic obesity was identified as an independent negative predictor of DFS (HR: 5.289, 95% CI: 1.298-21.546, p = 0.020) and OS (HR: 2.645, 95% CI: 1.275-5.488, p = 0.009). This study highlights the potential of sarcopenic obesity as an independent predictor of clinical outcomes. These results support their inclusion in prognostic assessments and treatment planning for patients with advanced cervical cancer.
Collapse
Affiliation(s)
- Federica Medici
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Martina Ferioli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Silvia Cammelli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Ludovica Forlani
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Viola Laghi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Johnny Ma
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy
| | - Maria Vadalà
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Anna Myriam Perrone
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), CH-6500 Lugano, Switzerland
| | - Alessandra Arcelli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| |
Collapse
|
16
|
Hatzantonis C, Satkunam L, Rabey KN, Hocking JC, Agur AMR. Fatty infiltration of gastrocnemius-soleus muscle complex: Considerations for myosteatosis rehabilitation. J Anat 2024. [PMID: 38361481 DOI: 10.1111/joa.14025] [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: 10/26/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/17/2024] Open
Abstract
Although previous studies have reported fatty infiltration of the gastrocnemius-soleus complex, little is known about the volumetric distribution and patterns of fatty infiltration. The purpose of this anatomical study was to document and quantify the frequency, distribution, and pattern of fatty infiltration of the gastrocnemius-soleus complex. One hundred formalin-embalmed specimens (mean age 78.1 ± 12.3 years; 48F/52M) were serially dissected to document the frequency, distribution, and pattern of fatty infiltration in the medial and lateral heads of gastrocnemius and soleus muscles. Fatty infiltration was found in 23% of specimens, 13 unilaterally (8F/5M) and 10 (5M/5F) bilaterally. The fatty infiltration process was observed to begin medially from the medial aspect of the medial head of gastrocnemius and medial margin of soleus and then progressed laterally throughout the medial head of gastrocnemius and the marginal, anterior, and posterior soleus. The lateral head of gastrocnemius remained primarily muscular in all specimens. Microscopically, the pattern of infiltration was demonstrated as intramuscular with intact aponeuroses, and septa. The remaining endo-, peri-, and epimysium preserved the overall contour of the gastrocnemius-soleus complex, even in cases of significant fatty replacement. Since the external contour of the calf is preserved, the presence of fatty infiltration may be underdiagnosed in the clinic without imaging. Myosteatosis is associated with gait and balance challenges in the elderly, which can impact quality of life and result in increased risk of falling. The findings of the study have implications in the rehabilitation management of elderly patients with sarcopenia and myosteatosis.
Collapse
Affiliation(s)
| | - Lalith Satkunam
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Karyne N Rabey
- Division of Anatomy, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer C Hocking
- Division of Anatomy, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Anne M R Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
17
|
Rentz LE, Malone BM, Vettiyil B, Sillaste EA, Mizener AD, Clayton SA, Pistilli EE. New Perspectives for Estimating Body Composition From Computed Tomography: Clothing Associated Artifacts. Acad Radiol 2024:S1076-6332(24)00013-8. [PMID: 38355363 DOI: 10.1016/j.acra.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Lauren E Rentz
- Division of Exercise Physiology, Department of Human Performance, West Virginia University School of Medicine, Morgantown, West Virginia 26505, USA; Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA
| | - Briauna M Malone
- Division of Exercise Physiology, Department of Human Performance, West Virginia University School of Medicine, Morgantown, West Virginia 26505, USA
| | - Beth Vettiyil
- Section of Musculoskeletal Radiology, Department of Radiology, West Virginia University, Morgantown, West Virginia 26506, USA
| | - Erik A Sillaste
- Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA; College of Health and Human Sciences, Purdue University, West Lafayette, Indiana 47907, USA
| | - Alan D Mizener
- Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA
| | - Stuart A Clayton
- Division of Exercise Physiology, Department of Human Performance, West Virginia University School of Medicine, Morgantown, West Virginia 26505, USA; Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA
| | - Emidio E Pistilli
- Division of Exercise Physiology, Department of Human Performance, West Virginia University School of Medicine, Morgantown, West Virginia 26505, USA; Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA.
| |
Collapse
|
18
|
Chang CY, Lenchik L, Blankemeier L, Chaudhari AS, Boutin RD. Biomarkers of Body Composition. Semin Musculoskelet Radiol 2024; 28:78-91. [PMID: 38330972 DOI: 10.1055/s-0043-1776430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
The importance and impact of imaging biomarkers has been increasing over the past few decades. We review the relevant clinical and imaging terminology needed to understand the clinical and research applications of body composition. Imaging biomarkers of bone, muscle, and fat tissues obtained with dual-energy X-ray absorptiometry, computed tomography, magnetic resonance imaging, and ultrasonography are described.
Collapse
Affiliation(s)
- Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leon Lenchik
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Louis Blankemeier
- Department of Electrical Engineering, Stanford University, Stanford, California
| | - Akshay S Chaudhari
- Department of Radiology and of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
19
|
Arao M, Yajima T. Computed tomography-based abdominal sarcopenic indices and bio-impedance analysis-based skeletal muscle mass index in hemodialyzed patients. Clin Nutr ESPEN 2024; 59:21-28. [PMID: 38220378 DOI: 10.1016/j.clnesp.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/31/2023] [Accepted: 11/17/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND AND AIMS Information about muscle wasting in hemodialyzed patients evaluated using computed tomography (CT) is limited. The present study aimed to examine the relationships between CT-based abdominal sarcopenic indices and bio-impedance analysis (BIA)-based skeletal muscle mass index (SMMI) in these patients. METHODS A total of 100 consecutive maintenance hemodialyzed patients who underwent CT and BIA were included. The psoas muscle index (PMI), paraspinous muscle index (PSMI), and abdominal skeletal muscle index (ASMI) were calculated by adjusting each muscle area to the height square. The psoas muscle thickness per height (PMTH) was measured using a single cross-sectional CT image obtained at the level of the third lumbar vertebra. The relationships between these CT-based sarcopenic indices and the BIA-based SMMI were examined. Moreover, the diagnostic values of these CT-based indices for BIA-defined muscle wasting (defined by the sex-specific SMMI: males, <7.0 kg/m2; females, <5.7 kg/m2) were investigated. RESULTS The PMI, PMTH, PSMI, and ASMI were significantly correlated with the SMMI (r = 0.678, 0.760, 0.708, and 0.785, respectively; p < 0.0001 for all). Twenty-eight patients with reduced muscle mass determined by BIA were identified. After age-sex adjustment, a multivariate logistic regression analysis revealed that the C-statistics of the PMI, PMTH, PSMI, and ASMI for the diagnosis of low muscle mass were 0.863 (p = 0.0099), 0.870 (p = 0.013), 0.891 (p = 0.040), and 0.950 (reference), respectively. CONCLUSIONS CT-based abdominal sarcopenic indices presented here may be useful for evaluating muscle wasting in hemodialyzed patients; the ASMI may be the most recommended sarcopenic index for such evaluations.
Collapse
Affiliation(s)
- Maiko Arao
- Department of Nephrology, Matsunami General Hospital, Gifu, 501-6062, Japan
| | - Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu, 501-6062, Japan.
| |
Collapse
|
20
|
Wang D, Zhang G, Yu Y, Zhang Z. Imaging of Sarcopenia in Type 2 Diabetes Mellitus. Clin Interv Aging 2024; 19:141-151. [PMID: 38292460 PMCID: PMC10826713 DOI: 10.2147/cia.s443572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
Sarcopenia is an age-related condition characterized by the loss of skeletal muscle mass, muscular strength, and muscle function. In older adults, type 2 diabetes mellitus (T2DM) constitutes a significant health burden. Skeletal muscle damage and deterioration have emerged as novel chronic complications in patients with diabetes, often linked to their increased longevity. Diabetic sarcopenia has been associated with increased rates of hospitalization, cardiovascular events, and mortality. Nevertheless, effectively managing metabolic disorders in patients with T2DM through appropriate therapeutic interventions could potentially mitigate the risk of sarcopenia. Utilizing imaging technologies holds substantial clinical significance in the early detection of skeletal muscle mass alterations associated with sarcopenia. Such detection is pivotal for arresting disease progression and preserving patients' quality of life. These imaging modalities offer reproducible and consistent patterns over time, as they all provide varying degrees of quantitative data. This review primarily delves into the application of dual-energy X-ray absorptiometry, computed tomography, magnetic resonance imaging, and ultrasound for both qualitative and quantitative assessments of muscle mass in patients with T2DM. It also juxtaposes the merits and limitations of these four techniques. By understanding the nuances of each method, clinicians can discern how best to apply them in diverse clinical scenarios.
Collapse
Affiliation(s)
- Dingyue Wang
- Department of Ultrasound, the First Affiliated Hospital China Medical University, Shenyang City, Liaoning Province, 110001, People’s Republic of China
| | - Gaosen Zhang
- Department of Ultrasound, the First Affiliated Hospital China Medical University, Shenyang City, Liaoning Province, 110001, People’s Republic of China
| | - Yana Yu
- Department of Ultrasound, the First Affiliated Hospital China Medical University, Shenyang City, Liaoning Province, 110001, People’s Republic of China
| | - Zhen Zhang
- Department of Ultrasound, the First Affiliated Hospital China Medical University, Shenyang City, Liaoning Province, 110001, People’s Republic of China
| |
Collapse
|
21
|
Wei Z, Gao X, Liu Y, Hu N, Chen X, Xie C, Wang J, Chen X. Age and gender differences in erector spinae area and their role in sarcopenia evaluation in a Chinese population. J Nutr Health Aging 2024; 28:100009. [PMID: 38267156 DOI: 10.1016/j.jnha.2023.100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/02/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Zicheng Wei
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China
| | - Xifa Gao
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China
| | - Yongkang Liu
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China
| | - Nandong Hu
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China
| | - Xin Chen
- Department of Radiology, Shanghai Longhua Hospital, Shanghai 200233, China
| | - Chao Xie
- Center for Musculoskeletal Research, School of Medicine and Dentistry, University of Rochester, NY 14642, USA
| | - Jianhua Wang
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China.
| | - Xiao Chen
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China.
