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Skeletal Radiology
Published in: Skeletal Radiology 3/2024

09-09-2023 | Sarcopenia | Scientific Article

Clinical, functional, and opportunistic CT metrics of sarcopenia at the point of imaging care: analysis of all-cause mortality

Authors: Lawrence Yao, Anahit Petrosyan, Abhijit J Chaudhari, Leon Lenchik, Robert D. Boutin

Published in: Skeletal Radiology | Issue 3/2024

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Abstract

Purpose

This study examines clinical, functional, and CT metrics of sarcopenia and all-cause mortality in older adults undergoing outpatient imaging.

Methods

The study included outpatients ≥ 65 years of age undergoing CT or PET/CT at a tertiary care institution. Assessments included screening questionnaires for sarcopenia (SARC-F) and frailty (FRAIL scale), and measurements of grip strength and usual gait speed (6 m course). Skeletal muscle area (SMA), index (SMI, area/height2) and density (SMD) were measured on CT at T12 and L3. A modified SMI was also examined (SMI-m, area/height). Mortality risk was studied with Cox proportional hazard analysis.

Results

The study included 416 patients; mean age 73.8 years [sd 6.2]; mean follow-up 2.9 years (sd 1.34). Abnormal grip, SARC-F, and FRAIL scale assessments were associated with higher mortality risk (HR [95%CI] = 2.0 [1.4–2.9], 1.6 [1.1–2.3], 2.0 [1.4–2.8]). Adjusting for age, higher L3-SMA, T12-SMA, T12-SMI and T12-SMI-m were associated with lower mortality risk (HR [95%CI] = 0.80 [0.65–0.90], 0.76 [0.64–0.90], 0.84 [0.70–1.00], and 0.80 [0.67–0.90], respectively). T12-SMD and L3-SMD were not predictive of mortality. After adjusting for abnormal grip strength and FRAIL scale assessments, T12-SMA and T12-SMI-m remained predictive of mortality risk (HR [95%CI] = 0.83 [0.70–1.00] and 0.80 [0.67–0.97], respectively).

