Psoas Muscle Research Articles

High-grade mucinous tubular and spindle cell carcinoma of the kidney in a patient on hemodialysis: a case report and literature review

BackgroundEnd-stage renal disease is a risk factor for renal cell carcinoma. However, mucinous tubular and spindle cell carcinoma of the kidney is rare. We report a patient on hemodialysis who had high-grade mucinous tubular and spindle cell carcinoma of the kidney.Case presentationA 62-year-old Japanese woman had end-stage renal disease and had been on hemodialysis for the previous 4 years. However, periodic imaging examinations to detect kidney cancer had not been conducted. The patient visited our department of urology complaining of general fatigue and dyspnea. Computed tomography with enhancement revealed a solid renal mass with a diameter of 66 mm. It had invaded the right psoas muscle and had multiple lymph node metastases. In addition, the patient had massive ascites and right-sided predominant pleural effusion. We drained the pleural effusion, but she died 11 days after admission. An autopsy was performed. Pathological examination revealed high-grade mucinous tubular and spindle cell carcinoma of the right kidney; multiple organ metastases to the bilateral lungs, liver, gall bladder, uterus, ovary, and inferior vena cava; cancerous pleuritis; and cancerous peritonitis. Our case indicates that high-grade mucinous tubular and spindle cell carcinoma emerging in end-stage kidney causes a detrimental clinical course.ConclusionHigh-grade mucinous tubular and spindle cell carcinoma of the kidney had a severe clinical course. We recommend periodic screening of patients with end-stage renal disease, using computed tomography or ultrasound.

Prognostic Significance of Psoas Muscle Index in Unresectable Hepatocellular Carcinoma: Comparative Analysis of Lenvatinib and Atezolizumab Plus Bevacizumab.

Background and Aims: Skeletal muscle loss has been identified as a prognostic factor in patients with unresectable hepatocellular carcinoma (uHCC) undergoing treatment with lenvatinib (LEN). While atezolizumab plus bevacizumab (ATZ-BEV) is recommended as first-line therapy for uHCC, the impact of skeletal muscle loss in these patients remains unclear. Methods: We enrolled 97 patients treated with either LEN or ATZ-BEV as their first-line therapy and divided them into two groups based on the presence or absence of a low psoas muscle index (low PMI) before treatment. We compared patient characteristics and overall survival (OS) between the groups. Additionally, we investigated the transition of the PMI during drug therapy, specifically before treatment, at the initial evaluation, and after the end of treatment. Results: Seventy percent of patients in the LEN group and seventy-one percent in the ATZ-BEV group had a low PMI. Multivariate analysis across all patients revealed a low PMI (hazard ratio [HR] 3.25, p = 0.0004) as a prognostic factor for OS. The PMI decreased more in the LEN group compared to the ATZ-BEV group. In the Barcelona Clinic Liver Cancer-C group, the OS of ATZ-BEV therapy was significantly better than that of LEN therapy when a low PMI was present (p = 0.046). Conclusions: A low PMI emerges as a significant prognostic factor in uHCC patients undergoing drug therapy, not only in LEN therapy but also in ATZ-BEV therapy. Additionally, ATZ-BEV therapy may be more favorable for sarcopenic patients with advanced HCC stages.

Evaluation of the reliability of measuring lower back muscles cross-sectional area based on manual segmentation within multi-level MRI images

