Cross-sectional Computed Tomography Research Articles

The Clinical Significance of Myosteatosis in Survival Outcomes in Patients with Hepatocellular Carcinoma Treated with Sorafenib.

The role of body composition parameters in sorafenib-treated hepatocellular carcinoma (HCC) patients is still not fully elucidated. Here, we aimed to evaluate the impact of computed tomography (CT)-based body composition parameters on the survival of such patients. In this multicenter study, we analyzed the data of 245 sorafenib-treated HCC patients from January 2008 to December 2019. Sarcopenia, visceral obesity, and myosteatosis were defined by using cross-sectional CT images at the third lumbar vertebra level. The effects of these parameters on overall survival (OS) and progression-free survival (PFS) were evaluated. The median age was 67.0 years (interquartile range: 61.0-78.0 year), and 211 patients (86.1%) were male. The median OS and PFS were 7.9 months and 4.8 months, respectively. Vascular invasion (hazard ratio (HR), 1.727; 95% confidence interval (CI), 1.258-2.371; p = 0.001), extrahepatic metastasis (HR, 1.401; 95% CI, 1.028-1.908; p = 0.033), alpha-fetoprotein level > 200 ng/mL (HR, 1.559; 95% CI, 1.105-2.201; p = 0.012), and myosteatosis (HR, 1.814; 95% CI, 1.112-2.960; p = 0.017) were associated with OS. Patient mortality was significantly higher in the group with two or more risk factors than in the group with fewer risk factors. In conclusion, myosteatosis may be a novel prognostic CT-based radiological biomarker in sorafenib-treated HCC patients.

Predicting Waist Circumference From a Single Computed Tomography Image Using a Mobile App (Measure It): Development and Evaluation Study.

Despite the existing evidence that waist circumference (WC) provides independent and additive information to BMI when predicting morbidity and mortality, this measurement is not routinely obtained in clinical practice. Using computed tomography (CT) scan images, mobile health (mHealth) has the potential to make this abdominal obesity parameter easily available even in retrospective studies. This study aimed to develop a mobile app as a tool for facilitating the measurement of WC based on a cross-sectional CT image. The development process included three stages: determination of the principles of WC measurement from CT images, app prototype design, and validation. We performed a preliminary validity study in which we compared WC measurements obtained both by the conventional method using a tape measurement in a standing position and by the mobile app using the last abdominal CT slice not showing the iliac bone. Pearson correlation, student t tests, and Q-Q and Bland-Altman plots were used for statistical analysis. Moreover, to perform a diagnostic test evaluation, we also analyzed the accuracy of the app in detecting abdominal obesity. We developed a prototype of the app Measure It, which is capable of estimating WC from a single cross-sectional CT image. We used an estimation based on an ellipse formula adjusted to the gender of the patient. The validity study included 20 patients (10 men and 10 women). There was a good correlation between both measurements (Pearson R=0.906). The student t test showed no significant differences between the two measurements (P=.98). Both the Q-Q dispersion plot and Bland-Altman analysis graphs showed good overlap with some dispersion of extreme values. The diagnostic test evaluation showed an accuracy of 83% when using the mobile app to detect abdominal obesity. This app is a simple and accessible mHealth tool to routinely measure WC as a valuable obesity indicator in clinical and research practice. A usability and validity evaluation among medical teams will be the next step before its use in clinical trials and multicentric studies.

Computed tomography-based abdominal sarcopenic indices and bio-impedance analysis-based skeletal muscle mass index in hemodialyzed patients

