Diagnosing sarcopenia at the point of imaging care: analysis of clinical, functional, and opportunistic CT metrics

Yao, Lawrence; Petrosyan, A; Fuangfa, Praman; Lenchik, Leon; Boutin, Robert D.

doi:10.1007/s00256-020-03576-9

Cited by 10 publications

(6 citation statements)

References 31 publications

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“…One, while multilevel body composition measurements are increasingly available, methods to aggregate this information are missing. 18,24,34,35 Two, the current study's performance characteristics indicate that multilevel body composition analysis using percentile-based averaging can improve upon the current standard of single-level complete-case analysis. We chose the C-statistic as a measure of predictive accuracy for the primary characteristic, as the C-statistic reflects a model's primary purpose.…”

Section: Discussionmentioning

confidence: 86%

“…There are multiple reasons to use percentile‐based averaging in addition to SMG. One, while multilevel body composition measurements are increasingly available, methods to aggregate this information are missing 18,24,34,35 . Two, the current study's performance characteristics indicate that multilevel body composition analysis using percentile‐based averaging can improve upon the current standard of single‐level complete‐case analysis.…”

Section: Discussionmentioning

confidence: 89%

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Percentile‐based averaging and skeletal muscle gauge improve body composition analysis: validation at multiple vertebral levels

Marquardt

Roeland

Seventer

et al. 2021

J cachexia sarcopenia muscle

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Background Skeletal muscle metrics on computed tomography (CT) correlate with clinical and patient-reported outcomes. We hypothesize that aggregating skeletal muscle measurements from multiple vertebral levels and skeletal muscle gauge (SMG) better predict outcomes than skeletal muscle radioattenuation (SMRA) or -index (SMI) at a single vertebral level. Methods We performed a secondary analysis of prospectively collected clinical (overall survival, hospital readmission, time to unplanned hospital readmission or death, and readmission or death within 90 days) and patient-reported outcomes (physical and psychological symptom burden captured as Edmonton Symptom Assessment Scale and Patient Health Questionnaire) of patients with advanced cancer who experienced an unplanned admission to Massachusetts General Hospital from 2014 to 2016. First, we assessed the correlation of skeletal muscle cross-sectional area, SMRA, SMI, and SMG at one or more of the following thoracic (T) or lumbar (L) vertebral levels: T5, T8, T10, and L3 on CT scans obtained ≤50 days before index assessment. Second, we aggregated measurements across all available vertebral levels using percentile-based averaging (PBA) to create the average percentile. Third, we constructed one regression model adjusted for age, sex, sociodemographic factors, cancer type, body mass index, and intravenous contrast for each combination of (i) vertebral level and average percentile, (ii) muscle metrics (SMRA, SMI, & SMG), and (iii) clinical and patient-reported outcomes. Fourth, we compared the performance of vertebral levels and muscle metrics by ranking otherwise identical models by concordance statistic, number of included patients, coefficient of determination, and significance of muscle metric. ResultsWe included 846 patients (mean age: 63.5 ± 12.9 years, 50.5% males) with advanced cancer [predominantly gastrointestinal (32.9%) or lung (18.9%)]. The correlation of muscle measurements between vertebral levels ranged from 0.71 to 0.84 for SMRA and 0.67 to 0.81 for SMI. The correlation of individual levels with the average percentile was 0.90-0.93 for SMRA and 0.86-0.92 for SMI. The intrapatient correlation of SMRA with SMI was 0.21-0.40. PBA allowed for inclusion of 8-47% more patients than any single-level analysis. PBA outperformed single-level analyses across all comparisons with average ranks 2.6, 2.9, and 1.6 for concordance statistic, coefficient of determination, and significance (range 1-5, μ = 3), respectively. On average, SMG outperformed SMRA and SMI across outcomes and vertebral levels: the average rank of SMG was 1.4, 1.4, and 1.4 for concordance statistic, coefficient of determination, and significance (range 1-3, μ = 2), respectively. Conclusions Multivertebral level skeletal muscle analyses using PBA and SMG independently and additively outperform analyses using individual levels and SMRA or SMI.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 89%

Percentile‐based averaging and skeletal muscle gauge improve body composition analysis: validation at multiple vertebral levels

Marquardt

Roeland

Seventer

et al. 2021

J cachexia sarcopenia muscle

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“…Sarcopenia was assessed using the Total Psoas Muscle Area Index (TPAI), which was calculated as the sum of the cross‐sectional area of the left and right psoas muscles at the third lumbar vertebra (L3) and adjusted for height from preoperative CT abdomen and pelvis portal venous phase axial images (Figure 1A,B). 23,24 Measurements were performed by a board‐certified musculoskeletal radiologist with ≥ 8 years of clinical experience. Sarcopenia was defined as TPAI values ≤ first quintile by sex (i.e., ≤3.10 cm 2 /m 2 for females and ≤ 4.77 cm 2 /m 2 for males).…”