| |
Collapse
|
22
|
Sheng W, Gao D, Liu P, Song M, Liu L, Miao H, Li T. Muscle-related parameters-based machine learning model for predicting postinduction hypotension in patients undergoing colorectal tumor resection surgery. Front Med (Lausanne) 2023; 10:1283503. [PMID: 38204484 PMCID: PMC10777389 DOI: 10.3389/fmed.2023.1283503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
Objectives This study used machine learning algorithms to identify important variables and predict postinduction hypotension (PIH) in patients undergoing colorectal tumor resection surgery. Methods Data from 318 patients who underwent colorectal tumor resection under general anesthesia were analyzed. The training and test sets are divided based on the timeline. The Boruta algorithm was used to screen relevant basic characteristic variables and establish a model for the training set. Four models, regression tree, K-nearest neighbor, neural network, and random forest (RF), were built using repeated cross-validation and hyperparameter optimization. The best model was selected, and a sorting chart of the feature variables, a univariate partial dependency profile, and a breakdown profile were drawn. R2, mean absolute error (MAE), mean squared error (MSE), and root MSE (RMSE) were used to plot regression fitting curves for the training and test sets. Results The basic feature variables associated with the Boruta screening were age, sex, body mass index, L3 skeletal muscle index, and HUAC. In the optimal RF model, R2 was 0.7708 and 0.7591, MAE was 0.0483 and 0.0408, MSE was 0.0038 and 0.0028, and RMSE was 0.0623 and 0.0534 for the training and test sets, respectively. Conclusion A high-performance algorithm was established and validated to demonstrate the degree of change in blood pressure after induction to control important characteristic variables and reduce PIH occurrence.
Collapse
Affiliation(s)
- Weixuan Sheng
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Danyang Gao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Pengfei Liu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Mingxue Song
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Lei Liu
- Department of Science and Technology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Huihui Miao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
23
|
Oh E, Cho NJ, Kang H, Kim SH, Park HK, Kwon SH. Computed tomography evaluation of skeletal muscle quality and quantity in people with morbid obesity with and without metabolic abnormality. PLoS One 2023; 18:e0296073. [PMID: 38134035 PMCID: PMC10745145 DOI: 10.1371/journal.pone.0296073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
We investigated the differences in quantity and quality of skeletal muscle between metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) individuals using abdominal CT. One hundred and seventy-two people with morbid obesity who underwent bariatric surgery and 64 healthy control individuals participated in this retrospective study. We divided the people with morbid obesity into an MHO and MUO group. In addition, nonobese metabolic healthy people were included analysis to provide reference levels. CT evaluation of muscle quantity (at the level of the third lumbar vertebra [L3]) was performed by calculating muscle anatomical cross-sectional area (CSA), which was normalized to patient height to produce skeletal muscle index (SMI). Muscle quality was assessed as skeletal muscle density (SMD), which was calculated from CT muscle attenuation. To characterize intramuscular composition, muscle attenuation was classified into three categories using Hounsfield unit (HU) thresholds: -190 HU to -30 HU for intermuscular adipose tissue (IMAT), -29 to +29 HU for low attenuation muscle (LAM), and +30 to +150 HU for normal attenuation muscle (NAM). People with morbid obesity comprised 24 (14%) MHO individuals and 148 (86%) MUO individuals. The mean age of the participants was 39.7 ± 12.5 years, and 154 (65%) participants were women. MUO individuals had a significantly greater total skeletal muscle CSA than MHO individuals in the model that adjusted for all variables. Total skeletal muscle SMI, SMD, NAM index, LAM index, and IMAT index did not differ between MHO and MUO individuals for all adjusted models. Total skeletal muscle at the L3 level was not different in muscle quantity, quality, or intramuscular composition between the MHO and MUO individuals, based on CT evaluation. MHO individuals who are considered "healthy" should be carefully monitored and can have a similar risk of metabolic complications as MUO individuals, at least based on an assessment of skeletal muscle.
Collapse
Affiliation(s)
- Eunsun Oh
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Nam-Jun Cho
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Heemin Kang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sang Hyun Kim
- Department of General Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyeong Kyu Park
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Soon Hyo Kwon
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| |
Collapse
|
24
|
Luengo-Pérez LM, Fernández-Bueso M, Ambrojo A, Guijarro M, Ferreira AC, Pereira-da-Silva L, Moreira-Rosário A, Faria A, Calhau C, Daly A, MacDonald A, Rocha JC. Body Composition Evaluation and Clinical Markers of Cardiometabolic Risk in Patients with Phenylketonuria. Nutrients 2023; 15:5133. [PMID: 38140392 PMCID: PMC10745907 DOI: 10.3390/nu15245133] [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: 10/21/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiovascular diseases are the main cause of mortality worldwide. Patients with phenylketonuria (PKU) may be at increased cardiovascular risk. This review provides an overview of clinical and metabolic cardiovascular risk factors, explores the connections between body composition (including fat mass and ectopic fat) and cardiovascular risk, and examines various methods for evaluating body composition. It particularly focuses on nutritional ultrasound, given its emerging availability and practical utility in clinical settings. Possible causes of increased cardiometabolic risk in PKU are also explored, including an increased intake of carbohydrates, chronic exposure to amino acids, and characteristics of microbiota. It is important to evaluate cardiovascular risk factors and body composition in patients with PKU. We suggest systematic monitoring of body composition to develop nutritional management and hydration strategies to optimize performance within the limits of nutritional therapy.
Collapse
Affiliation(s)
- Luis M. Luengo-Pérez
- Biomedical Sciences Department, University of Extremadura, 06008 Badajoz, Spain
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Mercedes Fernández-Bueso
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Ana Ambrojo
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Marta Guijarro
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Ana Cristina Ferreira
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; (A.C.F.); or (J.C.R.)
| | - Luís Pereira-da-Silva
- CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal; (L.P.-d.-S.); (A.F.)
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
| | - André Moreira-Rosário
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Ana Faria
- CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal; (L.P.-d.-S.); (A.F.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Conceição Calhau
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Anne Daly
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (A.M.)
| | - Anita MacDonald
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (A.M.)
| | - Júlio César Rocha
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; (A.C.F.); or (J.C.R.)
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| |
Collapse
|
25
|
Zhang W, Tang J, Tang H, Xie L, Wang J, Wu J, Yang M. Different computed tomography parameters for defining myosteatosis in patients with advanced non-small cell lung cancer. Clin Nutr 2023; 42:2414-2421. [PMID: 37871482 DOI: 10.1016/j.clnu.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/09/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND & AIMS Myosteatosis, excess muscle fat infiltration, is a novel prognostic factor in cancer patients. To define myosteatosis, skeletal muscle radiodensity (SMD) is most commonly used, while intramuscular adipose tissue (IMAT) is newly introduced. We aimed to compare SMD-defined and IMAT-defined myosteatosis for predicting overall survival (OS) in patients with advanced non-small cell lung cancer (NSCLC) and to explore whether patients with both low SMD and high IMAT had a shorter OS than patients with low SMD or high IMAT alone. METHODS We consecutively and prospectively recruited adult patients with stage IIIB or IV NSCLC at a teaching hospital. The mean SMD of all skeletal muscle areas and the area of IMAT on the unenhanced chest computed tomography (CT) images at the 12th thoracic vertebral level were segmented using Mimics version 21.0. Myosteatosis was defined by either low SMD (SMD-defined myosteatosis) or high IMAT (IMAT-defined myosteatosis). The optimal cutoffs for low SMD and high IMAT were also determined using the maximally selected rank statistics method. We calculated hazard ratios (HRs) and the corresponding confidence intervals (CIs) to evaluate the associations of OS with low SMD, high IMAT, and a combination of them. RESULTS We included 565 patients (345 men and 220 women; mean age 58.5 ± 9.0 years). Lower IMAT exhibited a tendency toward a favorable prognosis in men (p = 0.0015) and women (p < 0.0001); whereas higher SMD tended to have a favorable prognosis in men (p = 0.0006) and women (p < 0.0001). At baseline, 423 (74.9 %) participants had high IMAT, 432 (76.5 %) participants had low SMD and 370 (65.5 %) participants had both high IMAT and low SMD. Compared to those without either high IMAT or low SMD, the participants with either high IMAT or low SMD had a shorter OS, while the participants with both High IMAT and Low SMD had the shortest OS (log-rank p < 0.0001). After adjustment for the same confounders, high IMAT (HR, 1.44; 95 % CI, 1.10-1.87) and low SMD (HR, 1.92; 95 % CI, 1.36-2.43) were separately associated with poor prognosis. Moreover, the combination of high IMAT and low SMD indicated a higher risk of poor prognosis (HR, 2.43; 95 % CI, 1.62-3.66). CONCLUSIONS Both SMD-defined and IMAT-defined myosteatosis are highly prevalent in patients with advanced NSCLC and may serve as independent prognostic factors for OS. The diagnosis of myosteatosis might consider a combination of low SMD and high IMAT because this would help identify patients at a higher risk of mortality.
Collapse
Affiliation(s)
- Wenyi Zhang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Huiyu Tang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Lingling Xie
- West China School of Nursing, West China Hospital, Sichuan University/ Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Wang
- West China School of Nursing, West China Hospital, Sichuan University/ Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jinhui Wu
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
| | - Ming Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
26
|
Knoedler S, Schliermann R, Knoedler L, Wu M, Hansen FJ, Matar DY, Obed D, Vervoort D, Haug V, Hundeshagen G, Paik A, Kauke-Navarro M, Kneser U, Pomahac B, Orgill DP, Panayi AC. Impact of sarcopenia on outcomes in surgical patients: a systematic review and meta-analysis. Int J Surg 2023; 109:4238-4262. [PMID: 37696253 PMCID: PMC10720826 DOI: 10.1097/js9.0000000000000688] [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: 04/15/2023] [Accepted: 08/04/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, the authors aimed to synthesize the available literature and investigate the impact of sarcopenia on perioperative and postoperative outcomes across all surgical specialties. METHODS The authors systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Their primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at 1, 3, and 5 years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population and on those of higher quality or prospective study design. RESULTS A total of 294 studies comprising 97 643 patients, of which 33 070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes, including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P <0.00001). A significantly lower survival rate in patients with sarcopenia was noted at 1, 3, and 5 years (all P <0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P <0.00001), cardiovascular (both P <0.00001), and emergency ( P =0.03 and P =0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia ( P <0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients ( P =0.007). Sensitivity analysis based on higher quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P <0.00001). CONCLUSION Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical subspecialties.