Information about muscle wasting in hemodialyzed patients evaluated using computed tomography (CT) is limited. The present study aimed to examine the relationships between CT-based abdominal sarcopenic indices and bio-impedance analysis (BIA)-based skeletal muscle mass index (SMMI) in these patients. A total of 100 consecutive maintenance hemodialyzed patients who underwent CT and BIA were included. The psoas muscle index (PMI), paraspinous muscle index (PSMI), and abdominal skeletal muscle index (ASMI) were calculated by adjusting each muscle area to the height square. The psoas muscle thickness per height (PMTH) was measured using a single cross-sectional CT image obtained at the level of the third lumbar vertebra. The relationships between these CT-based sarcopenic indices and the BIA-based SMMI were examined. Moreover, the diagnostic values of these CT-based indices for BIA-defined muscle wasting (defined by the sex-specific SMMI: males, <7.0kg/m2; females, <5.7kg/m2) were investigated. The PMI, PMTH, PSMI, and ASMI were significantly correlated with the SMMI (r=0.678, 0.760, 0.708, and 0.785, respectively; p<0.0001 for all). Twenty-eight patients with reduced muscle mass determined by BIA were identified. After age-sex adjustment, a multivariate logistic regression analysis revealed that the C-statistics of the PMI, PMTH, PSMI, and ASMI for the diagnosis of low muscle mass were 0.863 (p=0.0099), 0.870 (p=0.013), 0.891 (p=0.040), and 0.950 (reference), respectively. CT-based abdominal sarcopenic indices presented here may be useful for evaluating muscle wasting in hemodialyzed patients; the ASMI may be the most recommended sarcopenic index for such evaluations.

Giant Pseudo Cyst of the Pancrease: A Case Report

Pancreatic cysts are usually asymptomatic over 70% of the time. They can be benign or malignant. Enhanced imaging modalities and increased usage of routine imaging have increased the identification of pancreatic cysts. If symptomatic, abdominal pain or back pain, unexplained weight loss, jaundice, steatorrhea or palpable mass are usually the presenting complaints. Pancreatic cysts are typically assessed by crosssectional computed tomography (CT) and magnetic resonance imaging (MRI). In this article, we present a case of a 55-year-old female with a large pancreatic pseudocyst, initially measured 27 cm x 23 cm, who was subsequently admitted to our unit and managed successfully. Exploratory laparotomy and pancreatic cystogastrostomy. It is rare to come across a pseudocyst of such large dimensions. Despite its large size, the patient presented with vague abdominal pain as the only chief complaint. The unusual presentation of symptoms and the enormous size of the pseudocyst make this a unique case. Managing giant pancreatic pseudocysts can be complex, as seen in this scenario by the multiple approaches attempted to treat the Pancreatic cysts.

Calcium evaluation using coronary computed tomography in combination with optical coherence tomography.

Optical coherence tomography (OCT) can assess calcium thickness, a key factor for predicting good stent expansion; however, it underestimates coronary calcium severity due to its penetration limitation. This study aimed to evaluate computed tomography (CT) and OCT images to assess calcification. We investigated 25 left anterior descending arteries of 25 patients, using coronary CT and OCT, and assessed their calcification. Of the 25 vessels, 1811 pairs of CT and OCT cross-sectional images were co-registered. Of the 1811 cross-sectional CT images, calcification was not detectable in 256 (14.1%) of the corresponding OCT images due to limited penetration. In the 1555 OCT calcium-detectable images, the maximum calcium thickness was not detectable in 763 (49.1%) images compared to the CT images. In CT images of slices corresponding to undetected calcium in OCT images, the angle, thickness, and maximum density of calcium were significantly smaller compared to slices corresponding to detected calcium in OCT. Calcium with an undetectable maximum thickness in the corresponding OCT image had a significantly greater calcium angle, thickness, and density than calcium with a detectable maximum thickness. There was an excellent correlation between CT and OCT with respect to calcium angle ( R= 0.82, P < 0.001). The calcium thickness on the OCT image had a stronger correlation with the maximum density on the corresponding CT image (R = 0.73, P < 0.001) than with the calcium thickness on the CT image (R = 0.61, P < 0.001). Cross-sectional CT imaging allows for pre-procedural assessment of calcium morphology and severity and could complement the lack of information on calcium severity in OCT-guided percutaneous coronary intervention.

Filament Structure Analysis of Multifilament MgB2 Wires by Using X-ray CT

We have investigated the filament structure of 18-filament MgB <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> wires by using an X-ray computed tomography (CT). For the structural analysis of MgB <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> filaments and Nb barriers, we adopted two image processing, the adoptive binarization method and the closing technique, to the series of cross-sectional CT images. After the image processing, we successfully eliminated the effect of several artifacts, such as metal artifacts and beam hardening, and extrapolated the area of MgB <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> filaments and Nb barriers. From the images, we made a three-dimensional model of MgB <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> filaments and confirmed whether the breakout of the filaments and sausaging phenomena exist or not. Although the broken filaments were not observed, the Nb barrier's break was confirmed in all six inner filaments of the MgB <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> wire after heat treatment. Moreover, from the statistical distribution analysis, sausaging is more significant in the inner filament than in the outer filament. These results indicate that the X-ray CT observation and advanced image processing is effective in understanding the filament structure in non-destructive ways.

