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Evaluating the Utility of L1 Level Measurement as an Alternative to L3 in Assessing Myosteatosis on Computed Tomography

Year 2024, Volume: 77 Issue: 2, 209 - 214, 12.08.2024

Abstract

Objectives: Myosteatosis is a pathology characterized by the accumulation of fat within muscle tissue and serves as a significant indicator for monitoring various medical conditions. Computed tomography (CT) is a useful method for objectively assessing myosteatosis, but exploring alternative anatomical levels for evaluation is necessary. The objective of our study is to investigate the possibility of using the lumbar 1 (L1) level as an alternative to lumbar 3 (L3) level for myosteatosis measurements in CT scans.

Materials and Methods: This retrospective study included 135 participants who underwent abdominopelvic CT scans without contrast. CT scans were performed using a Siemens Somatom Force scanner, and myosteatosis was quantified at the L1 and L3 levels. The abdominal skeletal muscles’ cross-sectional area (SMA) and skeletal muscle radiation attenuation (SMRA) values in Hounsfield units (HU) were measured. Statistical analysis included paired t-tests and Pearson correlation coefficients.

Results: SMA at the level of L3 vertebra was statistically significantly higher than that of L1 vertebra (143.5±31.4 cm2; 128.8 cm2±27.7 cm2, respectively, p<0.001) We found a significant correlation between SMA of L3 and L1 (p≤0.001, r=0.93). The difference in SMRA at L3 and L1 vertebras was small but significant (37.6±6.6 HU; 36.5±6.7 HU, respectively, p<0.001) We also found a significant correlation between the SMRA of L3 and L1 (p≤0.001, r=0.85).

Conclusion: This study demonstrates a strong correlation between muscle density and area at the L1 and L3 levels. The results of the study support the use of measurements at the L1 level as an alternative to L3 level measurements for evaluating myosteatosis. Future studies could investigate the variations in CT scanners and techniques and explore the reliability and applicability of the results

Ethical Statement

The study complied with the Declaration of Helsinki, and was approved by the Ethics Committee and the Institutional Review Board of Gazi University Faculty of Medicine (approval no: 548; date: 04.07.2022).