IntroductionManual segmentation of paraspinal muscle cross-sectional area (CSA) is widely used to assess related health disorders. This study aimed to evaluate the reliability of this segmentation process for each paraspinal region of interest across the three intervertebral levels commonly used for segmentation (L3/4, L4/5, and L5/S1). MethodsAxial-T2-weighted MRI images for 238 patients were divided among five raters (47 ± 1 cases each). To conduct the intra-rater reliability study, the CSA of each paraspinal lumber muscle (psoas major (PM), multifidus (MF), and erector spinae (ES)) and the intervertebral disc (ID) were manually segmented twice on all targeted levels before being assessed for each region per rater. The Inter-rater reliability was determined by comparing the results of different readers who segmented the same dataset. The Intraclass Correlation (ICC) and Coefficient-of-Variation percentage (CV%) were reported for each analysis. ResultsLow intra- and inter-rater variability (CV%<11) was found for each reader in each region and intervertebral level. The inter-rater reliability was excellent (ICC>0.9) for the PM, ID, and ES at L3/4. However, it was very good for MF at all levels and ES at L4/5, L5/S1 (ICC range: 0.82–0.88) affected by the fat-infiltration nature of the ES and MF muscles, their proximity to each other, and their smaller size (correlation between muscle size and ICC = 0.6, P < 0.01). The ID segmentation has the lowest CV (<3 %) and excellent ICC (>0.93). ConclusionManual paraspinal muscle segmentation using axial-T2-weighted MRI is reliable at all commonly segmented intervertebral levels. However, the reliability level can be degraded by the presence of high-fat infiltrate, unclear muscle boundaries, and muscle size. Implications for practiceFollowing consistent guidelines can help improve segmentation results. The IDs can be used as reliable internal references.

Impact of Sarcopenia on Treatment Outcomes and Toxicity in Locally Advanced Rectal Cancer

Background and Objectives: Sarcopenia, a condition characterized by muscle mass loss, is prevalent in up to 68% of rectal cancer patients and has been described as a negative prognostic factor, impacting overall survival and tumor response. While there are extensive data on rectal cancer globally, only a handful of studies have evaluated the role of sarcopenia in locally advanced rectal cancer (LARC). Our study aimed to investigate the relationship between sarcopenia, overall response rate, and toxicity in patients who underwent total neoadjuvant treatment (TNT) for LARC. Materials and Methods: We performed a retrospective study of patients with rectal cancer treated with TNT and surgery with curative intent between 2021 and 2023 at Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca. Sarcopenia was assessed on MRI images by measuring the psoas muscle area (PMA) at the level of the L4 vertebra before and after neoadjuvant therapy. The primary endpoints were the overall complete response rate (oCR) and acute toxicity. Results: This study included 50 patients with LARC. The oCR rate was 18% and was significantly associated with post-treatment sarcopenia (OR 0.08, p = 0.043). Patients who did not achieve a clinical or pathologic complete response had, on average, an 8% muscle loss during neoadjuvant therapy (p = 0.022). Cystitis and thrombocytopenia were significantly associated with post-treatment sarcopenia (p = 0.05 and p = 0.049). Conclusions: Sarcopenia and loss of psoas muscle during neoadjuvant therapy were negatively associated with tumor response in locally advanced rectal cancer. Thrombocytopenia and cystitis are more frequent in sarcopenic than non-sarcopenic patients undergoing neoadjuvant chemoradiation for rectal cancer.

Improving Osteoporosis Prediction Using Vertebral Bone Quality Score and Paravertebral Muscle Measurements From Lumbar MRI Scans.

Retrospective cohort. This study aims to use a novel method of combining vertebral bone quality score with paravertebral cross-sectional area measurements to improve the accuracy of predicting individuals with total hip T-scores <-2.5. Osteoporosis is a prevalent skeletal condition associated with decreased bone density and increased fracture risk. Dual-energy x-ray absorptiometry (DXA) is the conventional method for diagnosing osteoporosis, but it has limitations. Opportunistic osteoporosis screening techniques using lumbar magnetic resonance imaging (MRI), particularly the vertebral bone quality (VBQ) score, have shown promise. This study aims to improve the accuracy of predicting individuals with low total hip T-scores using a novel method that combines VBQ scores with paravertebral cross-sectional area (CSA) measurements. A retrospective cohort of 98 patients with DXA and lumbar MRI scans was analyzed. VBQ scores were calculated based on lumbar MRI images, and CSA measurements of paravertebral and psoas muscles were obtained. Threshold-based logistic regression was used to identify optimal thresholds for predicting total hip T-scores <-2.5. The combined model incorporating the VBQ score and paravertebral muscle percent achieved an accuracy of 96.9% for predicting total hip T-scores <-2.5, compared to 81.6% when using the VBQ score alone. Incorporating paravertebral muscle measurements significantly improved the accuracy of identifying osteoporotic individuals. The combination of VBQ score and paravertebral muscle measurements enhances the accuracy of predicting individuals with low total hip T-scores. Lumbar MRI scans provide valuable information beyond opportunistic osteoporosis screening, and the inclusion of paravertebral muscle measurements could aid in identifying at-risk individuals more accurately.