Collapse
Affiliation(s)
- Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Rainer Schliermann
- Faculty of Social and Health Care Sciences, University of Applied Sciences Regensburg, Regensburg
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Mengfan Wu
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Frederik J. Hansen
- Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen, Erlangen
| | - Dany Y. Matar
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Valentin Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Angie Paik
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Dennis P. Orgill
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Adriana C. Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| |
Collapse
|
27
|
Çinkooğlu A, Bayraktaroğlu S, Ufuk F, Unat ÖS, Köse T, Savaş R, Bishop NM. Reduced CT-derived erector spinae muscle area: a poor prognostic factor for short- and long-term outcomes in idiopathic pulmonary fibrosis patients. Clin Radiol 2023; 78:904-911. [PMID: 37690976 DOI: 10.1016/j.crad.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/25/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023]
Abstract
AIM To assess the relationship between idiopathic pulmonary fibrosis (IPF) prognosis, baseline skeletal muscle mass, and attenuation on computed tomography (CT) and clinical parameters. MATERIAL AND METHODS This retrospective cohort study enrolled 195 patients. The mean follow-up duration was 42.52 months. Erector spinae muscle area (ESMA), pectoralis muscle area (PMA), and the attenuation of the erector spinae muscle at the level of T12 vertebrae were measured. Muscle indexes were obtained by adjusting the measured muscle areas to the patients' heights. The relationship between baseline CT-derived muscle metrics and clinical parameters including short- and long-term mortality were evaluated. RESULTS There was a moderate correlation between ESMA and PMA and pectoralis muscle index (PMI; r=0.536, p<0001 and r=0.403, p<0.001 respectively). ESMA correlated significantly with forced expiratory volume in 1 second (FEV1; hazard ratio [HR] = 0.488 p<0.001) and forced vital capacity (FVC; HR=0.501, p<0.001). Compared with PMA, ESMA was more strongly associated with 1- and 2-year mortality in patients with IPF (HR=0.957, p=0.022). The survival rate in male patients with sarcopenia was significantly worse (p=0.040). CONCLUSION ESMA measurements obtained from CT correlated with clinical parameters in IPF patients and were also predictors of short- and long-term survival.
Collapse
Affiliation(s)
- A Çinkooğlu
- Department of Radiology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey.
| | - S Bayraktaroğlu
- Department of Radiology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - F Ufuk
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ö S Unat
- Department of Respiratory Medicine, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - T Köse
- Department of Biostatistics, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - R Savaş
- Department of Radiology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - N Moğulkoç Bishop
- Department of Respiratory Medicine, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| |
Collapse
|
28
|
Sheng M, Cao J, Hou S, Li M, Wang Y, Fang Q, Miao A, Yang M, Liu S, Hu C, Liu C, Wang S, Zheng J, Xiao J, Zhang X, Liu H, Liu B, Wang B. Computed tomography-determined skeletal muscle density predicts 3-year mortality in initial-dialysis patients in China. J Cachexia Sarcopenia Muscle 2023; 14:2569-2578. [PMID: 37722854 PMCID: PMC10751407 DOI: 10.1002/jcsm.13331] [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: 02/21/2023] [Revised: 06/21/2023] [Accepted: 08/21/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Skeletal muscle mass and quality assessed by computed tomography (CT) images of the third lumbar vertebra (L3) level have been established as risk factors for poor clinical outcomes in several illnesses, but the relevance for dialysis patients is unclear. A few studies have suggested a correlation between CT-determined skeletal muscle mass and quality at the first lumbar vertebra (L1) level and adverse outcomes. Generally, chest CT does not reach beyond L1. We aimed to determine whether opportunistic CT scan (chest CT)-determined skeletal muscle mass and quality at L1 are associated with mortality in initial-dialysis patients. METHODS This 3-year multicentric retrospective study included initial-dialysis patients from four centres between 2014 and 2017 in China. Unenhanced CT images of the L1 and L3 levels were obtained to assess skeletal muscle mass [by skeletal muscle index, (SMI), cm2 /m2 ] and quality [by skeletal muscle density (SMD), HU]. Skeletal muscle measures at L1 were compared with those at L3. The sex-specific optimal cutoff values of L1 SMI and L1 SMD were determined in relation to all-cause mortality. The outcomes were all-cause death and cardiac death. Cox regression models were applied to investigate the risk factors for death. RESULTS A total of 485 patients were enrolled, of whom 257 had both L1 and L3 images. Pearson's correlation coefficient between L1 and L3 SMI was 0.84 (P < 0.001), and that between L1 and L3 SMD was 0.90 (P < 0.001). No significant association between L1 SMI and mortality was observed (P > 0.05). Low L1 SMD (n = 280, 57.73%) was diagnosed based on the optimal cutoff value (<39.56 HU for males and <33.06 HU for females). Multivariate regression analysis revealed that the low L1 SMD group had higher risks of all-cause death (hazard ratio 1.80; 95% confidence interval 1.05-3.11, P = 0.034) and cardiac death (hazard ratio 3.74; 95% confidence interval 1.43-9.79, P = 0.007). CONCLUSIONS In initial-dialysis patients, there is high agreement between the L1 and L3 measures for SMI and SMD. Low SMD measured at L1, but not low SMI, is an independent predictor of both all-cause death and cardiac death.
Collapse
Affiliation(s)
- Ming‐jie Sheng
- Department of Nephrology, Zhong Da HospitalSoutheast University School of MedicineNanjingChina
- Department of NephrologyThe Affiliated Kunshan Hospital of Jiangsu UniversityKunshanChina
| | - Jing‐yuan Cao
- Department of Nephrology, Zhong Da HospitalSoutheast University School of MedicineNanjingChina
- Department of NephrologyThe Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical UniversityTaizhouChina
| | - Shi‐mei Hou
- Department of Nephrology, Zhong Da HospitalSoutheast University School of MedicineNanjingChina
| | - Min Li
- Department of NephrologyThe First People's Hospital of ChangzhouChangzhouChina
| | - Yao Wang
- Department of NephrologyThe Affiliated Hospital of Yangzhou University, Yangzhou UniversityYangzhouChina
| | - Qiang Fang
- Department of NephrologyThe Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical UniversityTaizhouChina
| | - A‐feng Miao
- Department of NephrologyThe Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical UniversityTaizhouChina
| | - Min Yang
- Department of NephrologyThe First People's Hospital of ChangzhouChangzhouChina
| | - Shu‐su Liu
- Department of NephrologyThe First People's Hospital of ChangzhouChangzhouChina
| | - Chun‐hong Hu
- Department of NephrologyThe Affiliated Hospital of Yangzhou University, Yangzhou UniversityYangzhouChina
| | - Cui‐lan Liu
- Department of NephrologyThe Affiliated Hospital of Yangzhou University, Yangzhou UniversityYangzhouChina
| | - Shi‐yuan Wang
- Department of Epidemiology and Health StatisticsSoutheast University School of Public HealthNanjingChina
| | - Jing Zheng
- Department of Geriatrics, Zhong Da HospitalSoutheast University School of MedicineNanjingChina
| | | | - Xiao‐liang Zhang
- Department of Nephrology, Zhong Da HospitalSoutheast University School of MedicineNanjingChina
| | - Hong Liu
- Department of Nephrology, Zhong Da HospitalSoutheast University School of MedicineNanjingChina
| | - Bi‐cheng Liu
- Department of Nephrology, Zhong Da HospitalSoutheast University School of MedicineNanjingChina
| | - Bin Wang
- Department of Nephrology, Zhong Da HospitalSoutheast University School of MedicineNanjingChina
| |
Collapse
|
29
|
Zambrano Chaves JM, Wentland AL, Desai AD, Banerjee I, Kaur G, Correa R, Boutin RD, Maron DJ, Rodriguez F, Sandhu AT, Rubin D, Chaudhari AS, Patel BN. Opportunistic assessment of ischemic heart disease risk using abdominopelvic computed tomography and medical record data: a multimodal explainable artificial intelligence approach. Sci Rep 2023; 13:21034. [PMID: 38030716 PMCID: PMC10687235 DOI: 10.1038/s41598-023-47895-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
Current risk scores using clinical risk factors for predicting ischemic heart disease (IHD) events-the leading cause of global mortality-have known limitations and may be improved by imaging biomarkers. While body composition (BC) imaging biomarkers derived from abdominopelvic computed tomography (CT) correlate with IHD risk, they are impractical to measure manually. Here, in a retrospective cohort of 8139 contrast-enhanced abdominopelvic CT examinations undergoing up to 5 years of follow-up, we developed multimodal opportunistic risk assessment models for IHD by automatically extracting BC features from abdominal CT images and integrating these with features from each patient's electronic medical record (EMR). Our predictive methods match and, in some cases, outperform clinical risk scores currently used in IHD risk assessment. We provide clinical interpretability of our model using a new method of determining tissue-level contributions from CT along with weightings of EMR features contributing to IHD risk. We conclude that such a multimodal approach, which automatically integrates BC biomarkers and EMR data, can enhance IHD risk assessment and aid primary prevention efforts for IHD. To further promote research, we release the Opportunistic L3 Ischemic heart disease (OL3I) dataset, the first public multimodal dataset for opportunistic CT prediction of IHD.