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References

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  • 2. Bir Yucel K, Karabork Kilic AC, Sutcuoglu O, et al. Effects of Sarcopenia, Myosteatosis, and the Prognostic Nutritional Index on Survival in Stage 2 and 3 Gastric Cancer Patients. Nutr Cancer. 2023;75:368-375.
  • 3. Aslan V, Kılıç ACK, Sütcüoğlu O, et al. Cachexia index in predicting outcomes among patients receiving immune checkpoint inhibitor treatment for metastatic renal cell carcinoma. Urol Oncol. 2022;40:494.e1-494.e10.
  • 4. Furukawa H. Current Clinical Implications of Frailty and Sarcopenia in Vascular Surgery: A Comprehensive Review of the Literature and Consideration of Perioperative Management. Ann Vasc Dis. 2022;15:165- 174.
  • 5. Manzano W, Lenchik L, Chaudhari AS, et al. Sarcopenia in rheumatic disorders: what the radiologist and rheumatologist should know. Skeletal Radiol. 2022;51:513-524.
  • 6. Ahmadiani ES, Ariyanfar S, Soroush M, et al. Role of sarcopenia risk in predicting COVID-19 severity and length of hospital stay in older adults: a prospective cohort study. Br J Nutr. 2023;129:1888-1896.
  • 7. Lewis R, Gómez Álvarez CB, Rayman M, et al. Strategies for optimising musculoskeletal health in the 21st century. BMC Musculoskelet Disord. 2019;20:164.
  • 8. Lee K, Shin Y, Huh J, et al. Recent Issues on Body Composition Imaging for Sarcopenia Evaluation. Korean J Radiol. 2019;20:205-217.
  • 9. Ugras S. Evaluating of altered hydration status on effectiveness of body composition analysis using bioelectric impedance analysis. Libyan J Med. 2020;15:1741904.
  • 10. Perkisas S, Bastijns S, Baudry S, et al. Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update. Eur Geriatr Med. 2021;12:45-59.
  • 11. Vogele D, Otto S, Sollmann N, et al. Sarcopenia - Definition, Radiological Diagnosis, Clinical Significance. Rofo. 2023;195:393-405.
  • 12. Amini B, Boyle SP, Boutin RD, et al. Approaches to Assessment of Muscle Mass and Myosteatosis on Computed Tomography: A Systematic Review. J Gerontol A Biol Sci Med Sci. 2019;74:1671-1678.
  • 13. Pickhardt PJ. Value-added Opportunistic CT Screening: State of the Art. Radiology. 2022;303:E41.
  • 14. Vangelov B, Bauer J, Kotevski D, et al. The use of alternate vertebral levels to L3 in computed tomography scans for skeletal muscle mass evaluation and sarcopenia assessment in patients with cancer: a systematic review. Br J Nutr. 2022;127:722-735.
  • 15. Recio-Boiles A, Galeas JN, Goldwasser B, et al. Enhancing evaluation of sarcopenia in patients with non-small cell lung cancer (NSCLC) by assessing skeletal muscle index (SMI) at the first lumbar (L1) level on routine chest computed tomography (CT). Support Care Cancer. 2018;26:2353-2359.
  • 16. da Rocha DS, Tessari JA, Mainardi NB, et al. Assessment of muscle mass using chest computed tomography-based quantitative and qualitative measurements in patients with systemic sclerosis: A retrospective study with cross-sectional and longitudinal analyses. Semin Arthritis Rheum. 2023;59:152168.
  • 17. Kim EY, Kim YS, Park I, et al. Evaluation of sarcopenia in small-cell lung cancer patients by routine chest CT. Support Care Cancer. 2016;24:4721- 4726.
  • 18. Sanders KJC, Degens JHRJ, Dingemans AC, et al. Cross-sectional and longitudinal assessment of muscle from regular chest computed tomography scans: L1 and pectoralis muscle compared to L3 as reference in non-small cell lung cancer. Int J Chron Obstruct Pulmon Dis. 2019;14:781- 789.
  • 19. Derstine BA, Holcombe SA, Ross BE, et al. Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population. Sci Rep. 2018;8:11369.
  • 20. Feng Z, Rong P, Luo M, et al. Influence of Methods Used to Establish Sarcopenia Cutoff Values for Skeletal Muscle Measures Using Unenhanced and Contrast-Enhanced Computed Tomography Images. JPEN J Parenter Enteral Nutr. 2019;43:1028-1036.
  • 21. Gomez-Perez SL, Haus JM, Sheean P, et al. Measuring Abdominal Circumference and Skeletal Muscle From a Single Cross-Sectional Computed Tomography Image: A Step-by-Step Guide for Clinicians Using National Institutes of Health ImageJ. JPEN J Parenter Enteral Nutr. 2016;40:308-318.
  • 22. Liu S, Han X, Li J, et al. Feasibility of using chest computed tomography (CT) imaging at the first lumbar vertebra (L1) level to assess skeletal muscle mass: a retrospective study. PeerJ. 2023;11:e16652.

Bilgisayarlı Tomografide Miyosteatozun Değerlendirilmesinde L3’e Alternatif Olarak L1 Seviye Ölçümünün Değerlendirilmesi