The cross-sectional area of gluteal muscle on multiaxial CT scan as a predictor for diagnosing sarcopenia in patients with degenerative lumbar disease.

This study examined the predictive value of the gluteal muscle index (GMI) for diagnosing sarcopenia in patients with degenerative lumbar disease (DLD), highlighting the need for effective diagnostic markers in this population. This prospective observational study included 202 elderly patients scheduled for lumbar spine surgery. Muscle indices for psoas, paraspinal, and gluteal muscles were measured using multiaxial computed tomography. Sarcopenia was diagnosed per the 2019 Asian Working Group for Sarcopenia (AWGS) criteria. Statistical analysis comprised univariate and multivariate logistic regression to identify predictors of sarcopenia. Of patients, 77% were diagnosed with sarcopenia. The GMI and psoas muscle index (PMI) were identified as significant predictors of sarcopenia in the univariate analysis. Multivariate analysis confirmed their predictive value, with higher indices correlating with a reduced risk of sarcopenia (GMI odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.92-0.97; PMI OR = 0.95, 95% CI = 0.92-0.98, both P < .001). The GMI serves as a reliable predictor of sarcopenia in elderly patients undergoing lumbar spine surgery for DLD, suggesting a significant role of gluteal muscles in diagnosing sarcopenia. Incorporating GMI into clinical assessments is critical to better manage and diagnose sarcopenia in this population.

The relationship between sarcopenia and metabolic parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and the prognostic value of sarcopenia in early-stage non-small cell lung cancer.

Patients with lung cancer face a heightened risk of developing sarcopenia. Despite this known risk, the impact of sarcopenia on the long-term prognosis of lung cancer patients, specifically concerning progression-free survival (PFS) and overall survival (OS), remains unclear. The primary objective of our study was to examine the correlation between metabolic parameters derived from 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and sarcopenia, as well as the prognostic value of sarcopenia in patients with surgically resected early-stage non-small cell lung cancer (NSCLC). In this retrospective cross-sectional study, we analyzed 187 NSCLC patients who underwent 18F-FDG PET/CT at the First Affiliated Hospital of Soochow University between March 2019 and October 2023. Patients were divided into two groups based on the presence (n=46) or absence (n=141) of sarcopenia. The correlation between sarcopenia, metabolic parameters, and patient characteristics was evaluated using chi-square and Mann-Whitney U tests. Survival analyses, including PFS and OS, were conducted using Kaplan-Meier analysis and Cox proportional hazards regression. Based on sarcopenia, metabolic parameters and patient characteristics, patients were classified into high-risk (n=28), intermediate-risk (n=121), and low-risk (n=38) groups. Our analysis identified gender, body mass index (BMI), psoas Hounsfield unit (HU), and maximum standardized uptake value of the psoas major muscle (SUVmax-Muscle) as independent predictors of sarcopenia (P<0.05 for all). A nomogram model, utilizing these parameters, was constructed to predict sarcopenia. Survival analysis further demonstrated that total lesion glycolysis [hazard ratio (HR) =2.499; 95% confidence interval (CI): 2.014-3.267; P=0.016], sarcopenia (HR =3.323; 95% CI: 1.748-6.316; P<0.001), and programmed death ligand-1 (PD-L1) expression (HR =0.093; 95% CI: 0.012-0.698; P=0.021) emerged as independent predictors of OS in early-stage NSCLC. Notably, patients categorized as high-risk, characterized by elevated total lesion glycolysis, presence of sarcopenia, and PD-L1 positivity, exhibited a significantly poorer prognosis compared to the intermediate-risk (P<0.05) and low-risk groups (P<0.05). Our findings indicated an inverse relationship between SUVmax-Muscle or psoas HU with the incidence of sarcopenia in NSCLC patients. Additionally, total lesion glycolysis, sarcopenia, and PD-L1 expression were identified as independent prognostic factors for OS in early-stage NSCLC. The risk stratification model, incorporating total lesion glycolysis, sarcopenia, and PD-L1 expression, assumed a pivotal role in guiding personalized therapy decisions and post-treatment monitoring.