Collapse
Affiliation(s)
- Juan M Zambrano Chaves
- Department of Biomedical Data Science, Stanford University, 1265 Welch Road, MSOB West Wing, Third Floor, Stanford, CA, 94305, USA
| | - Andrew L Wentland
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - Arjun D Desai
- Department of Radiology, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
- Department of Electrical Engineering, Stanford University, 350 Jane Stanford Way, Stanford, CA, 94305, USA
| | - Imon Banerjee
- Department of Radiology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Gurkiran Kaur
- Department of Radiology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Ramon Correa
- Department of Radiology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Robert D Boutin
- Department of Radiology, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - David J Maron
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
- Department of Medicine, Stanford Prevention Research Center, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Daniel Rubin
- Department of Biomedical Data Science, Stanford University, 1265 Welch Road, MSOB West Wing, Third Floor, Stanford, CA, 94305, USA
- Department of Radiology, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Akshay S Chaudhari
- Department of Biomedical Data Science, Stanford University, 1265 Welch Road, MSOB West Wing, Third Floor, Stanford, CA, 94305, USA
- Department of Radiology, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
- Cardiovascular Institute, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Bhavik N Patel
- Department of Radiology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA.
| |
Collapse
|
30
|
Huang X, Zhang T, Wang X, Wang S, Nie M, Luo X, Yang M, Zou X. A simplified D 3 -creatine dilution method for skeletal muscle mass determination with dynamic correction of creatinine and D 3 -creatinine using ultra-performance liquid chromatography-tandem mass spectrometry. Biomed Chromatogr 2023; 37:e5724. [PMID: 37589257 DOI: 10.1002/bmc.5724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/14/2023] [Accepted: 07/29/2023] [Indexed: 08/18/2023]
Abstract
This study developed a simple method for muscle mass determination based on D3 -creatine dilution by removing the matrix effects of ultra-performance liquid chromatography-tandem mass spectrometry analysis through mutual correction of creatinine and D3 -creatinine. Rats were administered an oral tracer dose of D3 -creatine at age 6 weeks. Creatinine and D3 -creatinine in urine were detected using ultra-performance liquid chromatography-tandem mass spectrometry after diluting 20 times to obtain D3 -creatinine enrichment factor (mole percent excess). The mole percent excess obtained from peak area could be used to calculate muscle mass using the improved formula. The limit of detection was 0.500 ng/mL for D3 -creatinine. Creatinine and D3 -creatinine could be mutually corrected because of the same matrix effect, and D3 -creatine spillage was negligible within 0.22%. Isotopic steady time was consistent with that obtained using conventional methods. Bland-Altman plots demonstrated the satisfying consistency between the proposed method and magnetic resonance imaging. This is a simple and rapid measuring method of muscle mass based on D3 -creatine dilution that requires no accurate quantification of creatinine and D3 -creatinine concentrations and no urine sample collection to obtain D3 -creatine spillage.
Collapse
Affiliation(s)
- Xinyi Huang
- Department of Public Health Laboratory Science, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tianai Zhang
- Department of Public Health Laboratory Science, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xuan Wang
- Department of Public Health Laboratory Science, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Shuqiao Wang
- Department of Public Health Laboratory Science, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Manqing Nie
- Department of Public Health Laboratory Science, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xinyue Luo
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Ming Yang
- Department of National Clinical Research Center for Geriatrics/Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoli Zou
- Department of Public Health Laboratory Science, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
31
|
Liu H, Wang J, Tan S, Zhang Z, Yan M, Han J, Sui X, Yang F, Wu G. Sarcopenia and myosteatosis diagnostic tool for gastrointestinal cancer: creatinine to cystatin C ratio as evaluation marker. J Transl Med 2023; 21:744. [PMID: 37864250 PMCID: PMC10589997 DOI: 10.1186/s12967-023-04628-z] [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: 09/21/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVE This study aimed to develop a simplified diagnostic tool for assessing sarcopenia and myosteatosis in gastrointestinal cancer patients, focusing on the creatinine to cystatin C ratio (CCR) as an evaluation marker. METHODS 955 patients were split into training (n = 671) and validation (n = 284) cohorts. Using logistic regression, risk factors for sarcopenia and myosteatosis were identified. The predictive capacity of the developed model was examined. The association between CCR and muscle imaging parameters, along with its impact on clinical outcomes, was analyzed. RESULTS No significant differences were observed in baseline traits between cohorts. CCR emerged as a significant risk factor for both sarcopenia and myosteatosis. Nomograms for diagnosing these conditions demonstrated strong predictive ability, with AUC values indicating high accuracy (sarcopenia AUC: 0.865-0.872; myosteatosis AUC: 0.848-0.849). The clinical utility of the nomograms was confirmed through decision curve analysis. CCR showed significant association with muscle imaging parameters and was a reliable indicator for assessing the risk of sarcopenia, myosteatosis, and cachexia. Moreover, CCR was able to differentiate between patient survival and disease progression rates. CONCLUSION A diagnostic tool for sarcopenia and myosteatosis in gastrointestinal cancer patients was developed, with CCR being a pivotal biomarker for disease diagnosis and prognosis prediction.
Collapse
Affiliation(s)
- Hao Liu
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Junjie Wang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Shanjun Tan
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Zhige Zhang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Mingyue Yan
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Jun Han
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Xiangyu Sui
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Fan Yang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Guohao Wu
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| |
Collapse
|
32
|
Muraki I. Muscle Mass Assessment in Sarcopenia: A Narrative Review. JMA J 2023; 6:381-386. [PMID: 37941710 PMCID: PMC10628318 DOI: 10.31662/jmaj.2023-0053] [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: 03/30/2023] [Accepted: 06/01/2023] [Indexed: 11/10/2023] Open
Abstract
Sarcopenia is a condition characterized by age-related muscle loss and dysfunction. Over the past decade, several working groups have developed diagnostic criteria for sarcopenia, including muscle mass, grip strength, and gait speed measurements. However, there is debate over which muscle mass indicator is the most appropriate. Some groups used appendicular lean mass divided by height squared, whereas others used appendicular lean mass divided by body mass index. In addition, the association between muscle mass and long-term health outcomes is inconsistent. As a result, some experts question the necessity of using muscle mass as a diagnostic criterion for sarcopenia. This review summarizes the measurement methods and muscle mass indicators of previous studies, highlighting issues with past muscle mass assessments.
Collapse
Affiliation(s)
- Isao Muraki
- Public Health, Osaka University Graduate School of Medicine, Suita, Japan
| |
Collapse
|
33
|
Liu L, Liu S, Hao M, Hu S, Yu T, Yang Y, Liu Z. Sarcopenia as an important determinant for adverse outcomes in patients with pyogenic liver abscess. PeerJ 2023; 11:e16055. [PMID: 37810784 PMCID: PMC10559880 DOI: 10.7717/peerj.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/17/2023] [Indexed: 10/10/2023] Open
Abstract
Background Low muscle mass/sarcopenia has been associated with poor prognosis in many diseases, but its clinical significance in pyogenic liver abscess (PLA) remains unclear. The purpose of this study is to investigate the relationship between muscle mass and prognosis of patients with PLA. Methods A total of 154 adult patients with PLA hospitalized at Tongji Hospital (Wuhan, Hubei, China) between October 2011 and June 2021 were included in this retrospective analysis. Muscle-fat related indicators were measured by computed tomography (CT) images at the third lumbar vertebra (L3) level. The data of patients between the sarcopenia group and non-sarcopenia group were compared. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed. Results The skeletal muscle index (SMI) was independently associated with adverse outcomes (95% CI [0.649-0.954], P = 0.015) of PLA in multivariate logistic regression analysis. This conclusion held true in sex-specific subgroup analysis. ROC analysis indicated that SMI may predict adverse outcomes in both male (area under the ROC curve [AUC], 0.718; cut-off, 52.59; P < 0.001) and female (AUC, 0.714; cut-off, 38.39; P = 0.017) patient populations. Conclusions Sarcopenia serves as an independent risk factor for poor prognosis in PLA and patients with sarcopenia may be more prone to adverse outcomes.
Collapse
Affiliation(s)
- Li Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, Hubei, China
| | - Shaohua Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, Hubei, China
| | - Meng Hao
- Department of Gastroenterology, Zigui County People’s Hospital, Yichang, China
| | - Song Hu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tian Yu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, Hubei, China
| | - Yunkai Yang
- Eight-year Program of Clinical Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhelong Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, Hubei, China
| |
Collapse
|
34
|
Wang J, Tan S, Gianotti L, Wu G. Evaluation and management of body composition changes in cancer patients. Nutrition 2023; 114:112132. [PMID: 37441827 DOI: 10.1016/j.nut.2023.112132] [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: 01/30/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 07/15/2023]
Abstract
Wasting in cancer patients has long been recognized as a condition that adversely affects cancer patients' quality of life, treatment tolerance, and oncological outcomes. Historically, this condition was mainly evaluated by changes in body weight. However, this approach is not quite accurate because body weight is the overall change of all body compartments. Conditions such as edema and ascites can mask the severity of muscle and adipose tissue depletion. Changes in body composition assessment in cancer patients have historically been underappreciated because of the limited availability of measurement tools. As more evidence highlighting the importance of body composition has emerged, it is imperative to apply a more precise evaluation of nutritional status and a more targeted approach to provide nutritional support for cancer patients. In this review, we will discuss the modalities for evaluating body composition and how to manage body composition changes in cancer patients.
Collapse
Affiliation(s)
- Junjie Wang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanjun Tan
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca, and HBP Surgery Unit, and Foundation IRCCS San Gerardo, Monza, Italy.
| | - Guohao Wu
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
35
|
Kim L, Narayanan D, Liu J, Pattanayak P, Turkbey E, Shen TC, Linehan WM, Pinto PA, Summers RM. Radiologic reporting of MRI-proven thoracolumbar epidural metastases on body CT: 12-Year single-institution experience. Clin Imaging 2023; 102:19-25. [PMID: 37453304 PMCID: PMC10528163 DOI: 10.1016/j.clinimag.2023.06.025] [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: 01/11/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
RATIONALE AND OBJECTIVES Metastatic epidural masses are an important radiological finding. The purpose of this study is to determine factors associated with non-reporting of thoracolumbar epidural metastases on body CT. MATERIALS AND METHODS In a study population of 166 patients from a single institution over a 12-year period, 293 body CT examinations were identified which were performed within 30 days before or after a spine MRI diagnosis of epidural metastasis. Associations were sought between patient diagnosis, CT examination characteristics, reporting radiologist (n = 17), and lesion characteristics with respect to whether an epidural metastasis was reported on CT. RESULTS In retrospective consensus review comprised of 3 radiologists, epidural metastases reported on spine MRI were clearly visible in 80.5% (236/293) of body CT examinations, however 65.3% (154/236) of the body CT reports omitted reporting their presence, even in cases where there was a preceding MRI diagnosis within 30 days (65.4%, 74/113). The identity of the reporting radiologist was statistically significantly associated with the accurate diagnostic reporting of epidural metastasis on body CT (p = 0.04). The only lesion features which were statistically significantly associated with CT reporting were lesion volume (p = 0.03) on noncontrast CT, and lesion volume (p = 0.006) and percentage of spinal canal stenosis (p = 0.001) on intravenous contrast-enhanced CT. The presence or absence of intravenous contrast was not significantly associated with CT reporting (p = 1.0). CONCLUSION Using spine MRI as the reference standard for the presence of epidural tumor, the majority of body CT reports omit describing thoracolumbar epidural metastases which are clearly visible in retrospect.