Section: Methodsmentioning

confidence: 99%

“…Sarcopenia was assessed using the Total Psoas Muscle Area Index (TPAI), which was calculated as the sum of the cross-sectional area of the left and right psoas muscles at the third lumbar vertebra (L3) and adjusted for height from preoperative CT abdomen and pelvis portal venous phase axial images (Figure 1A,B). 23,24 Hypoalbuminemia was defined as preoperative albumin < 3.4 g/ dL. Frailty was measured using the mFI as previously described.…”

Section: Methodsmentioning

confidence: 99%

Sarcopenia and frailty as predictors of surgical morbidity and oncologic outcomes in retroperitoneal sarcoma

Nasirishargh

Grova

Bateni

et al. 2023

Journal of Surgical Oncology

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Background: Retroperitoneal sarcomas (RPS) are rare tumors for which surgical resection is the principal treatment. There is no established model to predict perioperative risks for RPS. We evaluated the association between preoperative sarcopenia, frailty, and hypoalbuminemia with surgical and oncological outcomes.Methods: We performed a prospective cohort analysis of 65 RPS patients who underwent surgical resection. Sarcopenia was defined as Total Psoas Area Index ≤ 1st quintile by sex. Frailty was estimated using the modified frailty index (mFI).Logistic regression models were used to assess predictors of 30-day postoperative morbidity. The Kaplan-Meier method with log-rank test was utilized to assess factors associated with overall (OS) and recurrence-free survival (RFS).Result: Sarcopenia was associated with worse OS with a median of 54 compared with 158 months (p = 0.04), but no differences in RFS (p > 0.05). Hypoalbuminemia was associated with worse OS with a median of 72 compared with 158 months (p < 0.01). MFI scores were not associated with OS or RFS (p > 0.05). Sarcopenia, mFI, and hypoalbuminemia were not associated with postoperative morbidity (p > 0.05). Conclusion:This study suggests that sarcopenia may be utilized as a measure of overall fitness, rather than a cancer-specific risk, and the mFI is a poor predictive measure of outcomes in RPS.

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“…16 Other reasons include the need for specialized software, time required for clinicians to develop methodological competency, and the slow emergence of evidence for development of clinical practice guidelines. 10,17,18 Although interest continues to gain momentum among radiologists, 16,19 other healthcare providers, including registered dietitians (RDs), are positioned to use CT images as part of their comprehensive nutrition assessments.…”

Section: Introductionmentioning

confidence: 99%

Piloting a training program in computed tomography skeletal muscle assessment for registered dietitians

Martin

Tom

Basualdo-Hammond

et al. 2022

J Parenter Enteral Nutr

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Background Consensus definitions for disease‐associated malnutrition and sarcopenia include reduced skeletal muscle mass as a diagnostic criterion. There is a need to develop and validate techniques to assess skeletal muscle in clinical practice. Skeletal muscle mass can be precisely quantified from computed tomography (CT) images. This pilot study aimed to train registered dietitians (RDs) to complete precise skeletal muscle measurements using CT. Methods Purposive sampling identified RDs employed in clinical areas in which CT scans are routinely performed. CT training included (1) a 3‐Day training session focused on manual segmentation of skeletal muscle cross‐sectional areas (cm2, centimeter squared) from abdominal CT images at the third lumbar vertebra (L3), using sliceOmatic® software, and (2) a precision assessment to quantify the intraobserver and interobserver precision error of repeated skeletal muscle measurements (30 images in duplicate). Precision error is reported as the root mean standard deviation (cm2) and percent coefficient of variation (%CV), our primary performance indicator, was defined as a precision error of <2%. Results Five RDs completed CT training. RDs were from three clinical areas: cancer care (N = 1), surgery (N = 2), and critical care (N = 1). RDs' precision error was low and below the minimal acceptable error of <2%; intraobserver error was ≤1.8 cm2 (range, 0.8–1.8 cm2) or ≤1.5% (range, 0.8%–1.5%) and interobserver error was 1.2 cm2 or 1.1%. Conclusion RDs can be trained to perform precise CT skeletal muscle measurements. Increasing capacity to assess skeletal muscle is a first step toward developing this technique for use in clinical practice.

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Diagnosing sarcopenia at the point of imaging care: analysis of clinical, functional, and opportunistic CT metrics

Cited by 10 publications

References 31 publications

Percentile‐based averaging and skeletal muscle gauge improve body composition analysis: validation at multiple vertebral levels

Percentile‐based averaging and skeletal muscle gauge improve body composition analysis: validation at multiple vertebral levels

Sarcopenia and frailty as predictors of surgical morbidity and oncologic outcomes in retroperitoneal sarcoma

Piloting a training program in computed tomography skeletal muscle assessment for registered dietitians

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