Skeletal muscle analyses: agreement between non‐contrast and contrast <scp>CT</scp> scan measurements of skeletal muscle area and mean muscle attenuation

Werf, A. van der; Dekker, Ingeborg M.; Meijerink, Martijn R.; Wierdsma, N.J.; Schueren, Marian A.E. de van der; Langius, J.A.E.

doi:10.1111/cpf.12422

Cited by 45 publications

(20 citation statements)

References 26 publications

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“…Although in all CT scans intravenous contrast was used, differences in contrastenhancement phases and tube voltages might affect calculations of determinants used in our study. 40,41 In conclusion, skeletal muscle mass and density, sarcopenia, and sarcopenic obesity are not associated with survival in advanced esophagogastric cancer patients treated with first-line chemotherapy. However, low SMD is independently associated with the occurrence of grade 3-4 toxicities and sarcopenic obesity with grade 2-4 peripheral sensory neuropathy.…”

Section: Discussionmentioning

confidence: 93%

Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Dijksterhuis

Pruijt

Woude

et al. 2019

J cachexia sarcopenia muscle

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Background Palliative systemic treatment in patients with advanced or metastatic esophagogastric cancer may result in improved overall survival and quality of life but can also lead to considerable toxicity. In various cancer types, severe muscle mass depletion (sarcopenia) and poor muscle strength are associated with decreased survival and increased chemotherapy‐related toxicity. The aim of this study is to determine the impact of body composition on survival and chemotherapy toxicity in esophagogastric cancer patients treated with first‐line palliative chemotherapy. Methods A total of 88 patients with advanced esophagogastric cancer treated with standard first‐line palliative systemic therapy consisting of capecitabine and oxaliplatin (CapOx) between January 2010 and February 2017 were included. Skeletal muscle index (SMI), reflecting muscle mass, and skeletal muscle density (SMD), associated with muscle strength, were measured using pre‐treatment of all patients and evaluation computed tomography scans after three treatment cycles of 65 patients and were used to determine sarcopenia and sarcopenic obesity (i.e. sarcopenia and body mass index >25 kg/m 2 ). The associations between body composition (SMI, SMD, sarcopenia, and sarcopenic obesity) and survival and toxicity were assessed using univariable and multivariable Cox and logistic regression analyses, respectively. Results Of 88 patients, 75% was male, and median age was 63 (interquartile range 56–69) years. The majority of patients had an adenocarcinoma (83%). Before start of treatment, 49% of the patients were sarcopenic, and 20% had sarcopenic obesity. Low SMD was observed in 50% of patients. During three cycles CapOx, SMI significantly decreased, with a median decrease of 4% (interquartile range −8.6–−0.4). Median progression‐free and overall survival were 6.9 and 10.1 months. SMI, SMD, sarcopenia, and sarcopenic obesity (both pre‐treatment and after three cycles) were neither associated with progression‐free nor overall survival. Pre‐treatment SMD was independently associated with grade 3–4 toxicity (odds ratio 0.94; 95% confidence interval 0.89–1.00) and sarcopenic obesity with grade 2–4 neuropathy (odds ratio 3.82; 95% confidence interval 1.20–12.18). Conclusions Sarcopenia was not associated with survival or treatment‐related toxicity in advanced esophagogastric cancer patients treated with CapOx. Pre‐treatment sarcopenic obesity was independently associated with the occurrence of grade 2–4 neurotoxicity and skeletal muscle density with grade 3–4 toxicity.

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Section: Discussionmentioning

confidence: 93%

Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Dijksterhuis

Pruijt

Woude

et al. 2019

J cachexia sarcopenia muscle

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“…Inclusion criteria for this study consisted of patients who (i) had pelvic exenteration surgery for cancer and for cure, (ii) provided consent for their data collection, and (iii) had non-contrast scans available to analyse, to ensure consistent assessments and comparisons of skeletal muscle index (SMI) [12]. Exclusion criteria included patients who (i) were <18 years of age, (ii) were unable to consent due to language barriers or cognitive function, (iii) had no available CT image at L3 within three months prior to surgery, which is consistent with other literature, (iv) had a CT of poor quality, and (v) had a CT that was not accessible via electronic health records [13].…”

Section: Study Populationmentioning

confidence: 99%

Is Preoperative Sarcopenia a Good Predictor of Postoperative Complications and Outcomes after Pelvic Exenteration Surgery?