Conclusion

CT areal metrics were weaker predictors of all-cause mortality than clinical and functional metrics of sarcopenia in our older patient cohort; a CT density metric (SMD) was not predictive. Of areal CT metrics, SMI (area/height2) appeared to be less effective than non-normalized SMA or SMA normalized by height1.
Literature
1.
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Writing group for the European working group on Sarcopenia in older people 2 (EWGSOP2), and the extended group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31.CrossRef
2.
Yang L, Yao X, Shen J, et al. Comparison of revised EWGSOP criteria and four other diagnostic criteria of sarcopenia in Chinese community-dwelling elderly residents. Exp Gerontol. 2020;130:110798.PubMedCrossRef
3.
Petermann-Rocha F, Balntzi V, Gray SR, et al. Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2022;13(1):86–99.PubMedCrossRef
4.
Mayhew AJ, Amog K, Phillips S, et al. The prevalence of sarcopenia in community-dwelling older adults, an exploration of differences between studies and within definitions: a systematic review and meta-analyses. Age Ageing. 2019;48(1):48–56.PubMedCrossRef
5.
Westbury LD, Beaudart C, Bruyère O, et al. International musculoskeletal ageing network. Recent sarcopenia definitions-prevalence, agreement and mortality associations among men: Findings from population-based cohorts. J Cachexia Sarcopenia Muscle. 2023;14(1):565–75.PubMedPubMedCentralCrossRef
6.
Lu JL, Ding LY, Xu Q, et al. Screening accuracy of SARC-F for Sarcopenia in the elderly: A diagnostic meta-analysis. J Nutr Health Aging. 2021;25(2):172–82.PubMedCrossRef
7.
Wu AH, Setiawan VW, Lim U, et al. Prognostic utility of self-reported sarcopenia (SARC-F) in the Multiethnic Cohort. J Cachexia Sarcopenia Muscle. 2022;13(2):987–1002.PubMedPubMedCentralCrossRef
8.
Ida S, Kaneko R, Imataka K, et al. Verification of the predictive validity for mortality of the SARC-F questionnaire based on a meta-analysis. Aging Clin Exp Res. 2021;33(4):835–42.PubMedCrossRef
9.
Reijnierse EM, Trappenburg MC, Blauw GJ, et al. Common ground? The concordance of Sarcopenia and frailty definitions. J Am Med Dir Assoc. 2016;17(4):371.e7-12.PubMedCrossRef
10.
Woo J, Leung J, Morley JE. Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation. J Am Geriatr Soc. 2012;60(8):1478–86.PubMedCrossRef
11.
Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601–8.PubMedPubMedCentralCrossRef
12.
Amini B, Boyle SP, Boutin RD, Lenchik L. Approaches to assessment of muscle mass and myosteatosis on computed tomography: a systematic review. J Gerontol A Biol Sci Med Sci. 2019;74:1671–8.PubMedPubMedCentralCrossRef
13.
Goodpaster BH, Thaete FL, Kelley DE. Composition of skeletal muscle evaluated with computed tomography. Ann N Y Acad Sci. 2000;904:18–24.PubMedCrossRef
14.
Walowski CO, Braun W, Maisch MJ, et al. Reference values for skeletal muscle mass - current concepts and methodological considerations. Nutrients. 2020;12(3):755.PubMedPubMedCentralCrossRef
15.
Boutin RD, Bamrungchart S, Bateni CP, et al. CT of patients with hip fracture: muscle size and attenuation help predict mortality. AJR Am J Roentgenol. 2017;208(6):W208–15.PubMedPubMedCentralCrossRef
16.
Pamoukdjian F, Bouillet T, Lévy V, Soussan M, Zelek L, Paillaud E. Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: A systematic review. Clin Nutr. 2018;37(4):1101–13.PubMedCrossRef
17.
Lenchik L, Lenoir KM, Tan J, Boutin RD, et al. Opportunistic measurement of skeletal muscle size and muscle attenuation on computed tomography predicts 1-year mortality in Medicare patients. J Gerontol A Biol Sci Med Sci. 2019;74(7):1063–9.PubMedCrossRef
18.
Yao L, Petrosyan A, Fuangfa P, Lenchik L, Boutin RD. Diagnosing sarcopenia at the point of imaging care: analysis of clinical, functional, and opportunistic CT metrics. Skeletal Radiol. 2021;50(3):543–50.PubMedCrossRef
19.
Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle. 2016;7:28–36.PubMedCrossRef
20.
Gleason LJ, Benton EA, Alvarez-Nebreda ML, Weaver MJ, Harris MB, Javedan H. FRAIL questionnaire screening tool and short-term outcomes in geriatric fracture patients. J Am Med Dir Assoc. 2017;18(12):1082–6.PubMedPubMedCentralCrossRef
21.
Hamilton GF, McDonald C, Chenier TC. Measurement of grip strength: validity and reliability of the sphygmomanometer and Jamar grip dynamometer. J Orthop Sports Phys Ther. 1992;16(5):215–9.PubMedCrossRef
22.
23.
Boutin RD, Kaptuch JM, Bateni CP, Chalfant JS, Yao L. Influence of IV contrast administration on CT measures of muscle and bone attenuation: Implications for Sarcopenia and osteoporosis evaluation. AJR Am J Roentgenol. 2016;207(5):1046–54.PubMedCrossRef
24.
van Vugt JL, Levolger S, Gharbharan A, et al. A comparative study of software programmes for cross-sectional skeletal muscle and adipose tissue measurements on abdominal computed tomography scans of rectal cancer patients. J Cachexia Sarcopenia Muscle. 2017;8(2):285–97.PubMedCrossRef
25.
Derstine BA, Holcombe SA, Goulson RL, et al. Quantifying Sarcopenia reference values using lumbar and thoracic muscle areas in a healthy population. J Nutr Health Aging. 2017;21(10):180–5.PubMed
26.
Derstine BA, Holcombe SA, Ross BE, Wang NC, Su GL, Wang SC. Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population. Sci Rep. 2018;8(1):11369.PubMedPubMedCentralCrossRef
27.
Heymsfield SB, Heo M, Thomas D, Pietrobelli A. Scaling of body composition to height: relevance to height-normalized indexes. Am J Clin Nutr. 2011;93(4):736–40.PubMedCrossRef
28.
Heymsfield SB, Hwaung P, Ferreyro-Bravo F, Heo M, Thomas DM, Schuna JM Jr. Scaling of adult human bone and skeletal muscle mass to height in the US population. Am J Hum Biol. 2019;31(4):e23252.PubMedPubMedCentralCrossRef
29.
Magudia K, Bridge CP, Bay CP, et al. Population-Scale CT-based body composition analysis of a large outpatient population using deep learning to derive age-, sex-, and race-specific reference curves. Radiology. 2021;298(2):319–29.PubMedCrossRef
30.
31.
Fernandes LV, Paiva AEG, Silva ACB, et al. Prevalence of sarcopenia according to EWGSOP1 and EWGSOP2 in older adults and their associations with unfavorable health outcomes: a systematic review. Aging Clin Exp Res. 2022;34(3):505–14.PubMedCrossRef
32.
Gong S, Qian D, Riazi S, et al. Association between the FRAIL scale and postoperative complications in older surgical patients: a systematic review and meta-analysis. Anesth Analg. 2023;136(2):251–61.PubMedCrossRef
33.
Petermann-Rocha F, Parra-Soto S, Cid V, et al. The association between walking pace and grip strength and all-cause mortality: A prospective analysis from the MAUCO cohort. Maturitas. 2023;168:37–43.PubMedCrossRef
34.
Cheng FW, Gao X, Mitchell DC, et al. Body mass index and all-cause mortality among older adults. Obesity (Silver Spring). 2016;24(10):2232–9.PubMedCrossRef
35.
36.
Zumsteg DM, Chu CE, Midwinter MJ. Radiographic assessment of sarcopenia in the trauma setting: a systematic review. Trauma Surg Acute Care Open. 2020;5(1):e000414.PubMedPubMedCentralCrossRef
37.
Su H, Ruan J, Chen T, Lin E, Shi L. CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis. Cancer Imaging. 2019;19(1):82.PubMedPubMedCentralCrossRef
38.
Nishimura JM, Ansari AZ, D’Souza DM, Moffatt-Bruce SD, Merritt RE, Kneuertz PJ. Computed tomography-assessed skeletal muscle mass as a predictor of outcomes in lung cancer surgery. Ann Thorac Surg. 2019;108(5):1555–64.PubMedCrossRef
39.
Rossi F, Valdora F, Bignotti B, Torri L, Succio G, Tagliafico AS. Evaluation of body computed tomography-determined sarcopenia in breast cancer patients and clinical outcomes: A systematic review. Cancer Treat Res Commun. 2019;21:100154.PubMedCrossRef
40.
Soud M, Alahdab F, Ho G, et al. Usefulness of skeletal muscle area detected by computed tomography to predict mortality in patients undergoing transcatheter aortic valve replacement: a meta-analysis study. Int J Cardiovasc Imaging. 2019;35(6):1141–7.PubMedCrossRef