The relation between preoperative radiological sarcopenia and postoperative recovery of physical activity in older surgical cancer patients; an explorative study

To identify older surgical cancer patients at risk of decreased postoperative recovery of physical activity (PA), this study assesses whether preoperative radiological sarcopenia (RS) is associated with a decreased ability to return to baseline PA. RS was defined as decreased psoas muscle mass or -density by gender-specific cut-offs on CT-scans at level of vertebra L3. PA was assessed as steps/day measured with PA tracker and recovery of PA was defined as >90% of preoperative steps/day at 3 months postoperatively. Of 44 included patients aged 65 and over undergoing oncologic surgery, 18 patients (41%) showed RS. Seventeen patients (39%) returned to baseline PA, of which eight patients had RS (47%). RS was not associated with a return to baseline PA (OR: 1.38, 95%CI 0.39–4.92, p = 0.61). In this exploratory study, no association was found between preoperative RS and recovery of PA postoperatively.

A decade's experience of robotic buccal ureteroplasty for post ureteroscopic laser lithotripsy induced strictures—Should this be the new standard?

ObjectiveTo present the surgical technique of robotic buccal ureteroplasty for strictures after laser lithotripsy and its outcomes. MethodsThis was a retrospective study conducted at the Department of Urology at Apollo Hospitals, Chennai, India from October 2012 to October 2022. Indications for surgery included worsening hydronephrosis, declining renal function, and recurrent urinary tract infections with obstruction. Apart from liberal exposure of the stricture, we stress upon the use of indocyanine green to assess vascularity and quilting of the graft to bare area of psoas muscle to increase the graft vascularity. ResultsAmong the 15 patients, ureteropelvic junction strictures were observed in eight (53.3 %), while five (33.3 %) had proximal stricture, and two (13.3 %) had mid-ureteral stricture. Notably, eight of the 15 (53.3 %) patients had previous unsuccessful double-J stenting. The median stricture length was 3.5 cm (range: 2–5 cm), with a mean operative time of 167 min (range: 126–214 min) and estimated blood loss of 140 mL (range: 40–200 mL). After a median follow-up of 12 months (range: 4–32 months), 13 out of 15 (86.7 %) patients showed significant improvement in their follow-up functional scans. ConclusionRobotic buccal ureteroplasty is a very effective technique for the management of laser-induced ureteral strictures with good long-term results and minimum morbidity. The results are comparable irrespective of previous failed stenting.

Different Degeneration Patterns of Paraspinal Muscles Between Double-Level and Single-Level Lumbar Spondylolisthesis: An Magnetic Resonance Imaging Analysis of 140 Patients.

To evaluate the degeneration patterns of paraspinal muscles in double-level degenerative lumbar spondylolisthesis (dl-DLS) versus single-level degenerative lumbar spondylolisthesis (sl-DLS). A total of 67 dl-DLS and 73 sl-DLS patients were included. Multifidus (MF), erector spinae (ES), and psoas major (PM)'s fatty infiltration (FI) and relative cross-sectional area (rCSA) were measured. Sagittal parameters such as lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) were also assessed. Comparisons and correlation analysis were performed between the 2 groups. MF atrophy is worse in dl-DLS patients from L3-4 to L5-S1, with higher FI from L1-2 to L5-S1 compared to sl-DLS patients. ES atrophy and FI are more pronounced in dl-DLS patients from L1-2 to L5-S1. PM atrophy is more significant in dl-DLS patients at L2-3 to L5-S1, with heavier FI from L1-2 to L3-4, though no difference in FI from L4-5 to L5-S1. The rCSA and FI of MF and ES show significant differences between adjacent segments in both groups, except for MF rCSA between L3-4 and L4-5 in dl-DLS. In dl-DLS, PM rCSA negatively correlates with PT from L4-5 to L2-3, while FI of MF and ES in L5-S1 positively correlates with LL. In sl-DLS, PM FI in L4-5 and L5-S1 negatively correlates with LL. Degeneration of MF, ES, and PM is more severe in dl-DLS patients, particularly at the spondylolisthesis level. Severe paraspinal muscle degeneration can lead to spinal force imbalance and progression from sl-DLS to dl-DLS. The degradation of PM and ES correlates negatively with PT and SVA, indicating a link to pelvic decompensation and SVA abnormalities, potentially causing disproportionate degenerative changes in dl-DLS patients.