Rangan¹,

Ritorni²,

Solomon³

et al. 2020

JSO

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Background: Sarcopenia is common in oncology patients and has been found to be associated with poorer outcomes after surgery. Pelvic exenteration is a major surgery associated with high rates of morbidity. The aim of this study was to determine if preoperative sarcopenia is associated with postoperative complications and outcomes after pelvic exenteration surgery. Methods: A retrospective study was conducted including 64 oncology patients who had undergone pelvic exenteration surgery between August 2015 and January 2018 and had available preoperative lumbar CT images. Skeletal muscle index (SMI) was calculated by analysing CT images using body composition software. Sarcopenia was determined by using previously published SMI sex-specific cut-offs. Preoperative nutritional status, nutritional indicators and other clinical factors were also collected. Results: There was no association between preoperative sarcopenia and outcomes after pelvic exenteration surgery, however, increased weight (p=0.027) and BMI (p=0.025) were associated with a greater number of total complications. Increasing age was also significant (p=0.001) in explaining the greater number of complications. Greater complexity of surgery itself was associated with greater postoperative complications (p=0.014) and increased length of hospital stay (p=0.001). Conclusion: Preoperative sarcopenia, using dichotomous cut-off points, is not sensitive enough to predict postoperative complications and outcomes in oncology patients undergoing pelvic exenteration surgery; however, other preoperative factors such as weight, BMI and age, and the complexity of surgery, do affect outcomes. Assessment tools that incorporate several clinical and physical factors, such as frailty assessments, should be used in future studies to identify risk factors in such major surgeries.

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“…Another limitation is that individuals are not usually submitted to this type of examination exclusively for research purposes or body composition assessment, due to the substantial ionization radiation emitted (MacDonald et al , 2011). Factors related to the CT examination can also affect SM radiodensity, such as tube voltage, equipment calibration, slice thickness, contrast agents use and phases (Fuchs et al , 2018; van der Werf et al , 2018). On the other hand, as mentioned above, this tool is convenient and easily accessed in health services (Heymsfield, et al, 1997; Daly, Prado, et al, 2018; Hopkins & Sawyer, 2018).…”

Section: Resultsmentioning

confidence: 99%

“…Thereby, the effects of these agents on increasing SM radiodensity may be only partial in CT scans containing adipose tissue (Rollins et al , 2017). Despite the observations concerning the impact of the contrast administration when assessing SM radiodensity, the literature in this area is still scarce and needs to be further studied (Rollins et al , 2017; van der Werf et al , 2018).…”

Section: Resultsmentioning

confidence: 99%

Assessing skeletal muscle radiodensity by computed tomography: An integrative review of the applied methodologies

Poltronieri

Paula

Chaves

2020

Clin Physio Funct Imaging

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Low‐radiodensity skeletal muscle has been related to the degree of muscle fat infiltration and seems to be associated with worse outcomes. The aim of this study was to summarize the methodologies used to appraise skeletal muscle radiodensity by computed tomography, to describe the terms used in the literature to define muscle radiodensity and to give recommendations for its measurement standardization. An integrative bibliographic review in four databases included studies published until August 2019 in Portuguese, English or Spanish and performed in humans, adults and/or the elderly, of both sex, which investigated skeletal muscle radiodensity through computed tomography (CT) of the region between the third and fifth lumbar vertebrae and evaluated at least two muscular groups. One hundred and seventeen studies were selected. We observed a trend towards selecting all abdominal region muscle. A significant methodological variation in terms of contrast use, selection of skeletal muscle areas, radiodensity ranges delimitation and their cut‐off points, as well as the terminologies used, was also found. The methodological differences detected are probably due to the lack of more precise information about the correlation between skeletal muscle radiodensity by CT and its molecular composition, among others. Therefore, until the gaps are addressed in future studies, authors should avoid arbitrary approaches when reporting skeletal muscle radiodensity, especially when it comes to prognosis inference. Studies using both CT and direct methods of muscle composition evaluation are encouraged, to enable the definition and validation of the best approach to classify fat‐infiltrated muscle tissue, which will favour the nomenclature uniformization.

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Skeletal muscle analyses: agreement between non‐contrast and contrast CT scan measurements of skeletal muscle area and mean muscle attenuation

Cited by 45 publications

References 26 publications

Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Is Preoperative Sarcopenia a Good Predictor of Postoperative Complications and Outcomes after Pelvic Exenteration Surgery?

Assessing skeletal muscle radiodensity by computed tomography: An integrative review of the applied methodologies

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