Automated CT-Based Body Composition Analysis: A Golden Opportunity

Pickhardt, Perry J.; Summers, Ronald M.; Garrett, John W.

doi:10.3348/kjr.2021.0775

Cited by 20 publications

(14 citation statements)

References 29 publications

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“…Among these, CT scans quantify bone mineral density, visceral and subcutaneous fat, skeletal muscle, liver fat, and arterial vascular calcification. Thus, they are the most comprehensive modality ( 28 ). The predictive value of a chest CT in whole-body composition has been evaluated in healthy adults or patients with cancer.…”

Section: Discussionmentioning

confidence: 99%

Association Between the Growth Hormone/Insulin-Like Growth Factor-1 Axis and Muscle Density in Children and Adolescents of Short Stature

Yang

et al. 2022

Front. Endocrinol.

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ObjectiveTo evaluate the association between the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis and muscle density in children and adolescents of short stature.MethodsParticipants were children and adolescents of short stature hospitalized in the Affiliated Hospital of Jining Medical University between January 2020 and June 2021. All participants had CT scan images available. We performed an analysis of the images to calculate the muscle density or skeletal muscle attenuation (SMA), skeletal muscle index (SMI), and fat mass index (FMI). Bioelectrical impedance analysis (BIA) was used to ensure that chest CT is a credible way of evaluating body composition.ResultsA total of 297 subjects were included with the mean age of 10.00 ± 3.42 years, mean height standard deviation score (SDS) of -2.51 ± 0.53, and mean IGF-1 SDS of -0.60 ± 1.07. The areas of muscle and fat tissues at the fourth thoracic vertebra level in the CT images showed strong correlation with the total weights of the participants (R2 = 0.884 and 0.897, respectively). The peak of GH was negatively associated with FMI (r = - 0.323, P <.01) and IGF-1 SDS was positively associated with SMI (r = 0.303, P <.01). Both the peak GH and IGF-1 SDS were positively associated with SMA (r = 0.244, P <.01 and r = 0.165, P <.05, respectively). Multiple stepwise linear regression analysis demonstrated that the GH peak was the predictor of FMI (β = - 0.210, P < .01), the IGF-1 SDS was the predictor of SMI (β = 0.224, P < .01), and both the peak GH and IGF-1 SDS were predictors of SMA (β = 0.180, P < .01 and β = 0.222, P < .01).ConclusionsA chest CT scan is a credible method of evaluating body composition in children and adolescents of short stature. In these patients, peak GH and IGF-1 SDS are independent predictors of muscle density and the GF/IGF-1 axis may regulate body composition through complex mechanisms.

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Section: Discussionmentioning

confidence: 99%

Association Between the Growth Hormone/Insulin-Like Growth Factor-1 Axis and Muscle Density in Children and Adolescents of Short Stature

Yang

et al. 2022

Front. Endocrinol.

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“…KJR pays close attention to external validation/testing while reviewing manuscripts, as demonstrated by some recent articles [ 7 12 13 14 ]. One particular issue that is garnering attention with respect to the introduction of AI in radiology is “opportunistic” automated body composition analyses using imaging performed for other targeted purposes such as quantitative measurements of bone mineral density, visceral and subcutaneous fat, skeletal muscle, liver fat, coronary vascular calcification, and organ size [ 12 15 16 17 18 19 ]. The labor-intensive nature of manual (or even semi-automated) body composition measurements has largely prevented their translation from the research realm to routine clinical practice or large-scale population healthcare [ 15 ].…”

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confidence: 99%

“…The labor-intensive nature of manual (or even semi-automated) body composition measurements has largely prevented their translation from the research realm to routine clinical practice or large-scale population healthcare [ 15 ]. However, the emergence of automated AI-based approaches has paved the way for both efficient prospective clinical reporting and large-scale studies [ 15 ]. The association between skeletal muscle mass and patient outcomes is currently an area of active research [ 20 21 22 ].…”

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“…Furthermore, these brief pieces may be more compatible with the era of mobile networks. KJR has already published several such brief articles in 2021 [ 15 23 24 25 ] including a few that were published in a slightly different interim format and category [ 23 24 ]. These articles address a singular topic rather than covering a broad topic.…”

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confidence: 99%

“…These articles address a singular topic rather than covering a broad topic. The examples include the proposal of a new goal in ablation therapy for benign thyroid nodules [ 23 ], the importance of specifying magnetic resonance imaging parameters for a high-resolution T2-weighted scan of rectal cancer [ 24 ], six mistakes to avoid for better reporting of survival analysis in imaging research [ 25 ], and a perspective on how automated computed tomography-based body composition analysis enabled by the current AI/machine-learning technology might influence routine radiology practice [ 15 ]. The KJR will publish more of these brief pieces in 2022.…”

