Diagnosing sarcopenia at the point of imaging care: analysis of clinical, functional, and opportunistic CT metrics
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SCIENTIFIC ARTICLE
Diagnosing sarcopenia at the point of imaging care: analysis of clinical, functional, and opportunistic CT metrics Lawrence Yao 1 & Anahit Petrosyan 2 & Praman Fuangfa 3 & Leon Lenchik 4 & Robert D. Boutin 5 Received: 8 June 2020 / Revised: 30 July 2020 / Accepted: 6 August 2020 # ISS 2020
Abstract Objective To determine the relationship between CT-derived muscle metrics and standardized metrics of sarcopenia in patients undergoing routine CT imaging. Materials and methods Data collected in 443 consecutive patients included body CT, grip strength, usual gait speed, and responses to SARC-F and FRAIL scale questionnaires. Functional and clinical metrics of sarcopenia were acquired at the time of CT. Metrics were analyzed using the diagnostic framework of the European Working Group on Sarcopenia in Older People (EWGSOP2). The skeletal muscle index (SMI) and skeletal muscle density (SMD) were measured at the T12 and L3 levels. Statistical methods include linear prediction models and ROC analysis. Results T12-SMD and L3-SMD in women and T12-SMD and L3-SMI in men show weak but significant (p < 0.05) predictive value for gait speed, after adjusting for subject age and body mass index. The prevalence of abnormal CT SMI at T12 and L3 was 29% and 71%, respectively, corresponding to prevalences of confirmed sarcopenia by EWGSOP2 of 10% and 15%, respectively. The agreement of abnormal SARC-F and FRAIL scale screening and EWGSOP2 confirmed sarcopenia was slight to fair (kappa: 0.20–0.28). CT cutpoints, based on EWGSOP2 criteria for abnormal grip strength or gait speed, are generally lower than cutpoints based on normative population data. Conclusion Collection of clinical and functional sarcopenia information at the point of imaging care can be accomplished quickly and safely. CT-derived muscle metrics show convergent validity with gait speed. Only a minority of subjects with low CT metrics have confirmed sarcopenia by EWGSOP2 definition. Keywords Sarcopenia . Frailty . Muscle . CT . Opportunistic CT . Screening
Introduction
* Lawrence Yao [email protected] 1
Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
2
Department of Radiology, University of California Davis School of Medicine, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
3
Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand
4
Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
5
Stanford University School of Medicine, 300 Pasteur Drive, MC-5105, Stanford, CA 94305, USA
Interest in sarcopenia has grown in parallel with a broader recognition of the prognostic significance of sarcopenia in many clinical settings [1, 2]. A universally accepted definition of sarcopenia has been elusive. The concept of sarcopenia has grown beyond an original definition of low muscle mass. Clinical definitions of sarcopenia by expert grou
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