Abstract
Simple SummaryDuring cancer cachexia, patients experience profound weight loss due to metabolic dysfunction, resulting in muscle composition alterations. The proton density fat fraction (PDFF) using magnetic resonance imaging (MRI) is an established biomarker to assess changes of muscle composition. We evaluated the suitability of MRI-determined psoas and erector spinae muscle PDFF and fat volume as biomarkers for monitoring cachexia development in an oncological cohort of 58 patients and assessed the regional variation in muscle parameters over time. Our results indicate that psoas muscle PDFF and fat volume could serve as MRI-determined biomarkers for early risk stratification and disease monitoring regarding progression and severity of weight loss in cancer cachexia.Purpose: To evaluate the suitability of psoas and erector spinae muscle proton density fat fraction (PDFF) and fat volume as biomarkers for monitoring cachexia severity in an oncological cohort, and to evaluate regional variances in muscle parameters over time. Methods: In this prospective study, 58 oncological patients were examined by a 3 T MRI receiving between one and five scans. Muscle volume and PDFF were measured, segmentation masks were divided into proximal, middle and distal muscle section. Results: A regional variation of fat distribution in erector spinae muscle at baseline was found (p < 0.01). During follow-ups significant relative change of muscle parameters was observed. Relative maximum change of erector spinae muscle showed a significant regional variation. Correlation testing with age as a covariate revealed significant correlations for baseline psoas fat volume (r = −0.55, p < 0.01) and baseline psoas PDFF (r = −0.52, p = 0.02) with maximum BMI change during the course of the disease. Conclusion: In erector spinae muscles, a regional variation of fat distribution at baseline and relative maximum change of muscle parameters was observed. Our results indicate that psoas muscle PDFF and fat volume could serve as MRI-determined biomarkers for early risk stratification and disease monitoring regarding progression and severity of weight loss in cancer cachexia.
Highlights
Cachexia is a complex syndrome characterized by weight loss due to depletion of muscle and fat mass [1]
Even though muscle proton density fat fraction (PDFF) did not exhibit significant changes during follow-ups, psoas and erector spinae muscle were subjected to profound alterations, as the presented analysis of total and regional muscle volume, contractile tissue volume and fat volume revealed
As we demonstrated using MRI, the loss of total and fat volume in muscle during cancer cachexia has been shown by others for different tumor entities using computed tomography before [21,29,30]
Summary
Cachexia is a complex syndrome characterized by weight loss due to depletion of muscle and fat mass [1]. It affects up to 23% of all cancer patients and can be accounted for up to 30% of all cancer deaths [2,3,4,5]. Patients with cancer of the gastrointestinal tract, especially patients with tumors of the esophagus, stomach, colon and pancreas, often develop cachexia: 40% to 83% of patients with these cancer entities develop cachexia during the course of the disease [6,7]. Dietary deficiencies are especially common and hazardous for elderly cancer patients. In this patient group, cachexia is associated with higher mortality, reduced quality of life, decreased tolerance and response to therapy and diminished capability to recover [10,11]. A valid monitoring method for quantitative cachexia risk stratification is necessary
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