Pectoralis muscle measures on preoperative computed tomography are strong predictors of early rehospitalization after left ventricular assist device implantation

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Skeletal muscle mass is reduced in severe heart failure and has a significantly impacts on subsequent outcomes and quality of life. The assessment of pectoralis muscle measures by computed tomography (CT) scan may be predictive of outcomes after left ventricular assist device (LVAD) implantation. Purpose This study aims to assess preoperative pectoralis muscle measures before LVAD implantation to predict early rehospitalization of the patient. Methods We measured the cross-sectional area and mean CT values of the unilateral pectoralis muscle (PHUm: mean Hounsfield unit of pectoralis muscle) by CT scans within 3 months before surgery in patients who underwent HeartMate 3 implantation for the bridge to transplant (BTT) or destination therapy (DT) at our hospital, by August 2022. The cross-sectional area of the unilateral pectoralis muscle was corrected for body surface area (PMI: pectoralis muscle index). The pectoralis muscle was measured by SYNAPSE VINCENT image analysis (Fuji Film) using an axial section of the superior margin of the aortic arch (Figure A). The area under the curve (AUC), sensitivity, and specificity of each index was calculated by receiver operating characteristic (ROC) analysis for the prediction accuracy of PHUm, PMI, and the product of PHUm and PMI in rehospitalization 30, 60, 90 and 180 days from discharge. Results Of reviewed 39 patients who underwent HeartMate 3 implantation, 32 (82%) were male, and 32 (82%) underwent BTT. The median age at LVAD implantation was 52 years (interquartile range [IQR], 42–57). During the follow-up period after discharge (median: 520 days, IQR: 116–707), 19 patients (53%) had unscheduled hospitalizations due to 8 LVAD-related infections, 1 heart failure, 1 cardiac arrhythmia, and 9 other reasons. The median time between discharge and rehospitalization was 70 days (IQR, 31–139). ROC analysis showed that the AUC was particularly high for early rehospitalization within 30 days, with the optimal cutoff of 21.8 Hounsfield unit (HU) for PHUm (sensitivity 0.903, specificity 0.800, AUC 0.884), 6.37 cm2/m2 for PMI (sensitivity 0.806, specificity 0.800, AUC 0.735), and 142.8 for the product of PHUm and PMI (sensitivity 0.903, specificity 1.000, AUC 0.948) (Figure B). Conclusion The product of PHUm and PMI may be a strong predictor of early rehospitalization within 30 days of discharge after LVAD implantation.

Association of sarcopenia and treatment tolerability in older adults with advanced cancer: Secondary analysis of a nationwide NCI Community Oncology Research Program (NCORP) randomized clinical trial.

