CT Measures of Bone Mineral Density and Muscle Mass Can Be Used to Predict Noncancer Death in Men with Prostate Cancer

Abstract

Purpose To determine if computed tomographic (CT) metrics of bone mineral density and muscle mass can improve the prediction of noncancer death in men with localized prostate cancer. Materials and Methods Institutional review board approval was obtained, with waiver of informed consent. All patients who underwent radiation therapy for localized prostate cancer between 2001 and 2012 with height, weight, and past medical history documented and who underwent CT that included the L4-5 vertebral interspace were included. On a single axial CT section obtained at the mid-L5 level, the mean CT attenuation of the trabecular bone of the L5 vertebral body (L5) was measured. The height-normalized psoas cross-sectional area (Psoas) was measured on a single CT section obtained at the L4-5 vertebral interface. Multivariable Cox proportional hazards models were used to assess effects on noncancer death. By using parameter estimates from an adjusted model, a prognostic index for prediction of noncancer death was generated and compared with age-adjusted Charlson Comorbidity Index (CCI) by using the Harrell c statistic. Results Six hundred fifty-three men met the inclusion criteria. Prostate cancer risk grouping, androgen deprivation, race, age-adjusted CCI, L5, and Psoas were included in a multivariable model. Age-adjusted CCI (hazard ratio [HR] = 1.36, P < .001), L5 (HR = 2.88 for L5 < 105 HU, HR = 1.42 for 105 HU ≤ L5 ≤ 150 HU, P < .001), Psoas (HR = 1.95 for Psoas < 7.5 cm/m, P = .003), and race (HR = 1.68 for African American race, HR = 1.77 for other nonwhite race, P = .019) were independent predictors of noncancer death. The prognostic index yielded a c value of 0.747 for the prediction of noncancer death versus 0.718 for age-adjusted CCI alone. Conclusion L5 and Psoas, which are surrogates for bone mineral density and muscle mass, respectively, were independent predictors of noncancer death. The prognostic index that incorporated these measures with the CCI was associated with improved accuracy for prediction of noncancer death. RSNA, 2016 Online supplemental material is available for this article.

Skeletal Muscle Loss Is an Imaging Biomarker of Outcome after Definitive Chemoradiotherapy for Locally Advanced Cervical Cancer

“…Therefore, no additional radiation exposure was incurred in our evaluation of sarcopenia. The measurements were simple to perform using commercially available software, which did not add additional cost (33). In addition, previous studies (36,37) have revealed that underweight patients with LACC (BMI < 18.5 kg/ m 2 ) have a lower OS than normal weight or obese patients.…”

“…Two consecutive transverse CT images extending from L3 to the iliac crest were analyzed using Varian Eclipse software (Varian Medical Systems Inc.; ref. 33), which contains a number of tools that are useful for delineating and analyzing specific regions of interest. The skeletal muscle area includes the psoas, paraspinal, transversus abdominis, rectus abdominis, and internal and external oblique muscles.…”

Muscle radiodensity loss during cancer therapy is predictive for poor survival in advanced endometrial cancer

“…CT image parameters included the following information: contrast‐enhanced, 5 mm slice thickness, 120 kVp, and approximately 290 mA. Two consecutive axial CT images extending from the third lumbar to the iliac crest were analysed using the Varian Eclipse software (Varian Medical Systems Inc., Palo Alto, CA, USA) . The skeletal muscle area (including psoas, paraspinal, transversus abdominis, rectus abdominis, and internal and external oblique muscles) was calculated by using Hounsfield unit (HU) thresholds of −29 and +150 .…”

“…Two consecutive axial CT images extending from the third lumbar to the iliac crest were analysed using the Varian Eclipse software (Varian Medical Systems Inc., Palo Alto, CA, USA). 55 The skeletal muscle area (including psoas, paraspinal, transversus abdominis, rectus abdominis, and internal and external oblique muscles) was calculated by using Hounsfield unit (HU) thresholds of À29 and +150. 27,28,56 The mean skeletal muscle radiation attenuation of the entire cross-sectional muscle area was reported as SMD.…”

Muscle Loss after Chemoradiotherapy as a Biomarker of Distant Failures in Locally Advanced Cervical Cancer

“…Two consecutive transverse CT images extending from L3 to the iliac crest were analysed using the Varian Eclipse software (Varian Medical Systems Inc., Palo Alto, CA, USA) [24]. Predetermined Hounsfield unit (HU) thresholds were −29 to +150 HU for skeletal muscle, −50 to −150 HU for visceral adipose tissue, and −30 to −190 HU for subcutaneous and intermuscular adipose tissue [14,15,20].…”