Influence of Contrast Administration on Computed Tomography–Based Analysis of Visceral Adipose and Skeletal Muscle Tissue in Clear Cell Renal Cell Carcinoma

Paris, Michael T.; Furberg, Helena; Petruzella, Stacey; Akın, Oğuz; Hötker, Andreas M.; Mourtzakis, Marina

doi:10.1002/jpen.1067

Cited by 40 publications

(44 citation statements)

References 30 publications

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“…Cross sectional areas of these tissues were quantified by summing up tissue pixels and multiplying by the pixel surface areas. Given the effect of contrast medium administration on muscle and VAT cross-sectional area and radiodensity estimation [29], only CT slices without contrast were selected for body composition analysis in this study. Using non-contrast abdominal CT images, high intraobserver and interobserver reproducibility was observed in measuring the body composition parameters in clinical populations [29].…”

Section: Ct Image Analysismentioning

confidence: 99%

“…Given the effect of contrast medium administration on muscle and VAT cross-sectional area and radiodensity estimation [29], only CT slices without contrast were selected for body composition analysis in this study. Using non-contrast abdominal CT images, high intraobserver and interobserver reproducibility was observed in measuring the body composition parameters in clinical populations [29]. Using software such as Slice-O-Matic, tissues were selected semi-automatically and the average time to quantify body composition parameters was found to be around eight minutes, which can be easily carried out by any trained observers with a knowledge of human anatomy [30].…”

Section: Ct Image Analysismentioning

confidence: 99%

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Visceral Adipose Tissue Radiodensity Is Linked to Prognosis in Hepatocellular Carcinoma Patients Treated with Selective Internal Radiation Therapy

Ebadi

Moctezuma‐Velázquez

Meza–Junco³

et al. 2020

Cancers

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Hepatocellular carcinoma (HCC) constitutes the fourth leading cause of cancer-related mortality. Various factors, such as tumor size, tumor multiplicity, and liver function, have been linked to the prognosis of HCC. The aim of this study was to explore the prognostic significance of muscle, subcutaneous and visceral adipose tissue (VAT) mass, and radiodensity, in a cohort of 101 HCC patients treated with selective internal radiation therapy (SIRT). Muscle and adipose tissue cross sectional area (cm2/m2) and radiodensity, reported as the Hounsfield Unit (HU), were determined using pre-SIRT computed tomography images. Cox proportional hazard models and exact logistic regression were conducted to assess associations between body composition and adverse outcomes. Majority of the patients were male (88%) with a mean VAT radiodensity of −85 ± 9 HU. VAT radiodensity was independently associated with mortality (HR 1.05; 95% CI: 1.01–1.08; p = 0.01), after adjusting for cirrhosis etiology, Barcelona Clinic Liver Cancer stage, previous HCC treatment, and portal hypertension markers. Patients with a high VAT radiodensity of ≥–85 HU had a two times higher risk of mortality (HR 2.01, 95% CI 1.14–3.54, p = 0.02), compared to their counterpart. Clinical features of portal hypertension were more prevalent in patients with high VAT radiodensity. High VAT radiodensity was associated with severe adverse events after adjusting for confounding factors. High VAT radiodensity is independently associated with both increased mortality and severe adverse events in patients treated with SIRT. VAT radiodensity measurement might serve as an objective approach to identify patients who will experience the most benefit from SIRT.

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Section: Ct Image Analysismentioning

confidence: 99%

Section: Ct Image Analysismentioning

confidence: 99%

Visceral Adipose Tissue Radiodensity Is Linked to Prognosis in Hepatocellular Carcinoma Patients Treated with Selective Internal Radiation Therapy

Ebadi

Moctezuma‐Velázquez

Meza–Junco³

et al. 2020

Cancers

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“…The slight increase of SMA and SMI may be attributed to the contrast agent, which increases the attenuation values of muscle fibers that were below the defined threshold on unenhanced images . Several previous studies showed similar results, and the increase in SMI does not alter the identification of patients with low SMI . Thus, CT‐based assessment of SMI is an easy and reliable method independent of contrast enhancement.…”

Section: Discussionmentioning

confidence: 73%

“…However, the time points of contrast enhancement and study cohort in our study were different from theirs. Paris et al also revealed that the increase in MRA with contrast‐enhancement phases altered the identification of individuals with low MRA. Hence, the definition of the skeletal muscle measures should be standardized to a particular phase to ensure their applicability and comparability, especially for MRA.…”

Section: Discussionmentioning

confidence: 99%

“…There is currently no consensus about the optimal method to date. In addition, contrast administration may influence the values of skeletal muscle measurements, and the time points of enhancement phases varied among studies and individuals, with many studies even providing no mention about it. It is conceivable that using SMI and/or MRA derived from different contrast‐enhancement phases may result in overestimation or underestimation of sarcopenia based on given cutoff values.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Methods Used to Establish Sarcopenia Cutoff Values for Skeletal Muscle Measures Using Unenhanced and Contrast‐Enhanced Computed Tomography Images