12038 Background: Sarcopenia (sarc) is defined by reduced muscle function paired with low muscle mass or quality. Sarc is common in older adults, but the relationship between sarc and treatment tolerability in older patients (pts) with cancer has not been established. This secondary analysis of our nationwide University of Rochester NCORP Research Base randomized trial examines whether pre-treatment sarc was associated with treatment toxicity and survival in older pts with advanced cancers. Methods: Pts aged 70 and older with incurable solid tumors and lymphoma initiating a new high-risk systemic treatment were enrolled in GAP70+ (NCT02054741). GAP70+ was a cluster randomized trial evaluating whether a geriatric assessment intervention can reduce cancer treatment toxicity. This secondary analysis included 161 pts with baseline computed tomography (CT) scans and physical function testing. Sarc was defined as low muscle strength (5-time Chair Stand Test &gt; 16.7 seconds) with reduced muscle mass (BMI and sex-specific cutoffs, cm/m2) or low muscle quality (Hounsfield units [HU] average radiodensity thresholds) utilizing validated cross-sectional CT imaging metrics. Sarc was defined as severe in presence of reduced physical performance (Timed-Up-And-Go &gt; 13.5 seconds). We evaluated if the proportion of pts experiencing any grade 3-5 toxicity in the first 3 months of treatment using Common Terminology Criteria for Adverse Events (CTCAE) V4.0 was higher in those with sarc than those without sarc. Multivariate logistic regression was used to further explore this relationship. Multivariate Cox regression analysis was performed to evaluate the association of sarc and severe sarc with 1-year survival. Results: Mean age of the 161 participants included in this cohort was 76.6 years and 60.9% of were male; over half had gastrointestinal (34.8%) or lung cancer (23.6%). Sarc was found in 91 of 161 (56.5%) pts; 54 had severe sarc. Pts with sarc did not experience significantly more grade 3-5 toxicity compared to those without sarc (79.1% vs. 71.4%, p = 0.26). However, pts with sarc experienced more grade 3-5 non-hematologic toxicity (63.7% vs. 44.3%, p = 0.01) on univariate and multivariate analysis (OR 2.2, CI 1.1-4.5, p = 0.02). The association between sarc and worse survival at 1-year was not statistically significant (OR 1.5, CI 0.9-2.4, p = 0.13). Those with severe sarc did demonstrate significantly worse 1-year survival on multivariate analysis (HR 1.8, CI 1.1-2.9, p = 0.02). Conclusions: Older pts with cancer and sarc were more likely to suffer serious non-hematologic toxicity from cancer treatment. Furthermore, those with severe sarc had significantly worse survival. Evaluation for sarc before initiating treatment in older adults could help oncologists identify pts at higher risk of toxicity and poor survival. Clinical trial information: NCT02054741 .

Calf extra-Fascial compartment area affects calf muscle pumping action: an air plethysmography and computed tomography study

We aimed to elucidate whether lower limb extra-fascial compartment and muscle areas affect the calf muscle pumping action on lower limbs. This study included 90 patients (180 limbs) who underwent preoperative air plethysmography (APG) and preoperative non-contrast computed tomography (CT) of the lower limbs for diagnosis of unilateral or bilateral primary varicose veins. A correlation between cross-sectional CT images and preoperative APG was confirmed. Cross-sectional CT was used to measure the extra-fascial compartment and muscle areas of the calf. The lower limbs were divided into two groups: those that were normal and those with primary varicose veins. The extra-fascial compartment area was significantly correlated with the ejection fraction in normal (r = 0.388, n = 53, p = 0.004) and varicose limbs (r = 0.232, n = 91, p = 0.027). In normal and varicose limbs, evaluation of ejection fraction, an indicator of muscle pumping, requires consideration of the extra-fascial compartment area.

Objective Evaluation With Noncontrast Computed Tomography Can Reveal Calcified Plaque Solidity in Peripheral Artery Diseases.

The presence of severely calcified plaque remains problematic in endovascular therapy, and no specific endovascular treatment strategy has been established. Estimating plaque solidity before the procedure may help operators penetrate calcified plaque with a guide wire. The aim of this study was to establish a method of measuring plaque solidity with noncontrast computed tomography (CT). This retrospective, single-center study included consecutive patients who, between October 2020 and July 2022, underwent noncontrast 5 mm and 1 mm CTs before endovascular therapy to penetrate calcified plaque with a wire in the common femoral, superficial femoral, and popliteal arteries. Three cross-sectional CT slices were selected. To target a calcified plaque lesion, the operator identified a region of interest, which corresponded to 24×24 pixels, and Hounsfield unit (HU) values of each pixel were displayed on the CT image. The average HU values and the ratio of number of pixels of lower values (130-599 HU) represented plaque solidity. We used the Mann-Whitney-Wilcoxon rank-sum test and the chi-square test to compare the solidity of plaques penetrated and not penetrated by the wire. We evaluated 108 images of 36 calcified plaque lesions (in 19 patients). The wire penetrated 28 lesions (77.8%) successfully. The average HU value was significantly lower in the lesions that the wire penetrated than in the others, in both the 5 mm CT slices (434.7±86.8 HU vs 554.3±112.7 HU, p=0.0174) and 1 mm slices (497.8±103.1 HU vs 593.5±114.5 HU, p=0.0381). The receiver operating curve revealed that 529.9 and 533.9 HU in the 5 and 1 mm slices, respectively, were the highest values at which wires could penetrate. Moreover, at the lesions that were penetrates successfully, the ratio of number of lower HU value pixels was significantly higher both in 5 mm slice CTs (74.7±13.4 vs 61.7±13.1%, p=0.0347) and 1 mm (68.7±11.8 vs 57.1±11.4%, p=0.0174). The use of noncontrast CT to evaluate plaque solidity was associated with successful wire penetration of calcified lesions in peripheral arteries. This study revealed an association between the wire penetration inside calcified plaque and plaque solidity estimated using non-contrasted computed tomography. The mean Hounsfield unit values of three cross-sections in calcified plaques were associated with the successful wire penetration. This wire penetration difficulty is associated with extended procedure time, excessive radiation exposure, usage of extra contrast agents, and increased medical costs. Therefore, estimating calcified plaque solidity before procedure enables us to choose effective and lean procedures. In addition, to predict the success of dilating calcified plaque from the inside is also beneficial when the operator wants to avoid extra scaffold implantation for target lesions.