Collapse
Affiliation(s)
- Lauren Kim
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, United States
| | - Divya Narayanan
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, United States
| | - Jiamin Liu
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, United States
| | - Puskar Pattanayak
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, United States
| | - Evrim Turkbey
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, United States
| | - Thomas C Shen
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, United States
| | - W Marston Linehan
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Peter A Pinto
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, United States.
| |
Collapse
|
36
|
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.
Collapse
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.
| |
Collapse
|
37
|
Vasilevska Nikodinovska V, Ivanoski S. Sarcopenia, More Than Just Muscle Atrophy: Imaging Methods for the Assessment of Muscle Quantity and Quality. ROFO-FORTSCHR RONTG 2023; 195:777-789. [PMID: 37160148 DOI: 10.1055/a-2057-0205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Sarcopenia, a progressive reduction of muscle mass and function, is associated with adverse outcomes in the elderly. Sarcopenia and muscle atrophy are not equal processes. Low muscle strength in association with muscle quantity/quality reduction is currently the optimal method for assessing sarcopenia. There is a practical need for indirect measurement of muscle strength using state-of-the-art imaging techniques. METHODS The following provides a narrative, broad review of all current imaging techniques for evaluating muscles and identifying sarcopenia, including DEXA, CT, MRI, and high-resolution ultrasound, their main strengths, weaknesses, and possible solutions to problems regarding each technique. RESULTS AND CONCLUSION Well-recognized imaging methods for the assessment of muscle mass are explained, including evaluation with DEXA, CT, and MRI muscle quantity assessment, ultrasound evaluation of muscle thickness and CSA, and their correlations with established muscle mass calculation methods. A special focus is on imaging methods for muscle quality evaluation. Several innovative and promising techniques that are still in the research phase but show potential in the assessment of different properties of muscle quality, including MRI DIXON sequences, MRI spectroscopy, Diffusion Tensor Imaging, ultrasound echo intensity, ultrasound elastography, and speed-of-sound ultrasound imaging are briefly mentioned. KEY POINTS · Sarcopenia definition includes low muscle strength and low muscle quantity/quality.. · DEXA is a low-radiation method for whole-body composition measurement in a single image.. · CT has established cut-off values for muscle quality/quantity evaluation and sarcopenia diagnosis.. · MRI is the most sophisticated muscle quality assessment method capable of evaluating myosteatosis, myofibrosis, and microstructure.. · Ultrasound can evaluate muscle quality, including tissue architecture, and elasticity with excellent spatial resolution.. CITATION FORMAT · Vasilevska Nikodinovska V, Ivanoski S, . Sarcopenia, More Than Just Muscle Atrophy: Imaging Methods for the Assessment of Muscle Quantity and Quality. Fortschr Röntgenstr 2023; 195: 777 - 789.
Collapse
Affiliation(s)
| | - Slavcho Ivanoski
- Diagnostic Radiology, St. Erasmo Hospital, Ohrid, North Macedonia
| |
Collapse
|
38
|
Giraudo C, Modugno A, Negro G, Dell'Amore A, Cecchin D, Motta R, Balestro E, Boscolo A, Calabrese F, Faccioli E, Navalesi P, Vianello A, Rea F, Stramare R. Radiomics of spinal muscles: toward a radiological biomarker for allograft rejection in lung transplant. LA RADIOLOGIA MEDICA 2023; 128:1070-1078. [PMID: 37458906 PMCID: PMC10474186 DOI: 10.1007/s11547-023-01674-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/29/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To assess the role of muscle composition and radiomics in predicting allograft rejection in lung transplant. MATERIAL AND METHODS The last available HRCT before surgery of lung transplant candidates referring to our tertiary center from January 2010 to February 2020 was retrospectively examined. Only scans with B30 kernel reconstructions and 1 mm slice thickness were included. One radiologist segmented the spinal muscles of each patient at the level of the 11th dorsal vertebra by an open-source software. The same software was used to extract Hu values and 72 radiomic features of first and second order. Factor analysis was applied to select highly correlating features and then their prognostic value for allograft rejection was investigated by logistic regression analysis (level of significance p < 0.05). In case of significant results, the diagnostic value of the model was computed by ROC curves. RESULTS Overall 200 patients had a HRCT prior to the transplant but only 97 matched the inclusion criteria (29 women; mean age 50.4 ± 13 years old). Twenty-one patients showed allograft rejection. The following features were selected by the factor analysis: cluster prominence, Imc2, gray level non-uniformity normalized, median, kurtosis, gray level non-uniformity, and inverse variance. The radiomic-based model including also Hu demonstrated that only the feature Imc2 acts as a predictor of allograft rejection (p = 0.021). The model showed 76.6% accuracy and the Imc2 value of 0.19 demonstrated 81% sensitivity and 64.5% specificity in predicting lung transplant rejection. CONCLUSION The radiomic feature Imc2 demonstrated to be a predictor of allograft rejection in lung transplant.
Collapse
Affiliation(s)
- Chiara Giraudo
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, University of Padova, Padua, Italy.
| | - Antonella Modugno
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Giacomo Negro
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Andrea Dell'Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Raffaella Motta
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Annalisa Boscolo
- Anesthesiology and Intensive Care Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Fiorella Calabrese
- Pathological Anatomy Section, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Paolo Navalesi
- Anesthesiology and Intensive Care Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Roberto Stramare
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, University of Padova, Padua, Italy
| |
Collapse
|
39
|
Jiang FL, Tang S, Eom SH, Lee JY, Chae JH, Kim CH. Distribution of Bioelectrical Impedance Vector Analysis and Phase Angle in Korean Elderly and Sarcopenia. SENSORS (BASEL, SWITZERLAND) 2023; 23:7090. [PMID: 37631626 PMCID: PMC10458265 DOI: 10.3390/s23167090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE This study aimed to verify whether bioelectrical impedance vector analysis (BIVA) can support the clinical evaluation of sarcopenia in elderly individuals and evaluate the relationships between phase angle (PhA), physical performance, and muscle mass. METHODS The sample comprised 134 free-living elderly individuals of both sexes aged 69-91 years. Anthropometric parameters, grip strength, dual-energy X-ray absorptiometry findings, bioimpedance analysis results, and physical performance were also measured. The impedance vector distributions were evaluated in elderly individuals using BIVA. RESULTS BIVA revealed significant differences between the sarcopenia and non-sarcopenia groups (both sexes). The sarcopenia group had a significantly lower PhA than the non-sarcopenia group in both sexes (p < 0.05). PhA was significantly correlated with age, appendicular skeletal muscle (ASM), handgrip strength (HGS), and muscle quality in both sexes and significantly correlated with ASM/Height2 and physical performance in males. CONCLUSION BIVA can be used as a field assessment method in elderly Koreans with sarcopenia. PhA is a good indicator of muscle strength, muscle quality, and physical performance in males. These methods can help diagnose sarcopenia in elderly individuals with reduced mobility.
Collapse
Affiliation(s)
- Fang-Lin Jiang
- Department of Wushu and Traditional National Sports, College of Physical Education, Hunan Normal University, Changsha 410012, China;
| | - Saizhao Tang
- Department of Sports Medicine, Soonchunhyang University, Asan 31538, Republic of Korea; (S.T.); (S.-H.E.); (J.-Y.L.); (J.H.C.)
| | - Seon-Ho Eom
- Department of Sports Medicine, Soonchunhyang University, Asan 31538, Republic of Korea; (S.T.); (S.-H.E.); (J.-Y.L.); (J.H.C.)
| | - Jae-Young Lee
- Department of Sports Medicine, Soonchunhyang University, Asan 31538, Republic of Korea; (S.T.); (S.-H.E.); (J.-Y.L.); (J.H.C.)
| | - Ji Heon Chae
- Department of Sports Medicine, Soonchunhyang University, Asan 31538, Republic of Korea; (S.T.); (S.-H.E.); (J.-Y.L.); (J.H.C.)
| | - Chul-Hyun Kim
- Department of Sports Medicine, Soonchunhyang University, Asan 31538, Republic of Korea; (S.T.); (S.-H.E.); (J.-Y.L.); (J.H.C.)
| |
Collapse
|
40
|
Charrière K, Boulouard Q, Artemova S, Vilotitch A, Ferretti GR, Bosson JL, Moreau-Gaudry A, Giai J, Fontaine E, Bétry C. A comparative study of two automated solutions for cross-sectional skeletal muscle measurement from abdominal computed tomography images. Med Phys 2023; 50:4973-4980. [PMID: 36724170 DOI: 10.1002/mp.16261] [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: 06/16/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Measurement of cross-sectional muscle area (CSMA) at the mid third lumbar vertebra (L3) level from computed tomography (CT) images is becoming one of the reference methods for sarcopenia diagnosis. However, manual skeletal muscle segmentation is tedious and is thus restricted to research. Automated solutions are required for use in clinical practice. PURPOSE The aim of this study was to compare the reliability of two automated solutions for the measurement of CSMA. METHODS We conducted a retrospective analysis of CT images in our hospital database. We included consecutive individuals hospitalized at the Grenoble University Hospital in France between January and May 2018 with abdominal CT images and sagittal reconstruction. We used two types of software to automatically segment skeletal muscle: ABACS, a module of the SliceOmatic software solution "ABACS-SliceOmatic," and a deep learning-based solution called "AutoMATiCA." Manual segmentation was performed by a medical expert to generate reference data using "SliceOmatic." The Dice similarity coefficient (DSC) was used to measure overlap between the results of the manual and the automated segmentations. The DSC value for each method was compared with the Mann-Whitney U test. RESULTS A total of 676 hospitalized individuals was retrospectively included (365 males [53.8%] and 312 females [46.2%]). The median DSC for SliceOmatic vs AutoMATiCA (0.969 [5th percentile: 0.909]) was greater than the median DSC for SliceOmatic vs. ABACS-SliceOmatic (0.949 [5th percentile: 0.836]) (p < 0.001). CONCLUSIONS AutoMATiCA, which used artificial intelligence, was more reliable than ABACS-SliceOmatic for skeletal muscle segmentation at the L3 level in a cohort of hospitalized individuals. The next step is to develop and validate a neural network that can identify L3 slices, which is currently a fastidious process.