Year 2024, Volume: 77 Issue: 2, 209 - 214, 12.08.2024

Abstract

Project Number

-

References

  • 1. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16-31.
  • 2. Bir Yucel K, Karabork Kilic AC, Sutcuoglu O, et al. Effects of Sarcopenia, Myosteatosis, and the Prognostic Nutritional Index on Survival in Stage 2 and 3 Gastric Cancer Patients. Nutr Cancer. 2023;75:368-375.
  • 3. Aslan V, Kılıç ACK, Sütcüoğlu O, et al. Cachexia index in predicting outcomes among patients receiving immune checkpoint inhibitor treatment for metastatic renal cell carcinoma. Urol Oncol. 2022;40:494.e1-494.e10.
  • 4. Furukawa H. Current Clinical Implications of Frailty and Sarcopenia in Vascular Surgery: A Comprehensive Review of the Literature and Consideration of Perioperative Management. Ann Vasc Dis. 2022;15:165- 174.
  • 5. Manzano W, Lenchik L, Chaudhari AS, et al. Sarcopenia in rheumatic disorders: what the radiologist and rheumatologist should know. Skeletal Radiol. 2022;51:513-524.
  • 6. Ahmadiani ES, Ariyanfar S, Soroush M, et al. Role of sarcopenia risk in predicting COVID-19 severity and length of hospital stay in older adults: a prospective cohort study. Br J Nutr. 2023;129:1888-1896.
  • 7. Lewis R, Gómez Álvarez CB, Rayman M, et al. Strategies for optimising musculoskeletal health in the 21st century. BMC Musculoskelet Disord. 2019;20:164.
  • 8. Lee K, Shin Y, Huh J, et al. Recent Issues on Body Composition Imaging for Sarcopenia Evaluation. Korean J Radiol. 2019;20:205-217.
  • 9. Ugras S. Evaluating of altered hydration status on effectiveness of body composition analysis using bioelectric impedance analysis. Libyan J Med. 2020;15:1741904.
  • 10. Perkisas S, Bastijns S, Baudry S, et al. Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update. Eur Geriatr Med. 2021;12:45-59.
  • 11. Vogele D, Otto S, Sollmann N, et al. Sarcopenia - Definition, Radiological Diagnosis, Clinical Significance. Rofo. 2023;195:393-405.
  • 12. Amini B, Boyle SP, Boutin RD, et al. Approaches to Assessment of Muscle Mass and Myosteatosis on Computed Tomography: A Systematic Review. J Gerontol A Biol Sci Med Sci. 2019;74:1671-1678.
  • 13. Pickhardt PJ. Value-added Opportunistic CT Screening: State of the Art. Radiology. 2022;303:E41.
  • 14. Vangelov B, Bauer J, Kotevski D, et al. The use of alternate vertebral levels to L3 in computed tomography scans for skeletal muscle mass evaluation and sarcopenia assessment in patients with cancer: a systematic review. Br J Nutr. 2022;127:722-735.
  • 15. Recio-Boiles A, Galeas JN, Goldwasser B, et al. Enhancing evaluation of sarcopenia in patients with non-small cell lung cancer (NSCLC) by assessing skeletal muscle index (SMI) at the first lumbar (L1) level on routine chest computed tomography (CT). Support Care Cancer. 2018;26:2353-2359.
  • 16. da Rocha DS, Tessari JA, Mainardi NB, et al. Assessment of muscle mass using chest computed tomography-based quantitative and qualitative measurements in patients with systemic sclerosis: A retrospective study with cross-sectional and longitudinal analyses. Semin Arthritis Rheum. 2023;59:152168.
  • 17. Kim EY, Kim YS, Park I, et al. Evaluation of sarcopenia in small-cell lung cancer patients by routine chest CT. Support Care Cancer. 2016;24:4721- 4726.
  • 18. Sanders KJC, Degens JHRJ, Dingemans AC, et al. Cross-sectional and longitudinal assessment of muscle from regular chest computed tomography scans: L1 and pectoralis muscle compared to L3 as reference in non-small cell lung cancer. Int J Chron Obstruct Pulmon Dis. 2019;14:781- 789.
  • 19. Derstine BA, Holcombe SA, Ross BE, et al. Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population. Sci Rep. 2018;8:11369.
  • 20. Feng Z, Rong P, Luo M, et al. Influence of Methods Used to Establish Sarcopenia Cutoff Values for Skeletal Muscle Measures Using Unenhanced and Contrast-Enhanced Computed Tomography Images. JPEN J Parenter Enteral Nutr. 2019;43:1028-1036.
  • 21. Gomez-Perez SL, Haus JM, Sheean P, et al. Measuring Abdominal Circumference and Skeletal Muscle From a Single Cross-Sectional Computed Tomography Image: A Step-by-Step Guide for Clinicians Using National Institutes of Health ImageJ. JPEN J Parenter Enteral Nutr. 2016;40:308-318.
  • 22. Liu S, Han X, Li J, et al. Feasibility of using chest computed tomography (CT) imaging at the first lumbar vertebra (L1) level to assess skeletal muscle mass: a retrospective study. PeerJ. 2023;11:e16652.
There are 22 citations in total.