Establishment and validation of reference values for abdominal skeletal muscle compartments in children

Sarcopenia, resulting from skeletal muscle loss, is a serious concern in children, for whom nutrition and physical activity are essential for growth. In sarcopenia research, the skeletal muscle mass is often obtained from computed tomography (CT) cross-sectional images in both adults and children; however, the method of evaluating skeletal muscle using CT, especially the area range to be measured, has not yet been validated in children. The aim of this study is to establish reference values for three compartments of the abdominal skeletal muscle area (aSMA) obtained from cross-sectional CT images, and to validate the differences among them by assessing correlations with physical development. We conducted a single-centre, retrospective, cross-sectional study and included patients aged 1-17 years who underwent abdominal CT at Chiba University Hospital from 2007 to 2020. Patients with chronic diseases such as malignant tumours and inflammatory bowel disease were excluded from the analysis. aSMA was obtained from CT cross-sections at the lumbar L3-L4 intervertebral disc level by dividing it into three compartments: the psoas muscle area (PMA), paraspinal muscle area (PSMA), and total skeletal muscle area (TSMA). Quartile regression curves by sex and muscle compartment were generated using non-crossover and nonparametric regression quantile estimation. The correlation between each compartment of aSMA with height and weight was assessed using Spearman's rank correlation coefficient. We analysed the abdominal CT images of 593 children (male: n=335, female: n=258) and generated curves predictive for the 5th, 25th, 50th, 75th, and 95th percentiles for each compartment of aSMA by sex. In patients aged 13 years and older, boys had significantly larger aSMA areas than girls in all three compartments. Among the three compartments, PSMA had the strongest correlation coefficient with height and weight for both boys and girls. We generated quantile regression curves for three aSMA compartments obtained from cross-sectional CT images and established reference values in children. PSMA values were most strongly correlated with height and weight among the three aSMA compartments.

Mean density of computed tomography for predicting rotational atherectomy during percutaneous coronary intervention

BackgroundMulti-slice computed tomography (CT) allows noninvasive evaluation of the severity of coronary calcification. However, there has yet to be a definitive parameter based on the cross-sectional CT image for predicting the need for rotational atherectomy (RA). Therefore, we aimed to investigate the mean density of cross-sectional CT images to predict the need for RA during percutaneous coronary intervention (PCI). MethodsA total of 154 lesions with moderate to severe calcification detected in coronary angiography were identified in 126 patients who underwent coronary CT prior to PCI for stable angina. PCI with RA was performed for 48 lesions, and the remaining 106 were treated without RA. Multi-slice CT was retrospectively evaluated for its ability to predict the use of RA. We chose the most severely calcified cross-sectional image for each lesion. The mean density within the outer vessel contour, calcium arc quadrant of the cross-sectional CT image, calcium length, calcification remodeling index, and per-lesion coronary artery calcium score was studied. ResultsReceiver-operator characteristic curve analysis revealed 637 Hounsfield units (HU) (area under the curve ​= ​0.98, 95% confidence interval: 0.97–1.00, p ​< ​0.001) as the best mean density cutoff value for predicting RA. Multivariate logistic regression analysis showed that a mean calcium level >637 HU was a strong independent predictor (odds ratio: 32.8, 95% confidence interval: 7.0–153, p ​< ​0.001) for using RA. ConclusionsThe mean density of the cross-sectional CT image, a simple quantitative parameter, was the strongest predictor of the need for RA during PCI.

