Preoperative assessment of skeletal muscle mass during magnetic resonance enterography in patients with Crohn\u2019s disease

V Celentano,L Kamil-Mustafa,Z Jennings,D P O’ Leary,A Higginson,C Ball,R Beable,K G Flashman,S Luxton

doi:10.1007/s13304-020-00790-x

V Celentano, L Kamil-Mustafa + Show 7 more

Open Access

https://doi.org/10.1007/s13304-020-00790-x

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Abstract

Measurement of the psoas muscle area has been applied to estimate lean muscle mass as a surrogate marker of sarcopenia, but there is a paucity of evidence regarding the influence of sarcopenia on clinical outcomes following inflammatory bowel disease surgery. The aim of this study was to evaluate the association between MRI enterography defined sarcopenia and postoperative complications in patients undergoing elective ileocaecal resection for Crohn’s disease. To obtain cross sectional area measurement of the psoas muscle, the freehand area tool was used to trace the margin of each psoas muscle at the level of L4, with the sum recorded as Total Psoas Area (TPA). The total cross sectional muscle area of the abdominal wall was recorded as Skeletal Muscle Area (SMA), while myosteatosis was measured by normalising the psoas muscle intensity with the mean intensity of the cerebrospinal fluid. The primary outcome was the incidence of 30-day postoperative complications in patients in the lowest quartile of TPA and SMA. 31 patients were included and ten patients (32.25%) developed postoperative complications within 30 days of surgery. The cut-off values for the lowest quartile for TPA were 11.93 cm2 in men and 9.77 cm2 in women, including a total of 8 patients (25.8%) with 5 patients in this group (62.5%) developing postoperative complications and 3 patients (37.5%) Clavien-Dindo class ≥ 3 complications. The cut-off values for the lowest quartile for SMA were 73.49 cm2 in men and 65.85 cm2 in women, with 4 patients out of 8 (50%) developing postoperative complications. Psoas muscle cross sectional area and skeletal mass area can be estimated on Magnetic Resonance Enterography as surrogate markers of sarcopenia with high inter-observer agreement.

Highlights

Measurement of the psoas muscle area has been increasingly applied to estimate lean muscle mass as a surrogate marker of sarcopenia, which is a reduction in lean body mass and function [1]
A number of studies have used a radiological assessment of fat and skeletal muscle compartments to predict disease activity and progression in Crohn’s disease (CD) with lower muscle attenuation and a high visceral fat index having been associated with more severe phenotypes [5] and L3 skeletal muscle area being demonstrated a prognostic factor for intestinal resection in CD patients [6]
A temporary ileostomy was fashioned in 2 patients (6.45%) and in both cases this had been already reversed at the 12 months follow up visit

Summary

Introduction

Measurement of the psoas muscle area has been increasingly applied to estimate lean muscle mass as a surrogate marker of sarcopenia, which is a reduction in lean body mass and function [1]. Loss of lean muscle mass estimated by measuring the cross-sectional area and density of the psoas muscle preoperatively has been associated with a significantly increased risk of developing major complications following resection for colorectal cancer especially anastomotic leak [4]. A number of studies have used a radiological assessment of fat and skeletal muscle compartments to predict disease activity and progression in Crohn’s disease (CD) with lower muscle attenuation and a high visceral fat index having been associated with more severe phenotypes [5] and L3 skeletal muscle area being demonstrated a prognostic factor for intestinal resection in CD patients [6]. The role of radiologically assessed sarcopenia in predicting postoperative

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