A novel computed tomography method to detect normal from abnormal psoas muscle: a pilot feasibility study

Jayshil Patel, Dhiraj Baruah, Kaushik Shahir

Abstract


Background: Sarcopenia is a syndrome characterized by progressive loss of skeletal muscle which can be detected by computed tomography (CT) by estimating total psoas muscle cross-sectional area (CSA).  Relying on total psoas CSA alone takes into account abnormal muscle and intramuscular fat, both of which may be increased in sarcopenic obesity.  We developed a novel CT-method to identify the proportion of normal to abnormal psoas muscle at the third lumbar (L3) level.  The primary objective of our pilot study was to measure inter-observer agreement between measuring total psoas CSA and proportion of normal and abnormal psoas muscle using a novel CT-method.  We hypothesized total psoas CSA and proportion of normal and abnormal psoas muscle would be reliably quantifiable.

Methods: CT abdomen images were obtained for 20 adults.  Two radiologists independently identified and traced the L3 psoas muscle circumference to estimate CSA.  Hounsfield units were applied to the tracing to identify proportion of normal muscle, abnormal muscle, and fat.  Inter-observer agreement was assessed using Pearson’s correlation coefficient.

Results: Of the 20 patients, 13 were male and six were obese.  Mean age was 66 years.  Correlation coefficient was excellent for total psoas CSA (r=0.93,p-value<0.00001) and proportion of normal psoas muscle (r=0.94,p-value<0.0001).  Correlation was excellent between BMI and abnormal muscle (r=0.67, p-value=0.001).  Correlation was poor between total psoas CSA and body mass index (BMI) (r=0.369,p-value=0.108) and negative between proportion of normal muscle and BMI (r= -0.50,p-value=0.025).

Conclusions: Our study findings demonstrate that total psoas CSA and proportion of normal and abnormal psoas can be reliably quantified.  Our CT-method may be superior to total psoas CSA in identifying sarcopenic obesity, the results of which can be used to explore clinical outcomes.


Full Text:

PDF

References


Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA. 2012; 307:483-490; doi: 10.1001/jama.2012.40 [doi].

Hurt RT, Frazier TH, McClave SA, Kaplan LM. Obesity epidemic: overview, pathophysiology, and the intensive care unit conundrum. JPEN J Parenter Enteral Nutr. 2011; 35:4S-13S; doi: 10.1177/0148607111415110 [doi].

Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L, et al. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med. 2003; 138:24-32; doi: 200301070-00008 [pii].

Muscaritoli M, Lucia S, Molfino A. Sarcopenia in critically ill patients: the new pandemia. Minerva Anestesiol. 2013; 79:771-777; doi: R02138378 [pii].

Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010; 39:412-423; doi: 10.1093/ageing/afq034 [doi].

Fearon K, Arends J, Baracos V. Understanding the mechanisms and treatment options in cancer cachexia. Nat Rev Clin Oncol. 2013; 10:90-99; doi: 10.1038/nrclinonc.2012.209 [doi].

Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008; 9:629-635; doi: 10.1016/S1470-2045(08)70153-0 [doi].

Hanna JS. Sarcopenia and critical illness: a deadly combination in the elderly. JPEN J Parenter Enteral Nutr. 2015; 39:273-281; doi: 10.1177/0148607114567710 [doi].

Jones KI, Doleman B, Scott S, Lund JN, Williams JP. Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications. Colorectal Dis. 2015; 17:O20-6; doi: 10.1111/codi.12805 [doi].

Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011; 12:489-495; doi: 10.1016/S1470-2045(10)70218-7 [doi].

Hounsfield GN. Nobel Award address. Computed medical imaging. Med Phys. 1980; 7:283-290; doi: 10.1118/1.594709 [doi].

Hurt RT, Frazier TH, McClave SA, Kaplan LM. Obesity epidemic: overview, pathophysiology, and the intensive care unit conundrum. JPEN J Parenter Enteral Nutr. 2011; 35:4S-13S; doi: 10.1177/0148607111415110 [doi].

Mosteller RD. Simplified calculation of body-surface area. N Engl J Med. 1987; 317:1098; doi: 10.1056/NEJM198710223171717 [doi].

Aubrey J, Esfandiari N, Baracos VE, Buteau FA, Frenette J, Putman CT, et al. Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta Physiol (Oxf). 2014; 210:489-497; doi: 10.1111/apha.12224 [doi].

Cauley JA. An Overview of Sarcopenic Obesity. J Clin Densitom. 2015; 18:499-505; doi: 10.1016/j.jocd.2015.04.013 [doi].

Bazzocchi A, Ponti F, Albisinni U, Battista G, Guglielmi G. DXA: Technical aspects and application. Eur J Radiol. 2016; 85:1481-1492; doi: 10.1016/j.ejrad.2016.04.004 [doi].

Orgel E, Mueske NM, Sposto R, Gilsanz V, Freyer DR, Mittelman SD. Limitations of body mass index to assess body composition due to sarcopenic obesity during leukemia therapy. Leuk Lymphoma. 2016:1-8; doi: 10.3109/10428194.2015.1136741 [doi].

Pompe E, Willemink MJ, Dijkhuis GR, Verhaar HJ, Mohamed Hoesein FA, de Jong PA. Intravenous contrast injection significantly affects bone mineral density measured on CT. Eur Radiol. 2015; 25:283-289; doi: 10.1007/s00330-014-3408-2 [doi].




DOI: http://dx.doi.org/10.17987/jcsm-cr.v2i1.14

Refbacks

  • There are currently no refbacks.