Development of a navigable 3D virtual model of temporal bone anatomy

Background Computed Tomography (CT) scanning offers an accurate structural definition of bones, blood vessels, and soft tissues; however, mental integration of cross-sectional 2D CT images for a 3D understanding of complex anatomical structures becomes difficult when the field of view is confined to the temporal bone. This project tried to provide a feasible solution to this problem by creating a navigable 3D virtual model which may aid in better comprehension of the temporal bone anatomy. Methods A helical-CT scan was used to obtain high-resolution cross-sectional slices of a cadaveric human temporal bone. Using the volume-rendering capabilities of 3D Slicer®, which involves volume data management, cropping of the data set, and threshold painting, detailed anatomical structures were segmented based on the intensity captured from different regions. This volumetric data was converted to an interactive virtual model using Blender®. Results The final product is a web page that allows interaction and navigation with a 3D annotated model of the temporal bone, which can be accessed from any device with a web browser. Conclusion This model can function as a training tool for students, teachers, and practitioners to understand and review the complex anatomy of the temporal bone.

Linear CT-scan measurements of cerebral ventricles in senile Poodle dogs.

Breed traits seem to influence the dimensions of the cerebral ventricles in dogs. The ratios between the ventricles and the brain are crucial diagnostic criteria for suspected canine cognitive dysfunction (CCD). This study aimed to establish linear computed tomography (CT)-scan measurements of the cerebral ventricles in 55 Poodle dogs aged >7 years. To this end, cross-sectional CT images were evaluated. The measurements in the whole sample were: height of the right ventricle, 6.0 ± 1.6 mm; height of the left ventricle, 5.8 ± 1.6 mm; width of the right ventricle, 6.9 ± 1.4 mm; width of the left ventricle, 7.0 ± 1.3 mm; height of the third ventricle, 3.4 ± 0.8 mm; height of the right cerebral hemisphere, 39.5 ± 2.0 mm; and height of the left cerebral hemisphere, 40.2 ± 2.6 mm. The average ventricular measurements were higher in dogs older than 11 years (p < 0.05). However, the average ratio of the ventricle height to the height of the brain did not reveal differences between age groups, sex, or antimeres. In addition, none of the images showed fused lateral ventricles. Thus, these data can assist in interpreting ventricle size in senile Poodle dogs (aged >7 years).

Imaging features inferring symptom onset due to spinal metastasis progression: a preliminary study.

Spinal metastases can cause intractable pain and neurological deficits, which can markedly worsen both patients' activities of daily living (ADL) and their health-related quality of life (QOL). Early intervention is essential to prevent irreversible neurological deficits and pain associated with spinal metastases. We investigated the imaging features of spinal metastases that led to neurological deficits. We analyzed axial cross-sectional computed tomography (CT) images of cervical and thoracic spinal metastases in patients with and without lower limb motor paralysis, neuropathic pain, and local nociceptive pain. We distinguished regions of the spine associated with these respective symptoms, and explored their inferable performance using images obtained before symptom onset. In addition, we analyzed the imaging features and type of bone metastasis (osteolytic and osteoblastic). Spinal lesions occupied the area in and around the spinal canal and around the pedicle in patients with motor paralysis. Lesions around the pedicle and in the most posterior vertebral body part before symptom onset were inferable. In patients with neuropathic pain, spinal metastases spread along the pedicle before symptom onset, and had surrounded the spinal canal circumferentially at symptom onset. Local nociceptive pain was more common near the center of the vertebral body either at or before symptom onset. There was no difference in the imaging features according to the type of bone metastasis. Lesions in certain regions in the asymptomatic metastatic spine can indicate the onset of spinal metastasis-related symptoms in the next few months. Early therapeutic intervention might be applied to prevent neurological disorder.

Impact of sarcopenia and myosteatosis on survival outcomes for patients with head and neck cancer undergoing curative-intent treatment.