Collapse
Affiliation(s)
- Katia Charrière
- Public Health Department, Clinical Investigation Center-Technological, Innovation, INSERM CIC1406, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Quentin Boulouard
- Public Health Department, Clinical Investigation Center-Technological, Innovation, INSERM CIC1406, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Svetlana Artemova
- Public Health Department, Clinical Investigation Center-Technological, Innovation, INSERM CIC1406, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Antoine Vilotitch
- CHU Grenoble Alpes, Cellule d'ingénierie des données, Grenoble, France
| | - Gilbert R Ferretti
- INSERM U1209, IAB, CHU Grenoble Alpes, Service de radiologie diagnostique et interventionnelle, Université Grenoble Alpes, Grenoble, France
| | - Jean-Luc Bosson
- Public Health Department, Clinical Investigation Center-Technological, Innovation, INSERM CIC1406, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, Public Health Department, TIMC, Université Grenoble Alpes, Grenoble, France
| | - Alexandre Moreau-Gaudry
- Public Health Department, Clinical Investigation Center-Technological, Innovation, INSERM CIC1406, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, Public Health Department, TIMC, Université Grenoble Alpes, Grenoble, France
| | - Joris Giai
- Public Health Department, Clinical Investigation Center-Technological, Innovation, INSERM CIC1406, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, Public Health Department, TIMC, Université Grenoble Alpes, Grenoble, France
| | - Eric Fontaine
- Department of Endocrinology, Diabetology and Nutrition, INSERM U1055, LBFA, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Cécile Bétry
- Department of Endocrinology, Diabetology and Nutrition, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Université Grenoble Alpes, Grenoble, France
| |
Collapse
|
41
|
Bradley NA, Walter A, Dolan R, Wilson A, Siddiqui T, Roxburgh CS, McMillan DC, Guthrie GJ. Evaluation of the prognostic value of computed tomography-derived body composition in patients undergoing endovascular aneurysm repair. J Cachexia Sarcopenia Muscle 2023; 14:1836-1847. [PMID: 37221439 PMCID: PMC10401537 DOI: 10.1002/jcsm.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/23/2023] [Accepted: 04/24/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) is the most common mode of repair of abdominal aortic aneurysms (AAA) in the UK. EVAR ranges from standard infrarenal repair to complex fenestrated and branched EVAR (F/B-EVAR). Sarcopenia is defined by lower muscle mass and function, which is associated with inferior perioperative outcomes. Computed tomography-derived body composition analysis offers prognostic value in patients with cancer. Several authors have evaluated the role of body composition analysis in predicting outcomes in patients undergoing EVAR; however, the evidence base is limited by heterogeneous methodology. METHODS Six hundred seventy-four consecutive patients (58 (8.6%) female, mean (SD) age 74.4 (6.8) years) undergoing EVAR and F/B-EVAR at three large tertiary centres were retrospectively recruited. Subcutaneous and visceral fat indices (SFI and VFI), psoas and skeletal muscle indices, and skeletal muscle density were measured at the L3 vertebral level from pre-operative computed tomographies. The maximally selected rank statistic technique was used to define optimal thresholds to predict mortality. RESULTS There were 191 deaths during the median follow-up period of 60.0 months. Mean (95% CI) survival in the low SMI versus high SMI subgroups was 62.6 (58.5-66.7) versus 82.0 (78.7-85.3) months (P < 0.001). Mean (95% CI) survival in the low SFI versus high SFI subgroups was 56.4 (48.2-64.7) versus 77.1 (74.2-80.1) months (P < 0.001). One-year mortality in the low SMI versus high SMI subgroups was 10% versus 3% (P < 0.001). Low SMI was associated with increased odds of one-year mortality (OR 3.19, 95% CI 1.60-6.34, P < 0.001). Five-year mortality in the low SMI versus high SMI subgroups was 55% versus 28% (P < 0.001). Low SMI was associated with increased odds of five-year mortality (OR 1.54, 95% CI 1.11-2.14, P < 0.01). On multivariate analysis of all patients, low SFI (HR 1.90, 95% CI 1.30-2.76, P < 0.001) and low SMI (HR 1.88, 95% CI 1.34-2.63, P < 0.001) were associated with poorer survival. On multivariate analysis of asymptomatic AAA patients, low SFI (HR 1.54, 95% CI 1.01-2.35, P < 0.05) and low SMI (HR 1.71, 95% CI 1.20-2.42, P < 0.01) were associated with poorer survival. CONCLUSIONS Low SMI and SFI are associated with poorer long-term survival following EVAR and F/B-EVAR. The relationship between body composition and prognosis requires further evaluation, and external validation of the thresholds proposed in patients with AAA is required.
Collapse
|
42
|
Salati V, Mandralis K, Becce F, Koerfer J, Lambercy K, Simon C, Gorostidi F. Preoperative CT-Based Skeletal Muscle Mass Depletion and Outcomes after Total Laryngectomy. Cancers (Basel) 2023; 15:3538. [PMID: 37509201 PMCID: PMC10377557 DOI: 10.3390/cancers15143538] [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: 05/21/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE To assess the role of preoperative CT-based skeletal muscle mass depletion on postoperative clinical outcomes and survival in patients who underwent total laryngectomy for cancer. METHODS Patients operated on between January 2011 and March 2020 were retrospectively included. Skeletal muscle area and intra- and inter-muscular fat accumulation were measured at the third lumbar vertebral level on preoperative CT scans. Skeletal muscle mass depletion was defined based on pre-established cut-off values. Their association with postoperative morbidity, length of stay (LOS), costs, and survival was assessed. RESULTS A total of 84 patients were included, of which 37 (44%) had preoperative skeletal muscle mass depletion. The rate of postoperative fistula (23% vs. 35%, p = 0.348), cutaneous cervical dehiscence (17% vs. 11%, p = 0.629), superficial incisional surgical site infections (SSI) (12% vs. 10%, p = 1.000), and unplanned reoperation (38% vs. 37%, p = 1.000) were comparable between the two patient groups. No difference in median LOS was observed (41 vs. 33 days, p = 0.295), nor in treatment costs (119,976 vs. 109,402 CHF, p = 0.585). The median overall survival was comparable between the two groups (3.43 vs. 4.95 years, p = 0.09). CONCLUSIONS Skeletal muscle mass depletion alone had no significant impact on postoperative clinical outcomes or survival.
Collapse
Affiliation(s)
- Victoria Salati
- Department of Otolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Katerina Mandralis
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Joachim Koerfer
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Karma Lambercy
- Department of Otolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Christian Simon
- Department of Otolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - François Gorostidi
- Department of Otolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| |
Collapse
|
43
|
Bunout D, Gonzalez S, Canales M, Barrera G, Hirsch S. Ultrasound assessment of rectus femoris pennation angle and echogenicity. Their association with muscle functional measures and fat infiltration measured by CT scan. Clin Nutr ESPEN 2023; 55:420-424. [PMID: 37202077 DOI: 10.1016/j.clnesp.2023.04.015] [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: 02/22/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND & AIMS Ultrasound can be used to measure the pennation angle between muscle fiver and the presumed axis of force generation and muscle echogenicity as an indicator of muscle fat infiltration. We aimed to assess the association of the rectus femoris pennation angle and echogenicity with muscle functional measures. Also, to assess the concordance of rectus femoris echogenicity with muscle fat infiltration as determined by CT scan. METHODS Rectus femoris ultrasound pennation angle and thickness were measured in 78 participants aged 69 (65,73) years (37 women). Also hand grip strength, gait speed in 4 m, the 12 min' walk and body composition by DEXA were measured. In a different group of 114 participants aged 44 (31,52) years (80 females), non-dominant rectus femoris echogenicity and thickness were measured by ultrasound and muscle fat infiltration was assessed by CT scan. Handgrip strength and quadriceps torque were also measured. RESULTS There was a weak correlation between the pennation angle and rectus femoris thickness in men (r = 0.31 p = 0.05) but not in women (r = 0.29 NS). Women, but not men with a low pennation angle covered a longer distance during the 12 min' walk. The concordance between the z scores of rectus femoris echogenicity and CT radiological density was 0.43 (p < 0.01) and 0.01 (NS) in men and women, respectively. Men and women with an echogenicity below the 25th percentile had a higher quadriceps torque. Men with an echogenicity 25th percentile below 25th percentile had also a higher handgrip strength. CONCLUSIONS Rectus femoris pennation angle had a weak or absent association with muscle performance. Rectus femoris echogenicity had a moderate overall concordance with radiological density by CT scan and was inversely associated with quadriceps torque. Therefore, echogenicity was associated with muscle strength, but pennation angle measurement did not contribute to the assessment of muscle function.