Feng

Rong

Luo

et al. 2019

J Parenter Enteral Nutr

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Background:Multiple cutoff values of computed tomography (CT)-based skeletal muscle measures have been proposed, but there is currently no consensus used to identify sarcopenia. We aimed to evaluate the influence of statistical methods used to establish sarcopenia cutoff values and to examine the impact of contrast enhancement on the skeletal muscle measures. Methods: The skeletal muscle area (SMA) and muscle radiation attenuation (MRA) of 316 healthy individuals were measured on unenhanced CT images at the third lumbar vertebra level, and the skeletal muscle index (SMI) was SMA divided by height squared. Possible cutoff values were established using 2 methods: 5 th percentile of individuals aged 20-60 years or mean − 2 × SD of individuals aged 20-50 years. The concordance was assessed using Cohen's κ coefficients and McNemar test. The skeletal muscle parameters on 3 phases from 30 CT examinations were compared. Results: The concordance between the 2 methods was almost perfect (κ coefficients: 0.830-0.849) for low MRA but slight to moderate (κ coefficients: 0.189-0.591) for low SMI, especially in the men (P < 0.01). Compared with the unenhanced images, the mean SMA, SMI, and MRA on the contrast-enhanced images increased by 0.8%-1.7%, 0.8%-1.8%, and 14.8%-21.6% (all P < 0.001), respectively, and only the changes in MRA were clinically significant. Conclusions: The methods for establishing cutoff values and contrast enhancement influence the identification of low SMI and low MRA, respectively. Thus, the definition of sarcopenia should include the standardized method for establishing cutoff values and the phase of CT for analysis. (JPEN J Parenter Enteral Nutr. In this study, we comprehensively evaluated the influence of statistical methods used to establish sarcopenia cutoff values in a healthy population and examined the impact of contrast enhancement on the skeletal muscle measures. Our study highlights the standardized method for establishing cutoff values and the phase of computed tomography for analysis in the definition of sarcopenia. Future research should further validate the proposed sex-specific cutoff values in different patient populations.From the

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Muscle loss during primary debulking surgery and chemotherapy predicts poor survival in advanced‐stage ovarian cancer

Huang

Yang

Chen

et al. 2020

J cachexia sarcopenia muscle

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Background Sarcopenia is commonly observed in patients with advanced-stage epithelial ovarian cancer (EOC). However, the effect of body composition changes-during primary debulking surgery (PDS) and adjuvant platinum-based chemotherapy-on outcomes of patients with advanced-stage EOC is unknown. This study aimed to evaluate the association between body composition changes and outcomes of patients with stage III EOC treated with PDS and adjuvant platinum-based chemotherapy. Methods Pre-treatment and post-treatment computed tomography (CT) images of 139 patients with stage III EOC were analysed. All CT images were contrast-enhanced scans and were acquired according to a standardized protocol. The skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), and total adipose tissue index were measured using CT images obtained at the L3 vertebral level. Predictors of overall survival were identified using Cox regression models. Results The median follow-up was 37.9 months. The median duration between pre-treatment and post-treatment CT was 182 days (interquartile range: 161-225 days). Patients experienced an average SMI loss of 1.8%/180 days (95% confidence interval: À3.1 to À0.4; P = 0.01) and SMD loss of 1.7%/180 days (95% confidence interval: À3.3 to À0.03; P = 0.046). SMI and SMD changes were weakly correlated with body mass index changes (Spearman ρ for SMI, 0.15, P = 0.07; ρ for SMD, 0.02, P = 0.82). The modified Glasgow prognostic score was associated with SMI loss (odds ratio: 2.42, 95% confidence interval: 1.03-5.69; P = 0.04). The median time to disease recurrence was significantly shorter in patients with SMI loss ≥5% after treatment than in those with SMI loss <5% or gain (5.4 vs. 11.2 months, P = 0.01). Pre-treatment SMI (1 cm 2 /m 2 decrease; hazard ratio: 1.08, 95% confidence interval: 1.03-1.11; P = 0.002) and SMI change (1%/180 days decrease; hazard ratio: 1.04, 95% confidence interval: 1.01-1.08; P = 0.002) were independently associated with poorer overall survival. SMD, body mass index, and total adipose tissue index at baseline and changes were not associated with overall survival. Conclusions Skeletal muscle index decreased significantly during treatment and was independently associated with poor overall survival in patients with stage III EOC treated with PDS and adjuvant platinum-based chemotherapy. The modified Glasgow prognostic score might be a predictor of SMI loss during treatment.

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Influence of Contrast Administration on Computed Tomography–Based Analysis of Visceral Adipose and Skeletal Muscle Tissue in Clear Cell Renal Cell Carcinoma

Abstract: Future analyses should consider the phase of contrast during CT imaging because it may alter the interpretations of several parameters.

Cited by 40 publications

References 30 publications

Visceral Adipose Tissue Radiodensity Is Linked to Prognosis in Hepatocellular Carcinoma Patients Treated with Selective Internal Radiation Therapy

Visceral Adipose Tissue Radiodensity Is Linked to Prognosis in Hepatocellular Carcinoma Patients Treated with Selective Internal Radiation Therapy

Influence of Methods Used to Establish Sarcopenia Cutoff Values for Skeletal Muscle Measures Using Unenhanced and Contrast‐Enhanced Computed Tomography Images

Muscle loss during primary debulking surgery and chemotherapy predicts poor survival in advanced‐stage ovarian cancer

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