Malnutrition and sarcopenia are prevalent in patients with head and neck squamous cell carcinoma (HNSCC). Pre-treatment sarcopenia and adverse oncological outcomes in this population are well described. The impact of myosteatosis and post-treatment sarcopenia is less well known. Patients with HNSCC (n = 125) undergoing chemoradiotherapy, radiotherapy alone and/or surgery were assessed for sarcopenia and myosteatosis, using cross-sectional computed tomography (CT) imaging at the third lumbar (L3) vertebra, at baseline and 3 months post-treatment. Outcomes were overall survival (OS) at 12 months and 5 years post-treatment. One hundred and one participants had a CT scan evaluable at one or two time points, of which sixty-seven (66 %) participants were sarcopenic on at least one time point. Reduced muscle attenuation affected 93 % (n = 92) pre-treatment compared with 97 % (n = 90) post-treatment. Five-year OS favoured those without post-treatment sarcopenia (hazard ratio, HR 0·37, 95 % CI 0·16, 0·88, P = 0·06) and those without both post-treatment myosteatosis and sarcopenia (HR 0·33, 95 % CI 0·13, 0·83, P = 0·06). Overall, rates of myosteatosis were high at both pre- and post-treatment time points. Post-treatment sarcopenia was associated with worse 5-year OS, as was post-treatment sarcopenia in those who had myosteatosis. Post-treatment sarcopenia should be evaluated as an independent risk factor for decreased long-term survival post-treatment containing radiotherapy (RT) for HNSCC.

Clinical Impact of Nutritional Status and Sarcopenia in Pediatric Patients with Bone and Soft Tissue Sarcomas: A Pilot Retrospective Study (SarcoPed).

Background: We evaluated nutritional and sarcopenia status and their clinical impact in pediatric patients affected by bone and soft tissue sarcomas. Methods: Body mass index (BMI), prognostic nutritional index (PNI), and total psoas muscle area (tPMA) at diagnosis and after 12 months were analyzed. tPMA was measured from single cross-sectional computed tomography (CT) images at L4–L5. Age-specific and sex-specific tPMA Z-scores were retrieved from an online calculator. Results: A total of 21 patients were identified between February 2013 and December 2018. Twelve patients (57.1%) experienced sarcopenia at diagnosis, although not statistically associated with overall survival (OS) (p = 0.09). BMI Z-score, PNI, and tPMA Z-score significantly decreased between diagnosis and after 12 months of treatment (p < 0.05). Univariate analysis showed significant associations between poor OS and the presence of metastasis (p = 0.008), the absence of surgery (p = 0.005), PNI decrease (p = 0.027), and the reduction in tPMA > 25% (p = 0.042) over the 12 months. Conclusions: Sarcopenia affects more than half of the patients at diagnosis. Decreased PNI during 12 months of treatment has significant predictive value for OS. The role of tPMA derived from CT scan among pediatric patients with sarcoma should be investigated in further prospective and larger studies.

The type of gastrectomy affects skeletal muscle loss and the long-term outcomes of elderly patients with gastric cancer: a retrospective study using computed tomography images

Sarcopenia is common in elderly gastrectomized patients and a known risk factor for postoperative complications and poor overall survival. However, the long-term outcomes of skeletal muscle loss after gastrectomy and the differences in outcomes of different gastrectomy procedures remain unclear. The subjects of this retrospective study were 136 patients who underwent various gastrectomy procedures for early gastric cancer, namely: total gastrectomy (TG; n = 20), proximal gastrectomy (PG; n = 16), distal gastrectomy (DG; n = 60), and pylorus-preserving gastrectomy (PPG; n = 40). Skeletal muscle volume (SMV), calculated as the skeletal muscle index (SMI), was measured using cross-sectional computed tomography (CT) scans preoperatively and then 1, 2, and 3years after gastrectomy. Sarcopenia developed from 2years onwards in all the patients who underwent TG. The SMI and sarcopenia prevalence after gastrectomy deteriorated over time. Multivariate analysis revealed that TG and PG were significant risk factors for skeletal muscle loss in postoperative years 1 and 3. A decrease in the SMI after TG or PG was most remarkable in elderly patients. The type of gastrectomy affects skeletal muscle loss in the long term. Elderly patients who undergo TG or PG are at high risk of severe skeletal muscle loss.