Psoas Muscle Morphology: A Novel Classification System and Its Anatomic Relationship with Adjacent Neurovascular Structures.

Cross-sectional radioanatomic study. To introduce a classification system using MRI to describe psoas morphology and examine the position of nearby neurovascular structures. Oblique lumbar interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) offer sagittal malignment correction and reduced morbidity. LLIF has a higher incidence of nerve injuries, while OLIF has a higher incidence of vascular injuries. Measurements were completed on the left psoas at the inferior L4 endplate. Class A was designated if the ventral border of the psoas muscle was >2mm anterior; B if it was ≤ 2mm anterior or posterior to the vertebral body, and C if >2mm posterior to the vertebral body ventral border. Modified oblique corridor, measured as the distance between two lines, one at the medial border of the psoas muscle and the other at the lateral border of the nearest vascular structure, and a preferred LLIF trajectory was projected onto an axial image of the left psoas. If the trajectory violated the posterior third of the psoas, it was considered a dangerous approach due to potential iatrogenic nerve injury. 100 patient MRIs (Class A: 44; Class B: 27; Class C: 29) were analyzed. Average modified oblique corridor was 7.49mm. Modified oblique corridor varied amongst the three types of psoas morphologies (A: 8.99mm vs. B: 8.10mm vs. C: 4.66mm, P=0.040). LLIF trajectory intersected the 'danger zone' in 34.1%, 3.7%, and 0.0% of patients, (P<0.001) respectively. Class A psoas had the largest modified oblique corridor but highest proportion of those with a dangerous LLIF trajectory. Class C psoas had the narrowest modified oblique corridor, but no dangerous LLIF trajectories were identified.

Non-pancreatic retroperitoneal pseudocyst: a rare case report

A retroperitoneal pseudocyst is usually pancreatic in origin. Non-pancreatic retroperitoneal pseudocyst has a very low incidence, primarily benign and usually asymptomatic. The absence of epithelial lining in the cyst wall characterizes the pseudocyst. The absence of epithelial lining in the cyst wall characterizes the pseudocyst. Here, we report a case of a 53-year-old male patient who presented to OPD with mass per abdomen and lower abdomen pain. The computed tomography scan of the abdomen and pelvis revealed a retroperitoneal cyst abutting the right psoas muscle. The patient underwent an open excision of a retroperitoneal cyst. Histopathological examination of the specimen showed a non-pancreatic retroperitoneal pseudocyst. It is a rare case; very few cases have been reported in the literature. One such case is reported here.

ADAR1 Promotes Myogenic Proliferation and Differentiation of Goat Skeletal Muscle Satellite Cells.

As one of the most important economic traits for domestic animal husbandry, skeletal muscle is regulated by an intricate molecular network. Adenosine deaminase acting on RNA (ADAR1) involves various physiological processes and diseases, such as innate immunity and the development of lung adenocarcinoma, breast cancer, gastric cancer, etc. However, its role in skeletal muscle growth requires further clarification. Here, we explored the functions of ADAR1 in the myogenic process of goat skeletal muscle satellite cells (MuSCs). The ADAR1 transcripts were noticeably enriched in goat visceral tissues compared to skeletal muscle. Additionally, its levels in slow oxidative muscles like the psoas major and minor muscles were higher than in the fast oxidative glycolytic and fast glycolytic muscles. Among the two common isoforms from ADAR1, p110 is more abundant than p150. Moreover, overexpressing ADAR1 enhanced the proliferation and myogenic differentiation of MuSCs. The mRNA-seq performed on MuSCs' knockdown of ADAR1 obtained 146 differentially expressed genes (DEGs), 87 upregulated and 59 downregulated. These DEGs were concentrated in muscle development and process pathways, such as the MAPK and cAMP signaling pathways. Furthermore, many DEGs as the key nodes defined by protein-protein interaction networks (PPI), including STAT3, MYH3/8, TGFβ2, and ACTN4, were closely related to the myogenic process. Finally, RNA immunoprecipitation combined with qPCR (RIP-qPCR) showed that ADAR1 binds to PAX7 and MyoD mRNA. This study indicates that ADAR1 promotes the myogenic development of goat MuSCs, which provides a useful scientific reference for further exploring the ADAR1-related regulatory networks underlying mammal skeletal muscle growth.