Details

Primary Language English
Subjects Radiology and Organ Imaging
Journal Section Research Article
Authors

Atiye Cenay Karabörk Kılıç This is me 0000-0002-9980-8397

Sümeyra Çayıröz This is me 0009-0004-0447-5166

Sevcihan Kesen Özbek 0000-0001-6529-9232

Mustafa Kaya

Hüseyin Koray Kılıç 0000-0002-9015-1755

Gonca Erbaş 0000-0003-0788-9386

Project Number -
Submission Date April 11, 2024
Acceptance Date June 6, 2024
Publication Date August 12, 2024
Published in Issue Year 2024 Volume: 77 Issue: 2

Cite

APA Karabörk Kılıç, A. C., Çayıröz, S., Kesen Özbek, S., … Kaya, M. (2024). Evaluating the Utility of L1 Level Measurement as an Alternative to L3 in Assessing Myosteatosis on Computed Tomography. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 77(2), 209-214. https://doi.org/10.4274/atfm.galenos.2024.60566
AMA Karabörk Kılıç AC, Çayıröz S, Kesen Özbek S, Kaya M, Kılıç HK, Erbaş G. Evaluating the Utility of L1 Level Measurement as an Alternative to L3 in Assessing Myosteatosis on Computed Tomography. Ankara Üniversitesi Tıp Fakültesi Mecmuası. August 2024;77(2):209-214. doi:10.4274/atfm.galenos.2024.60566
Chicago Karabörk Kılıç, Atiye Cenay, Sümeyra Çayıröz, Sevcihan Kesen Özbek, Mustafa Kaya, Hüseyin Koray Kılıç, and Gonca Erbaş. “Evaluating the Utility of L1 Level Measurement As an Alternative to L3 in Assessing Myosteatosis on Computed Tomography”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 77, no. 2 (August 2024): 209-14. https://doi.org/10.4274/atfm.galenos.2024.60566.
EndNote Karabörk Kılıç AC, Çayıröz S, Kesen Özbek S, Kaya M, Kılıç HK, Erbaş G (August 1, 2024) Evaluating the Utility of L1 Level Measurement as an Alternative to L3 in Assessing Myosteatosis on Computed Tomography. Ankara Üniversitesi Tıp Fakültesi Mecmuası 77 2 209–214.
IEEE A. C. Karabörk Kılıç, S. Çayıröz, S. Kesen Özbek, M. Kaya, H. K. Kılıç, and G. Erbaş, “Evaluating the Utility of L1 Level Measurement as an Alternative to L3 in Assessing Myosteatosis on Computed Tomography”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 77, no. 2, pp. 209–214, 2024, doi: 10.4274/atfm.galenos.2024.60566.
ISNAD Karabörk Kılıç, Atiye Cenay et al. “Evaluating the Utility of L1 Level Measurement As an Alternative to L3 in Assessing Myosteatosis on Computed Tomography”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 77/2 (August2024), 209-214. https://doi.org/10.4274/atfm.galenos.2024.60566.
JAMA Karabörk Kılıç AC, Çayıröz S, Kesen Özbek S, Kaya M, Kılıç HK, Erbaş G. Evaluating the Utility of L1 Level Measurement as an Alternative to L3 in Assessing Myosteatosis on Computed Tomography. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2024;77:209–214.
MLA Karabörk Kılıç, Atiye Cenay et al. “Evaluating the Utility of L1 Level Measurement As an Alternative to L3 in Assessing Myosteatosis on Computed Tomography”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 77, no. 2, 2024, pp. 209-14, doi:10.4274/atfm.galenos.2024.60566.
Vancouver Karabörk Kılıç AC, Çayıröz S, Kesen Özbek S, Kaya M, Kılıç HK, Erbaş G. Evaluating the Utility of L1 Level Measurement as an Alternative to L3 in Assessing Myosteatosis on Computed Tomography. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2024;77(2):209-14.