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Looking Ahead to 2022 for the Korean Journal of Radiology

Park

2022

Korean J Radiol

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Body Composition in Advanced Non-Small Cell Lung Cancer Treated With Immunotherapy

Chaunzwa,

Qian,

et al. 2024

JAMA Oncol

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ImportanceThe association between body composition (BC) and cancer outcomes is complex and incompletely understood. Previous research in non–small-cell lung cancer (NSCLC) has been limited to small, single-institution studies and yielded promising, albeit heterogeneous, results.ObjectivesTo evaluate the association of BC with oncologic outcomes in patients receiving immunotherapy for advanced or metastatic NSCLC.Design, Setting, and ParticipantsThis comprehensive multicohort analysis included clinical data from cohorts receiving treatment at the Dana-Farber Brigham Cancer Center (DFBCC) who received immunotherapy given alone or in combination with chemotherapy and prospectively collected data from the phase 1/2 Study 1108 and the chemotherapy arm of the phase 3 MYSTIC trial. Baseline and follow-up computed tomography (CT) scans were collected and analyzed using deep neural networks for automatic L3 slice selection and body compartment segmentation (skeletal muscle [SM], subcutaneous adipose tissue [SAT], and visceral adipose tissue). Outcomes were compared based on baseline BC measures or their change at the first follow-up scan. The data were analyzed between July 2022 and April 2023.Main Outcomes and MeasuresHazard ratios (HRs) for the association of BC measurements with overall survival (OS) and progression-free survival (PFS).ResultsA total of 1791 patients (878 women [49%]) with NSCLC were analyzed, of whom 487 (27.2%) received chemoimmunotherapy at DFBCC (DFBCC-CIO), 825 (46.1%) received ICI monotherapy at DFBCC (DFBCC-IO), 222 (12.4%) were treated with durvalumab monotherapy on Study 1108, and 257 (14.3%) were treated with chemotherapy on MYSTIC; median (IQR) ages were 65 (58-74), 66 (57-71), 65 (26-87), and 63 (30-84) years, respectively. A loss in SM mass, as indicated by a change in the L3 SM area, was associated with worse oncologic outcome across patient groups (HR, 0.59 [95% CI, 0.43-0.81] and 0.61 [95% CI, 0.47-0.79] for OS and PFS, respectively, in DFBCC-CIO; HR, 0.74 [95% CI, 0.60-0.91] for OS in DFBCC-IO; HR, 0.46 [95% CI, 0.33-0.64] and 0.47 [95% CI, 0.34-0.64] for OS and PFS, respectively, in Study 1108; HR, 0.76 [95% CI, 0.61-0.96] for PFS in the MYSTIC trial). This association was most prominent among male patients, with a nonsignificant association among female patients in the MYSTIC trial and DFBCC-CIO cohorts on Kaplan-Meier analysis. An increase of more than 5% in SAT density, as quantified by the average CT attenuation in Hounsfield units of the SAT compartment, was associated with poorer OS in 3 patient cohorts (HR, 0.61 [95% CI, 0.43-0.86] for DFBCC-CIO; HR, 0.62 [95% CI, 0.49-0.79] for DFBCC-IO; and HR, 0.56 [95% CI, 0.40-0.77] for Study 1108). The change in SAT density was also associated with PFS for DFBCC-CIO (HR, 0.73; 95% CI, 0.54-0.97). This was primarily observed in female patients on Kaplan-Meier analysis.Conclusions and RelevanceThe results of this multicohort study suggest that loss in SM mass during systemic therapy for NSCLC is a marker of poor outcomes, especially in male patients. SAT density changes are also associated with prognosis, particularly in female patients. Automated CT-derived BC measurements should be considered in determining NSCLC prognosis.

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Automated CT-Based Body Composition Analysis: A Golden Opportunity

Cited by 20 publications

References 29 publications

Association Between the Growth Hormone/Insulin-Like Growth Factor-1 Axis and Muscle Density in Children and Adolescents of Short Stature

Association Between the Growth Hormone/Insulin-Like Growth Factor-1 Axis and Muscle Density in Children and Adolescents of Short Stature

Looking Ahead to 2022 for the Korean Journal of Radiology

Body Composition in Advanced Non-Small Cell Lung Cancer Treated With Immunotherapy

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