Long-term efficacy of oblique lateral interbody fusion combined with vertebral screw fixation for the treatment of lumbar specific infection

To explore medium and long term efficacy of oblique lateral interbody fusion (OLIF) in treating lumbar specific infection. From October 2017 to January 2021, 24 patients with lumbar specific infection were treated by OLIF combined with vertebral screw internal fixation, including 15 males and 9 females, aged from 27 to 61 years old with an average of (43.0±15.0) years old;the courses of disease ranged from 6 to 24 months with an average of (14.0±7.0) months;7 patients with L2-L3, 12 patients with L3-L4 and 5 patients with L4-L5;19 patients with tuberculosis infection and 5 patients with brucella infection. The amount of intraoperative blood loss, operative time and complications were recorded, and erythrocyte sedimentation rate(ESR), C-reactive protein (CRP), visual analogue scale (VAS), Japanese Orthopaedic Association(JOA) score and American Spinal Injury Association (ASIA) rating were compared before and one month after opertaion. All patients were followed up from 9 to 24 months with an average of (13.0±6.0) months. Operative time was (132.5±21.4) min, and intraoperative blood loss was (227.3±43.1) ml. ESR and CRP were decreased from (82.34±18.62) mmol·h-1 and (53.08±21.84) mg·L-1 before operation to (33.52±17.31) mmol·h-1 and (15.48±8.36) mg·L-1 at one month after operation, respectively (P<0.05). VAS was decreased from (7.52±1.36) before opertaion to (1.74±0.87) at one month after operation (P<0.05). JOA was increased from (17.86±3.95) before operation to (24.72±3.19) at one month after operation (P<0.05). Four patients had neurological symptoms before operation, and were classified to grade D according to ASIA classification, who were recovered to grade E at 1 month after operation. One patient was suffered from psoas major muscle injury after operation, and returned to normal at 3 weeks. One patient was suffered from abdominal distension and difficulty in defecation, and relieved after gastrointestinal decompression and enema. No complications such as abdominal organ injury and poor wound healing occurred in all patients. OLIF combined with vertebral screw internal fixation is a new minimally invasive surgical method for the treatment of lumbar specific infection, especially the lesion located on the middle lumbar vertebra. It has advantages of less trauma, short operation time, less blood loss, convenient operation, complete removal of the lesion, safety and effectiveness, and has good medium-and long-term efficacy for lumbar specific infection.

Normal, accessory, and aberrant branches of the common iliac artery: angiographic prevalence and clinical implications.

Catheter angiography remains essential to detect, characterize, and treat many vascular, traumatic, and neoplastic conditions affecting the pelvis, but the angiographic literature rarely mentions the common iliac artery (CIA) and its branches. The "normal" branches of the CIA principally consist of subangiographic rami supplying neighboring structures. Larger branches participate in the vascularization of the psoas muscle and the ureter. Less often, the CIA provides anomalous branches that complement or replace critical neighboring vessels. This study investigates the prevalence, type, and clinical relevance of CIA branches detectable during pelvic angiography. This study analyzes the prevalence of CIA branches in 100 consecutive angiograms that included bilateral CIA injections as well as selective catheterizations of the median sacral artery, both L4 ISAs, and both internal iliac arteries. CIA branches were classified as normal (i.e., neither supplementing nor replacing a normal artery), accessory (i.e., supplementing a normal artery), or aberrant (i.e., replacing a normal artery). Forty-three branches arose from 38 CIAs (19% of CIAs) in 30 patients (30% of patients), including 20 normal branches (46.5%), 21 aberrant branches (48.8%), and 2 accessory branches (4.7%). Each of the 15 patients with aberrant branches had at least one anomalous vessel capable of providing a radicular or radiculomedullary artery. CIA branches were present in 30% of patients undergoing spinal angiography. While most normal branches were diminutive and clinically irrelevant, CIAs also provided vessels able to vascularize pelvic and vertebral structures, including the spinal cord or a spinal vascular malformation in 16% of cases. Our study therefore confirms that CIA injections represent an essential component of pelvic and spinal angiography.

