Preoperative assessment of skeletal muscle mass during magnetic resonance enterography in patients with Crohn’s disease

Abstract

Measurement of the psoas muscle area has been applied to estimate lean muscle mass as a surrogate marker of sarcopenia, but there is a paucity of evidence regarding the influence of sarcopenia on clinical outcomes following inflammatory bowel disease surgery. The aim of this study was to evaluate the association between MRI enterography defined sarcopenia and postoperative complications in patients undergoing elective ileocaecal resection for Crohn’s disease. To obtain cross sectional area measurement of the psoas muscle, the freehand area tool was used to trace the margin of each psoas muscle at the level of L4, with the sum recorded as Total Psoas Area (TPA). The total cross sectional muscle area of the abdominal wall was recorded as Skeletal Muscle Area (SMA), while myosteatosis was measured by normalising the psoas muscle intensity with the mean intensity of the cerebrospinal fluid. The primary outcome was the incidence of 30-day postoperative complications in patients in the lowest quartile of TPA and SMA. 31 patients were included and ten patients (32.25%) developed postoperative complications within 30 days of surgery. The cut-off values for the lowest quartile for TPA were 11.93 cm2 in men and 9.77 cm2 in women, including a total of 8 patients (25.8%) with 5 patients in this group (62.5%) developing postoperative complications and 3 patients (37.5%) Clavien-Dindo class ≥ 3 complications. The cut-off values for the lowest quartile for SMA were 73.49 cm2 in men and 65.85 cm2 in women, with 4 patients out of 8 (50%) developing postoperative complications. Psoas muscle cross sectional area and skeletal mass area can be estimated on Magnetic Resonance Enterography as surrogate markers of sarcopenia with high inter-observer agreement.

Inflammatory Bowel Disease and Sarcopenia: Its Mechanism and Clinical Importance

“…Table 1 shows the evaluation methods and frequency of sarcopenia reported in recent years in patients with IBD [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. In more than half of the reports, computed tomography (CT, L3 level) is used to assess sarcopenia, but many reports only use muscle mass assessment to determine sarcopenia, while a few include grip strength and walking speed in the assessment of sarcopenia [ 17 ].…”

Impact of myopenia and myosteatosis on postoperative outcome and recurrence in Crohn’s disease

“…In the literature, there are only two known smaller scaled studies using different MRI sequences to assess myopenia or myosteatosis in patients with CD. Spooren et al [ 24 ] evaluated T1-weighted fat-saturated post-contrast images in 35 CD patients, while Celentano et al [ 25 ] assessed axial T2-weighted sequences in 31 CD patients. In these studies, myopenia and myosteatosis were associated with a higher rate of postoperative complications and unfavorable disease outcome, indicating potential clinical relevance for these two parameters [ 24 , 25 ].…”

“…Spooren et al [ 24 ] evaluated T1-weighted fat-saturated post-contrast images in 35 CD patients, while Celentano et al [ 25 ] assessed axial T2-weighted sequences in 31 CD patients. In these studies, myopenia and myosteatosis were associated with a higher rate of postoperative complications and unfavorable disease outcome, indicating potential clinical relevance for these two parameters [ 24 , 25 ]. In our cohort of 223 CD patients, we investigated the role of MRI-defined myopenia and myosteatosis with anastomotic leakage, postoperative complications, and recurrence rates based on a homogeneous cohort, including only patients with Crohn’s disease undergone ileocecal resection.…”

“…Myopenia, defined as the presence of clinically relevant muscle wasting due to any illness and at any age [19], and myosteatosis, the infiltration of fat in skeletal muscle, have been proposed to be prognostic factors of relevant clinical and socio-economic negative outcomes, such as poor surgical outcomes and survival rates for cancer patients [20][21][22][23]. However, their exact role in CD is unknown, since only limited data exists showing that myopenia and myosteatosis in CD patients were associated with a higher rate of postoperative complications and unfavorable disease outcome [24,25]. The aim of the present study was to assess the impact of MRI defined myopenia and myosteatosis on anastomotic leakage after ileocecal resection in patients with CD based on data of a high-volume center.…”

Impact of myopenia and myosteatosis on postoperative outcome and recurrence in Crohn’s disease

“…In the literature, there are only two known smaller scaled studies using different MRI sequences to assess myopenia or myosteatosis in patients with CD. Spooren et al [24] evaluated T1-weighted fatsaturated post-contrast images in 35 CD patients, while Celentano et al [25] assessed axial T2-weighted sequences in 31 CD patients. In these studies, myopenia and myosteatosis were associated with a higher rate of postoperative complications and unfavorable disease outcome, indicating potential clinical relevance for these two parameters [24,25].…”