Abstract 9903: CT Number Predicts Calcium Thickness in Optical Coherence Tomography Guided Percutaneous Coronary Intervention

Introduction: Optical coherence tomography (OCT) can assess calcium thickness, which is the key factor for predicting good stent expansion in calcified lesions. However, OCT can underestimate coronary calcium severity due to its penetration limitation and lipid accumulation while multi-slice computed tomography (CT) allows for a noninvasive assessment of coronary calcification. This study aimed to compare cross-sectional CT and OCT images for the assessment of calcification. Methods and Results: We investigated 33 lesions using coronary CT and OCT for the assessment of calcification. Of the 33 lesions, 211 regions of interest were set every 30 degrees in both the CT and OCT cross-sectional images. In 88 (41.7%) regions of interest with CT-detected calcium, the thickness of calcium was not detectable in the corresponding OCT image due to limited penetration, lipid attenuation, and guidewire artifact. There was an excellent correlation between CT number and thickness of calcium in the corresponding OCT image (R=0.797, P&lt;0.001). Receiver-operator curve analysis also showed fair discrimination between calcium thickness less than 500 μm and 500 μm or higher at a CT number of 1021 HU. Conclusions: Cross-sectional CT imaging could complement the underestimation of calcium severity in OCT-guided PCI, predicting the calcium thickness by CT number.

Body composition predictors of mortality on computed tomography in patients with spinal metastases undergoing surgical treatment

Background contextAlthough survival of patients with spinal metastases has improved over the last decades due to advances in multi-modal therapy, there are currently no reliable predictors of mortality. Body composition measurements obtained using computed tomography (CT) have been recently proposed as biomarkers for survival in patients with and without cancer. Patients with cancer routinely undergo CT for staging or surveillance of therapy. Body composition assessed using opportunistic CTs might be used to determine survival in patients with spinal metastases. PurposeThe purpose of this study was to determine the value of body composition measures obtained on opportunistic abdomen CTs to predict 90-day and 1-year mortality in patients with spinal metastases undergoing surgery. We hypothesized that low muscle and abdominal fat mass were positive predictors of mortality. Study designRetrospective study at a single tertiary care center in the United States. Patient sampleThis retrospective study included 196 patients between 2001 and 2016 that were 18 years of age or older, underwent surgical treatment for spinal metastases, and had a preoperative CT of the abdomen within three months prior to surgery. Outcome measuresNinety-day and 1-year mortality by any cause. MethodsQuantification of cross-sectional areas (CSA) and CT attenuation of abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and paraspinous and abdominal skeletal muscle were performed on CT images at the level of L4 using an in-house automated algorithm. Sarcopenia was determined by total muscle CSA (cm2) divided by height squared (m2) with cutoff values of <52.4 cm2/m2 for men and <38.5 cm2/m2 for women. Bivariate and multivariate Cox proportional-hazard analyses were used to determine the associations between body compositions and 90-day and 1-year mortality. ResultsThe median age was 62 years (interquartile range=53–70). The mortality rate for 90-day was 24% and 1-year 54%. The presence of sarcopenia was associated with an increased 1-year mortality rate of 66% compared with a 1-year mortality rate of 41% in patients without sarcopenia (hazard ratio, 1.68; 95% confidence interval, 1.08–2.61; p=.02) after adjusting for various clinical factors including primary tumor type, ECOG performance status, additional metastases, neurology status, and systemic therapy. Additional analysis showed an association between sarcopenia and increased 1-year mortality when controlling for the prognostic modified Bauer score (HR, 1.58; 95%CI, 1.04–2.40; p=.03). Abdominal fat CSAs or muscle attenuation were not independently associated with mortality. ConclusionsThe presence of sarcopenia is associated with an increased risk of 1-year mortality for patients surgically treated for spinal metastases. Sarcopenia retained an independent association with mortality when controlling for the prognostic modified Bauer score. This implies that body composition measurements such as sarcopenia could serve as novel biomarkers for prediction of mortality and may supplement other existing prognostic tools to improve shared decision making for patients with spinal metastases that are contemplating surgical treatment.