Bilateral tuberculosis psoas abscess in a human immunodeficiency virus-positive patient: a case report

BackgroundWorldwide, there is an increase in the frequency of reports of psoas abscesses due to advances in imaging technology, which has led to early diagnosis and treatment. A bilateral psoas abscess is rare and, when it occurs, is usually secondary and in immunocompromised patients. We present a case of a bilateral tuberculosis psoas abscess in a human immunodeficiency virus-positive patient.Case presentationA 21-year-old Ugandan female undergraduate who contracted human immunodeficiency virus through vertical transmission and has been on highly active antiretroviral drugs presented with bilateral lower abdominal pain with associated fever and headache. Clinical examination revealed abdominal tenderness in both iliac fossae with palpable masses. Ultrasonography revealed fluid collection in both psoas muscles confirming bilateral abscesses. The aspirate was acid-fast bacilli positive. A diagnosis of bilateral tuberculosis psoas abscess was made. Open drainage was performed and antituberculosis drugs were commenced.ConclusionsBilateral tuberculosis psoas abscesses occurring in human immunodeficiency virus-positive patients, although uncommon, is not unexpected. It is a form of secondary psoas abscess in immunocompromised patients. Here, the outcome was successful with a combination of early surgical drainage and appropriate medical therapy.

Paraspinal muscle volume and fatty infiltration after circumferential minimally-invasive deformity correction

IntroductionParaspinal muscle robustness is an area of growing interest in spinal deformity that may impact biomechanical integrity and patient quality-of-life after reconstructive surgery. Changes in paraspinal musculature after circumferential minimally-invasive (cMIS) deformity correction have not yet been investigated. MethodsWe identified patients who underwent cMIS deformity correction and had lumbar spine MRIs at baseline and at minimum 1-year postoperatively. Using T2-weighted MRI, we measured total muscular volume of the psoas major, erector spinae, and multifidus muscles. We used the threshold method to determine fatty infiltration as percent fat area (PFA) along the length of these scanned regions, encompassing the final surgical construct. ResultsWe identified 10 patients who met inclusion criteria. On average, patients underwent interbody fusion at 3.8 ± 0.9 disc levels and posterior instrumentation at 4.6 ± 1.7 vertebral levels. All constructs included lateral interbody fusion (average 2.7 ± 0.8 levels); 6 were from a right-sided approach. Postoperative MRIs were obtained at 28 ± 14.2 months.There were no significant changes in pre- and postoperative volumes or PFA in any muscle group. There were no significant differences in left/right psoas volume or PFA in patients when stratified by side of lateral approach, nor did the number of lateral interbody fusion levels correlate with psoas volume or PFA. Change in posterior paraspinal musculature characteristics did not correlate with increasing number of fixated levels, nor significantly differ in patients who underwent posterior decompression. Preoperative muscle volumes were strongly correlated with postoperative volumes. ConclusionsIn this pilot series, paraspinal and psoas muscle volumes were preserved after circumferential MIS deformity correction. Fatty infiltration was not increased in paraspinal muscles after multi-level percutaneous instrumentation, nor in the psoas after multi-level trans-psoas approaches. These findings call for more in-depth investigation in a larger cohort of patients with comparison to open deformity correction patients to determine the impact of muscle volume changes on clinical outcomes.

Three-dimensional numerical schemes for the segmentation of the psoas muscle in X-ray computed tomography images

The analysis of the psoas muscle in morphological and functional imaging has proved to be an accurate approach to assess sarcopenia, i.e. a systemic loss of skeletal muscle mass and function that may be correlated to multifactorial etiological aspects. The inclusion of sarcopenia assessment into a radiological workflow would need the implementation of computational pipelines for image processing that guarantee segmentation reliability and a significant degree of automation. The present study utilizes three-dimensional numerical schemes for psoas segmentation in low-dose X-ray computed tomography images. Specifically, here we focused on the level set methodology and compared the performances of two standard approaches, a classical evolution model and a three-dimension geodesic model, with the performances of an original first-order modification of this latter one. The results of this analysis show that these gradient-based schemes guarantee reliability with respect to manual segmentation and that the first-order scheme requires a computational burden that is significantly smaller than the one needed by the second-order approach.