Collapse
Affiliation(s)
- Daniel Bunout
- Institute of Nutrition and Food Technology (INTA), University of Chile, Chile.
| | - Sonya Gonzalez
- Institute of Nutrition and Food Technology (INTA), University of Chile, Chile
| | - Marcela Canales
- Institute of Nutrition and Food Technology (INTA), University of Chile, Chile
| | - Gladys Barrera
- Institute of Nutrition and Food Technology (INTA), University of Chile, Chile
| | - Sandra Hirsch
- Institute of Nutrition and Food Technology (INTA), University of Chile, Chile
| |
Collapse
|
44
|
O'Mahony AT, Waldron MG, O'Shea S, Mulryan P, O'Connor OJ, Maher MM. Conventional versus ultra-low dose computed tomogram in Crohn's disease: Do morphomics correlate with clinical data? Radiography (Lond) 2023; 29:712-720. [PMID: 37196480 DOI: 10.1016/j.radi.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Cross-sectional study to assess the body composition of patients with Crohn's disease (CD) on standard (SDCT) and low dose CT (LDCT) protocols for the abdomen and pelvis (CTAP). We aimed to assess if a low dose CT protocol reconstructed with model-based iterative reconstruction (IR) could evaluate body morphometric data comparable to standard dose examination. METHODS The CTAP images of 49 patients who underwent a low dose CT scan (20% of standard dose) and a second at standard dose minus 20% were assessed retrospectively. Images were collected from the PACS system, deidentified and analysed using a web-based semi-automated threshold-based segmentation tool (CoreSlicer), capable of identifying tissue type based on differences in attenuation co-efficient. The cross-sectional area (CSA) and Hounsfield units (HU) of each tissue was recorded. RESULTS Muscle and fat CSA is well preserved on comparing these derived metrics from low dose and standard dose CT scans of abdomen and pelvic in CD ((LDCT:SDCT mean CSA (cm2); Psoas muscle - 29.00:28.67, total lumbar muscle - 127.45:125.55, visceral fat- 110.44:114.16, subcutaneous fat - 250.88:255.05)). A fixed difference exists when assessing the attenuation of muscle, with higher attenuation on the low dose protocol (LDCT:SDCT mean attenuation (HU); Psoas muscle - 61.67:52.25, total lumbar muscle - 49.29:41.20). CONCLUSION We found comparable CSA across all tissues (muscle and fat) on both protocols with a strong positive correlation. A marginally lower muscle attenuation suggestive of less dense muscle was highlighted on SDCT. This study augments previous studies suggesting that comparable and reliable morphomic data may be generated from low dose and standard dose CT images. IMPLICATIONS FOR PRACTICE Threshold-based segmental tools can be used to quantify body morphomics on standard and low dose computed tomogram protocols.
Collapse
Affiliation(s)
- A T O'Mahony
- Department of Radiology, Cork University Hospital, Cork, T12DC4A, Ireland.
| | - M G Waldron
- Department of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, Cork, T12AK54, Ireland.
| | - S O'Shea
- Department of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, Cork, T12AK54, Ireland.
| | - P Mulryan
- Department of Radiology, Cork University Hospital, Cork, T12DC4A, Ireland.
| | - O J O'Connor
- Department of Radiology, Cork University Hospital, Cork, T12DC4A, Ireland; Department of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, Cork, T12AK54, Ireland.
| | - M M Maher
- Department of Radiology, Cork University Hospital, Cork, T12DC4A, Ireland; Department of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, Cork, T12AK54, Ireland.
| |
Collapse
|
45
|
Yin L, Chu SL, Lv WF, Zhou CZ, Liu KC, Zhu YJ, Zhang WY, Wang CX, Zhang YH, Lu D, Cheng DL. Contributory roles of sarcopenia and myosteatosis in development of overt hepatic encephalopathy and mortality after transjugular intrahepatic portosystemic shunt. World J Gastroenterol 2023; 29:2875-2887. [PMID: 37274064 PMCID: PMC10237102 DOI: 10.3748/wjg.v29.i18.2875] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/08/2023] [Accepted: 04/17/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Skeletal muscle abnormalities, such as muscle mass depletion (sarcopenia) and fatty infiltration of the muscle (myosteatosis), are frequent complications in cirrhotic patients scheduled for transjugular intrahepatic portosystemic shunt (TIPS).
AIM To investigate the association and predictive value of sarcopenia and myosteatosis for overt hepatic encephalopathy (HE) and mortality after TIPS.
METHODS The records of cirrhotic patients who underwent the TIPS procedure at our hospital between January 2020 and June 2021 were retrospectively retrieved. The transversal psoas muscle thickness (TPMT) and psoas muscle attenuation (PMA) measured from the unenhanced abdominal computed tomography (CT) at the level of the third lumbar vertebrae were used to analyze the sarcopenia and myosteatosis, respectively. The area under curve (AUC) was used to evaluate the discriminative power of TPMT, PMA, and relevant clinical parameters. Fur-thermore, log-rank test was performed to compare the incidence of overt HE and survival between the different groups, and the association of risk factors with overt HE and mortality was analyzed using Cox proportional hazards regression models.
RESULTS A total of 108 patients were collected. Among these patients, 45.4% of patients developed overt HE after TIPS treatment. Furthermore, 32.4% and 28.7% of these patients were identified to have myosteatosis and sarcopenia, respectively. Myosteatosis (51.0% vs 16.9%, P < 0.001) and sarcopenia (40.8 vs 18.6%, P = 0.011) were found to be more frequent in patients with overt HE, when compared to patients without overt HE. The receiver operating characteristics analysis indicated that the predictive power of TPMT and PMA in overt HE (AUC = 0.713 and 0.778, respectively) was higher when compared to the neutrophil lymphocyte ratio (AUC = 0.636). The cumulative incidence of overt HE was the highest in patients with concomitant sarcopenia and myosteatosis, followed by patients with myosteatosis or sarcopenia, while this was the lowest in patients without sarcopenia and myosteatosis. In addition, sarcopenia and myosteatosis were inde-pendently associated with overt HE and mortality after adjusting for confounding factors in post-TIPS patients.
CONCLUSION CT-based estimations for sarcopenia and myosteatosis can be used as reliable predictors for the risk of developing overt HE and mortality in cirrhotic patients after TIPS.
Collapse
Affiliation(s)
- Liang Yin
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, Anhui Province, China
| | - Sen-Lin Chu
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, Anhui Province, China
| | - Wei-Fu Lv
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, Anhui Province, China
| | - Chun-Ze Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, Anhui Province, China
| | - Kai-Cai Liu
- Infection Hospital, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230000, Anhui Province, China
| | - Yi-Jiang Zhu
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, Anhui Province, China
| | - Wen-Yue Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, Anhui Province, China
| | - Cui-Xia Wang
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, Anhui Province, China
| | - Yong-Hui Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, Anhui Province, China
| | - Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, Anhui Province, China
| | - De-Lei Cheng
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, Anhui Province, China
| |
Collapse
|
46
|
Cho YK, Jung HN, Kim EH, Lee MJ, Park JY, Lee WJ, Kim HK, Jung CH. Association between sarcopenic obesity and poor muscle quality based on muscle quality map and abdominal computed tomography. Obesity (Silver Spring) 2023; 31:1547-1557. [PMID: 37133436 DOI: 10.1002/oby.23733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE This study evaluated whether sarcopenic obesity is closely associated with muscle quality using abdominal computed tomography. METHODS This cross-sectional study included 13,612 participants who underwent abdominal computed tomography. The cross-sectional area of the skeletal muscle was measured at the L3 level (total abdominal muscle area [TAMA]) and segmented into normal attenuation muscle area (NAMA, +30 to +150 Hounsfield units), low attenuation muscle area (-29 to +29 Hounsfield units), and intramuscular adipose tissue (-190 to -30 Hounsfield units). The NAMA/TAMA index was calculated by dividing NAMA by TAMA and multiplying by 100, and the lowest quartile of NAMA/TAMA index was defined as myosteatosis (<73.56 in men and <66.97 in women). Sarcopenia was defined using BMI-adjusted appendicular skeletal muscle mass. RESULTS The prevalence of myosteatosis was found to be significantly higher in participants with sarcopenic obesity (17.9% vs. 54.2%, p < 0.001) than the control group without sarcopenia or obesity. Compared with the control group, the odds ratio (95% CI) for having myosteatosis was 3.70 (2.87-4.76) for participants with sarcopenic obesity after adjusting for age, sex, smoking, drinking, exercise, hypertension, diabetes, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein. CONCLUSIONS Sarcopenic obesity is significantly associated with myosteatosis, which is representative of poor muscle quality.
Collapse
Affiliation(s)
- Yun Kyung Cho
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Han Na Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Eun Hee Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jung Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joong-Yeol Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Hong-Kyu Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| |
Collapse
|
47
|
Shinonaga A, Matsumoto H, Uekawa M, Kuramoto A, Mitani S, Hagino H. Relationship Between Preoperative Psoas Major Muscle Quality and Forgotten Joint Score-12 in Patients After Total Hip Arthroplasty. Arthroplast Today 2023; 20:101118. [PMID: 36938355 PMCID: PMC10015174 DOI: 10.1016/j.artd.2023.101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/04/2023] [Accepted: 01/29/2023] [Indexed: 03/21/2023] Open
Abstract
Background There are limited reports on the factors affecting the Forgotten Joint Score-12 (FJS-12) in patients after total hip arthroplasty (THA). Therefore, this study aimed to determine whether the quantity and quality of the preoperative psoas muscle are related to the FJS-12 in post-THA patients. Methods This retrospective cohort study used mailed questionnaires and medical records. Questionnaires containing the FJS-12 were mailed to 752 patients who underwent THA at our hospital between April 2015 and August 2020. The quantity and quality of the psoas major muscle were measured by computed tomography. The association between FJS-12 and the quantity and quality of the psoas major muscle was assessed by logistic regression analysis adjusted for potentially relevant factors. Results In total, 484 patients were included in the analysis. The FJS-12 score of the analyzed subjects was 75 points. Poor psoas major muscle quality was associated with a poor group of patients scoring <50 on the FJS-12. This association was independent of the adjustment factors. However, the quantity of psoas muscle was not associated. Conclusions The quality of the psoas major muscle is associated with FJS-12. In the rehabilitation of patients undergoing THA, focusing on the quality of the psoas major muscle may help achieve the ultimate goal.