41.
Lenchik L, Barnard R, Boutin RD, et al. Automated muscle measurement on chest CT predicts all-cause mortality in older adults from the national lung screening trial. J Gerontol A Biol Sci Med Sci. 2021;76(2):277–85.PubMedCrossRef
42.
Pickhardt PJ, Perez AA, Garrett JW, Graffy PM, Zea R, Summers RM. Fully automated deep learning tool for sarcopenia assessment on CT: L1 versus L3 vertebral level muscle measurements for opportunistic prediction of adverse clinical outcomes. AJR Am J Roentgenol. 2022;218(1):124–31.PubMedCrossRef
43.
44.
Shachar SS, Deal AM, Weinberg M, et al. Skeletal muscle measures as predictors of toxicity, hospitalization, and survival in patients with metastatic breast cancer receiving Taxane-based chemotherapy. Clin Cancer Res. 2017;23(3):658–65.PubMedCrossRef
45.
Crawford MA, Criqui MH, Forbang N, Unkart JT, Allison MA, Larsen BA. Associations of abdominal muscle area and density with coronary artery calcium volume and density: The multi-ethnic study of atherosclerosis. Metabolism. 2020;107:154230.PubMedPubMedCentralCrossRef
46.
Weinberg MS, Shachar SS, Muss HB, et al. Beyond sarcopenia: Characterization and integration of skeletal muscle quantity and radiodensity in a curable breast cancer population. Breast J. 2018;24(3):278–84.PubMedCrossRef
47.
Lortie J, Gage G, Rush B, Heymsfield SB, Szczykutowicz TP, Kuchnia AJ. The effect of computed tomography parameters on sarcopenia and myosteatosis assessment: a scoping review. J Cachexia Sarcopenia Muscle. 2022;13(6):2807–19.PubMedPubMedCentralCrossRef
48.
Burns JE, Yao J, Chalhoub D, Chen JJ, Summers RM. A machine learning algorithm to estimate Sarcopenia on abdominal CT. Acad Radiol. 2020;27(3):311–20.PubMedCrossRef
49.
Jing X, Tan L, Fu H, Yang L, Yang M. Associations of ADL disability with trunk muscle mass and muscle quality indicators measured by opportunistic chest computed tomography imaging among older inpatients. Front Med (Lausanne). 2021;28(8):743698.CrossRef
50.
Anyene I, Caan B, Williams GR, et al. Body composition from single versus multi-slice abdominal computed tomography: Concordance and associations with colorectal cancer survival. J Cachexia Sarcopenia Muscle. 2022;13(6):2974–84.PubMedPubMedCentralCrossRef
51.
Brown JC, Heymsfield SB, Caan BJ. Scaling of computed tomography body composition to height: relevance of height-normalized indices in patients with colorectal cancer. J Cachexia Sarcopenia Muscle. 2022;13(1):203–9.PubMedCrossRef
52.
Heymsfield SB, Gallagher D, Mayer L, Beetsch J, Pietrobelli A. Scaling of human body composition to stature: new insights into body mass index. Am J Clin Nutr. 2007;86:82–91.PubMedCrossRef
53.
Heymsfield SB, Gallagher D, Kotler DP, Wang Z, Allison DB, Heshka S. Body-size dependence of resting energy expenditure can be attributed to nonenergetic homogeneity of fat-free mass. Am J Physiol Endocrinol Metab. 2002;282(1):E132–8
54.
Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147(8):755–63.PubMedCrossRef
55.
Shen W, Punyanitya M, Wang Z, et al. Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol. 1985;2004(97):2333–8.
56.
Schweitzer L, Geisler C, Pourhassan M, et al. Estimation of skeletal muscle mass and visceral adipose tissue volume by a single magnetic resonance imaging slice in healthy elderly adults. J Nutr. 2016;146(10):2143–8.PubMedCrossRef
Metadata
Title
Clinical, functional, and opportunistic CT metrics of sarcopenia at the point of imaging care: analysis of all-cause mortality
Authors
Lawrence Yao
Anahit Petrosyan
Abhijit J Chaudhari
Leon Lenchik
Robert D. Boutin
Publication date
09-09-2023
Publisher
Springer Berlin Heidelberg
Keywords
Sarcopenia
Care
Published in
Skeletal Radiology / Issue 3/2024
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-023-04438-w

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