Psoas muscle cross sectional area relates to bone density and microarchitecture in candidates for spine fusion surgery

Prior studies demonstrate that muscle and bone health are integrally related, and both independently impact orthopedic surgery outcomes. However, relationships between bone density, in vivo microarchitecture, and muscle area have not been previously investigated in orthopedic surgery patients. This study assessed associations between psoas cross sectional area (CSA), bone mineral density (BMD), and microstructure in a cohort undergoing spine fusion. Pre-operatively, bilateral psoas CSA was measured on axial lumbar spine CT in the L3-L4 disc space. To adjust for body size, Psoas Muscle Index (PMI) was calculated (CSA divided by the square of patient height). High resolution peripheral quantitative CT (HR-pQCT, XtremeCT2) assessed volumetric BMD (vBMD), cortical (Ct) and trabecular (Tb) microarchitecture at the distal radius and tibia. Areal BMD (aBMD) was measured by DXA at the lumbar spine (LS), total hip (TH), femoral neck (FN), and the 1/3 radius (1/3R). Pearson correlations related psoas CSA and bone imaging parameters before and after correcting for height and weight. Among 88 patients included, mean age was 63 ± 12 years, BMI was 28 ± 7 kg/m2, 47 (53 %) were female. Larger psoas CSA was associated with higher vBMD, greater Ct thickness and better Tb microarchitecture (higher Tb number and lower Tb separation) at the tibia and radius. Larger psoas CSA was also associated with greater aBMD at TH and FN bilaterally and 1/3R (r 0.33 to 0.61; p < 0.002 for all comparisons). Psoas CSA was not associated with aBMD at the LS. Similar results were observed when relating PMI, and adjusting for age, height and weight to HR-pQCT and DXA measurements. Investigation of subgroups by sex demonstrated that relationships were similar magnitude among women but not the men. Patients who underwent primary compared to revision spine surgery had similar associations. Our results demonstrate a link between psoas muscle size and peripheral bone microarchitecture among patients undergoing posterior lumbar spinal fusion. Given the importance of both muscle and skeletal integrity to the success of spine surgery, further study regarding the associations between measurements of psoas muscle, bone microarchitecture, and surgical outcomes is warranted.

Evaluation of Sonographic Muscle Measurement Using Established Muscle Markers.

Loss of muscle quantity and function is associated with frailty and reduced quality of life. Sonography is a simple option to quantify muscle mass, which could be included into routine diagnostic workup. This study was designed to prospectively evaluate sonographic measurement and to compare it with established measurements of muscle quantity and function. Between March 2020 and May 2022, 723 patients were enrolled in the study. Psoas muscle area index (PMAI) and psoas muscle thickness height index (PMTI) were quantified. Thigh muscle thickness indices (TMTI) were either measured without compression (fTMTI) or under compression (cTMTI). Variation coefficient (VC) as well as intra- and inter-observer reliability were analyzed. The reliability and reproducibility of the sonographic morphometry were assessed using two examiners. Sonographic morphometry was compared with established measurements of muscle using computed tomography and hand grip strength, respectively. In 156 patients, sonographic indices were compared with corresponding CT indices. Of the 723 patients included, sonographic indices were compared with hand strength in 429 patients. Interobserver and intraobserver variability showed better results for the femur indices than for the psoas indices (correlation coefficient: 0.8697/0.9118 vs 0.7502/0.7319). Psoas muscle indices correlated best with the reference standard of the SMI. The optimal cut-off for each muscle index for determining muscle loss according to the SMI and hand grip strength was calculated. Sonography can simplify muscle measurement and should be used in the future. Sonographic muscle indices have the potential to simplify evaluation, especially in risk groups such as patients with liver cirrhosis or other wasting disorders.