Collapse
Affiliation(s)
- Atsushi Shinonaga
- Rehabilitation Center, Kawasaki Medical School Hospital, Okayama, Japan
- Integrated Medical Sciences, Graduate School of Medical Sciences, Tottori University, Tottori, Japan
- Corresponding author. Integrated Medical Sciences, Graduate School of Medical Sciences, Tottori University, Matsushima 577, Kurashiki, Okayama 701-0192, Japan. Tel.: +81 80 1991 5606.
| | - Hiromi Matsumoto
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Okayama, Japan
| | - Mana Uekawa
- Rehabilitation Center, Kawasaki Medical School Hospital, Okayama, Japan
| | - Akiho Kuramoto
- Rehabilitation Center, Kawasaki Medical School Hospital, Okayama, Japan
| | - Shigeru Mitani
- Department of Bone and Joint Surgery, Kawasaki Medical School, Okayama, Japan
| | - Hiroshi Hagino
- School of Health Science, Faculty of Medicine, Tottori University, Tottori, Japan
| |
Collapse
|
48
|
Dotan E, Catalano P, Lenchik L, Boutin R, Yao X, Marques HS, Ioffe D, Zhen DB, Li D, Wagner LI, Simon MA, Wong TZ, O'Dwyer PJ. The GIANT trial (ECOG-ACRIN EA2186) methods paper: A randomized phase II study of gemcitabine and nab-paclitaxel compared with 5-fluorouracil, leucovorin, and liposomal irinotecan in older patients with treatment-naïve metastatic pancreatic cancer - defining a new treatment option for older vulnerable patients. J Geriatr Oncol 2023; 14:101474. [PMID: 36963200 PMCID: PMC10425127 DOI: 10.1016/j.jgo.2023.101474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Pancreatic cancer is the fourth leading cause of cancer-related death in the US with an increasing incidence in older adults (OA) over age 70. There are currently no treatment guidelines for OA with metastatic pancreatic cancer (mPCA) and selecting a chemotherapy regimen for these patients is subjective, based largely on chronologic age and performance status (PS). Geriatric screening tools provide a more objective and accurate evaluation of a patient's overall health but have not yet been validated in patient selection for mPCA treatment. This study aims to elucidate the optimal chemotherapy treatment of vulnerable OA with mPCA and understand the geriatric factors that affect outcomes in this population. METHODS/DESIGN The GIANT (ECOG-ACRIN EA2186) study is multicenter, randomized phase II trial enrolling patients over age 70 with newly diagnosed mPCA. This study utilizes a screening geriatric assessment (GA) which characterizes patients as fit, vulnerable, or frail. Patients with mild abnormalities in functional status and/or cognition, moderate comorbidities, or over age 80 are considered vulnerable. Enrolled patients are randomized to one of two dose-reduced treatment regimens (gemcitabine/nab-paclitaxel every other week, or dose-reduced 5-fluoruracil (5FU)/ liposomal irinotecan (nal-IRI) every other week). GA and quality of life (QoL) evaluations are completed prior to treatment initiation and at each disease evaluation. Overall survival (OS) is the primary endpoint, with secondary endpoints including progression free survival (PFS) and objective response rate (ORR). Enrolled patients will be stratified by age (70-74 vs ≥75) and ECOG PS (0-1 vs 2). Additional endpoints of interest for OA include evaluation of risk factors identified through GA, QoL evaluation, and toxicities of interest for older adults. Correlative studies include assessment of pro-inflammatory biomarkers of aging in the blood (IL-6, CRP) and imaging evaluation of sarcopenia as predictors of treatment tolerance. DISCUSSION The GIANT study is the first randomized, prospective national trial evaluating vulnerable OA with mPCA aimed at developing a tailored treatment approach for this patient population. This trial has the potential to establish a new way of objectively selecting vulnerable OA with mPCA for modified treatment and to establish a new standard of care in this growing patient population. TRIAL REGISTRATION This trial is registered with ClinicalTrial.gov Identifier NCT04233866.
Collapse
Affiliation(s)
- Efrat Dotan
- Department of Hematology and Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA.
| | - Paul Catalano
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Robert Boutin
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Xin Yao
- ThedaCare Regional Cancer Center-Appelton, WI, USA
| | - Helga S Marques
- Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, RI, USA
| | - Dina Ioffe
- Department of Hematology and Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - David B Zhen
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Daneng Li
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Center for Health Equity Transformation, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Terence Z Wong
- Department of Radiology, Division of Nuclear Medicine and Radiotheranostics, Duke University Medical Center, Durham, NC, USA
| | - Peter J O'Dwyer
- University of Pennsylvania and Abramson Cancer Center, Philadelphia, PA, USA
| |
Collapse
|
49
|
Humphrey TJ, Salimy MS, Jancuska JM, Egan CR, Melnic CM, Alpaugh K, Bedair HS. Sarcopenia is an independent risk factor for failure to achieve the 1-year MCID of the KOOS, JR and PROMIS PF-SF10a after TKA. Knee 2023; 42:64-72. [PMID: 36913864 DOI: 10.1016/j.knee.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/07/2023] [Accepted: 02/28/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND Sarcopenia, which is a progressive and multifactorial condition of decreased muscle strength, has been identified as an independent predictor for falls, revision, infection, and readmissions following total knee arthroplasty (TKA), but its association to patient reported outcomes (PROMs) is less studied. The aim of this study is to determine if sarcopenia and other measures of body composition are correlated with ability to achieve the 1-year minimal clinically important difference (MCID) of the KOOS JR and PROMIS-PF-SF10a following primary TKA. METHODS A multicenter retrospective case-control study was performed. Inclusion criteria consisted of patients over the age of 18 undergoing primary TKA, body composition metrics determined by computed tomography (CT), and available pre- and post-operative PROM scores. Predictors of achievement of the 1-year MCID of the KOOS JR and PROMIS PF-SF-10a were determined through a multivariate linear regression. RESULTS 140 primary TKAs met inclusion criteria. 74 (52.85%) patients achieved the 1-year KOOS, JR MCID and 108 (77.41%) patients achieved the 1-year MCID for the PROMIS PF-SF10a. Sarcopenia was independently associated with decreased odds of achieving the MCID of both the KOOS, JR (OR 0.31, 95%CI 0.10-0.97, p = 0.04) and the PROMIS-PF-SF10a (OR 0.32, 95%CI 0.12-0.85, p = 0.02) CONCLUSIONS: In our study, sarcopenia was independently associated with increased odds of failure to achieve the 1-year MCID of the KOOS, JR and PROMIS PF-SF10a after TKA. Early identification of sarcopenic patients may be beneficial for arthroplasty surgeons so that targeted nutritional counseling and exercises can be recommended prior to TKA.
Collapse
Affiliation(s)
- Tyler J Humphrey
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, MA, United States.
| | - Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States.
| | - Jeffrey M Jancuska
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, MA, United States.
| | - Cameron R Egan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, MA, United States.
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, MA, United States.
| | - Kyle Alpaugh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, MA, United States.
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, MA, United States.
| |
Collapse
|
50
|
McDonald AM, DeMora L, Yang ES, Hoyle JM, Lenzie A, Williams GR, Michalski JM, Yee D, Bahary JP, Den RB, Roach M, Dess R, Mishra MV, Valicenti RK, Lau HY, Marcrom SR, Souhami L, Mendez LC, Chen Y, Doncals DE, Pugh SL, Feng FY, Sandler HM. Body composition and mortality in men receiving prostate radiotherapy: A pooled analysis of NRG/RTOG 9406 and NRG/RTOG 0126. Cancer 2023; 129:685-696. [PMID: 36579470 PMCID: PMC10231027 DOI: 10.1002/cncr.34596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To validate the association between body composition and mortality in men treated with radiation for localized prostate cancer (PCa). Secondarily, to integrate body composition as a factor to classify patients by risk of all-cause mortality. MATERIALS AND METHODS Participants of NRG/Radiation Therapy Oncology Group (RTOG) 9406 and NRG/RTOG 0126 with archived computed tomography were included. Muscle mass and muscle density were estimated by measuring the area and attenuation of the psoas muscles on a single slice at L4-L5. Bone density was estimated by measuring the attenuation of the vertebral body at mid-L5. Survival analyses, including Cox proportional hazards models, assessed the relationship between body composition and mortality. Recursive partitioning analysis (RPA) was used to create a classification tree to classify participants by risk of death. RESULTS Data from 2066 men were included in this study. In the final multivariable model, psoas area, comorbidity score, baseline prostate serum antigen, and age were significantly associated with survival. The RPA yielded a classification tree with four prognostic groups determined by age, comorbidity, and psoas area. Notably, the classification among older (≥70 years) men into prognostic groups was determined by psoas area. CONCLUSIONS This study strongly supports that body composition is related to mortality in men with localized PCa. The inclusion of psoas area in the RPA classification tree suggests that body composition provides additive information to age and comorbidity status for mortality prediction, particularly among older men. More research is needed to determine the clinical impact of body composition on prognostic models in men with PCa.
Collapse
Affiliation(s)
- Andrew M. McDonald
- Department of Radiation Oncology, University of Alabama at Birmingham O’Neal Comprehensive Cancer Center, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lyudmila DeMora
- Statistics and Data Management Department, NRG Oncology, Philadelphia, Pennsylvania, USA
- Statistical and Data Management Department, American College of Radiology, Philadelphia, Pennsylvania, USA
| | - Eddy S. Yang
- Department of Radiation Oncology, University of Alabama at Birmingham O’Neal Comprehensive Cancer Center, Birmingham, Alabama, USA
| | - John M. Hoyle
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrew Lenzie
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Grant R. Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Don Yee
- Radiation Oncology Department of Radiation Oncology, Edmonton Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Jean-Paul Bahary
- Department of Radio Oncology, CHUM - Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
| | - Robert B. Den
- Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mack Roach
- Department of Radiation Oncology, UCSF Medical Center-Mount Zion, San Francisco, California, USA
| | - Robert Dess
- Department of Radiation Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Mark V. Mishra
- Department of Radiation Oncology, University of Maryland/Greenebaum Cancer Center, Baltimore, Maryland, USA
| | - Richard K. Valicenti
- Department of Radiation Oncology, University of California Davis, Sacramento, California, USA
| | - Harold Y. Lau
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Samuel R. Marcrom
- Department of Radiation Oncology, University of Alabama at Birmingham O’Neal Comprehensive Cancer Center, Birmingham, Alabama, USA
| | - Luis Souhami
- The Research Institute, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Lucas C. Mendez
- Department of Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Yuhchyau Chen
- Department of Radiation Oncology, University of Rochester, Rochester, New York, USA
| | - Desiree E. Doncals
- Department of Radiation Oncology, Summa Health System - Akron Campus, Akron, Ohio, USA
| | - Stephanie L. Pugh
- Statistics and Data Management Department, NRG Oncology, Philadelphia, Pennsylvania, USA
- Statistical and Data Management Department, American College of Radiology, Philadelphia, Pennsylvania, USA
| | - Felix Y. Feng
- Department of Radiation Oncology, UCSF Medical Center-Mission Bay, San Francisco, California, USA
| | - Howard M. Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|