scholarly journals Pre and Postoperative Muscle Wastage and Sarcopenia Using CT Scans in Patients Undergoing Pelvic Exenteration Surgery

2020 ◽  
pp. 1-8
Author(s):  
Sophie Hogan ◽  
Sophie Hogan ◽  
James Farag ◽  
Claire Wilton ◽  
Felicity Ritorni ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Skeletal Muscle ◽  
Retrospective Review ◽  
Muscle Wasting ◽  
Pelvic Exenteration ◽  
Ct Scans ◽  
Inclusion Criteria ◽  
Skeletal Muscle Index ◽  
Nutritional Factors ◽  
Before And After

Background: Sarcopenia is associated with poor postoperative outcomes in oncology patients. Computed tomography (CT) scans can be used to identify muscle wasting and sarcopenia. This study aimed to investigate if pelvic exenteration surgery leads to muscle wastage and thus, induction or exacerbation of sarcopenia. Methods: This is a retrospective review involving the analysis of CT scans before and after pelvic exenteration surgery to determine skeletal muscle index and diagnose sarcopenia. Other clinical and nutritional factors were collected. Results: A total of 34 patients met the inclusion criteria. Postoperative skeletal muscle index was significantly lower compared to preoperative skeletal muscle index (p=0.008). The incidence of sarcopenia was 62% preoperatively and rose to 74% postoperatively (p=0.073). Postoperative sarcopenia was not significantly associated with complications or mortality. Conclusion: The skeletal muscle index significantly decreased postoperatively, indicating that pelvic exenteration surgery leads to muscle wastage. The use of CT scans to recognise sarcopenia would allow focusing of resources for those at risk.

scholarly journals Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation

Cancers ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 709 ◽  
Author(s):  
Patrick Naumann ◽  
Jonathan Eberlein ◽  
Benjamin Farnia ◽  
Thilo Hackert ◽  
Jürgen Debus ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Pancreatic Cancer ◽  
Weight Loss ◽  
Muscle Mass ◽  
Muscle Wasting ◽  
Statistical Tests ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Skeletal Muscle Index ◽  
Poor Outcomes

Background: Surgical resection offers the best chance of survival in patients with pancreatic cancer, but those with locally advanced disease (LAPC) are usually not surgical candidates. This cohort often receives either neoadjuvant chemotherapy or chemoradiation (CRT), but unintended weight loss coupled with muscle wasting (sarcopenia) can often be observed. Here, we report on the predictive value of changes in weight and muscle mass in 147 consecutive patients with LAPC treated with neoadjuvant CRT. Methods: Clinicopathologic data were obtained via a retrospective chart review. The abdominal skeletal muscle area (SMA) at the third lumbar vertebral body was determined via computer tomographic (CT) scans as a surrogate for the muscle mass and skeletal muscle index (SMI) calculated. Uni- and multi-variable statistical tests were performed to assess for impact on survival. Results: Weight loss (14.5 vs. 20.3 months; p = 0.04) and loss of muscle mass (15.1 vs. 22.2 months; p = 0.007) were associated with poor outcomes. The highest survival was observed in patients who had neither cachectic weight loss nor sarcopenia (27 months), with improved survival seen in those who ultimately received a resection (23 vs. 10 months; p < 0.001). Cox regression revealed that either continued weight loss or continued muscle wasting (SMA reduction) was predictive of poor outcomes, whereas a sarcopenic SMI was not. Conclusions: Loss of weight and lean muscle in patients with LAPC is prognostic when persistent. Therefore, both should be assessed longitudinally and considered before surgery.

scholarly journals Muscle Characteristics Obtained Using Computed Tomography as Prognosticators in Patients with Castration-Resistant Prostate Cancer

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1864
Author(s):  
Jongsoo Lee ◽  
Jee Soo Park ◽  
Ji Eun Heo ◽  
Hyun Kyu Ahn ◽  
Won Sik Jang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Computed Tomography ◽  
Skeletal Muscle ◽  
Body Composition ◽  
Survival Rates ◽  
Castration Resistant Prostate Cancer ◽  
Vertebral Level ◽  
Skeletal Muscle Index ◽  
Castration Resistant ◽  
Muscle Attenuation

Limited studies have investigated the correlation between body composition and prostate cancer outcomes. We analyzed the effect of muscle mass and quality on castration-resistant prostate cancer (CRPC) outcomes. Skeletal muscle index (SMI) and skeletal muscle attenuation (SMA) were measured for 411 patients at the L3 vertebral level using computed tomography at CRPC diagnosis and were dived to low and high groups at the value of median. Analysis of the skeletal phenotypes and age (<70 and >70 years) was performed to evaluate the effect of SMI and SMA. The median survival rates for patients with low and high SMI were 19 and 24 months (p = 0.015), and those with low and high SMAs were 15 and 26 months (p < 0.001), respectively. In the subgroup analysis by age, SMA was a significant prognosticator in both groups, while SMI was a significant prognosticator only in patients aged >70 years. Patients with low SMA + low SMI had the worst prognosis. Muscle characteristics seems to be a prognosticator in survival of CRPC patients and may be considered in treatment planning.

Skeletal muscle loss under chemotherapy and its association with survival and systemic treatment toxicity in metastatic colorectal cancer: An AGEO prospective multicenter study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4025-4025 ◽  
Author(s):  
Claire Gallois ◽  
Camille Bourillon ◽  
Edouard Auclin ◽  
Pascal Artru ◽  
Astrid Lievre ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Skeletal Muscle ◽  
Multivariate Analysis ◽  
Metastatic Colorectal Cancer ◽  
Survival Outcomes ◽  
Muscle Loss ◽  
Skeletal Muscle Index ◽  
Nutritional Factors ◽  
Multicenter Observational Study ◽  
Skeletal Muscle Loss

4025 Background: We showed in a previous work that “Patient Generated-Subjective Global Assessment” (PG-SGA) was independently associated with survival and treatment toxicities in non-pretreated metastatic colorectal cancer (mCRC) patients. We have evaluated here if muscle mass in these patients can provide useful additional information for clinical practice. The objective of the present work was to evaluate the association between baseline sarcopenia, and the variation of the Skeletal Muscle Index (SMI) under treatment with survival and chemotherapy-related toxicities in our population of non-pretreated mCRC patients. Methods: This prospective multicenter observational study enrolled non-pretreated mCRC patients. Measurement of SMI was performed on routine CT scan at day 0 (D0) and day 60 (D60). PG-SGA score and other nutritional factors were collected at D0. Progression-free survival (PFS) and overall survival (OS) were calculated from treatment start. Treatment related toxicities were registered according to the NCI CTCAE v4.0. Results: 149 patients were included in eight French centers from 7/2013 to 11/2016. Sarcopenia at baseline was not significantly associated with survival outcomes or chemotherapy-related toxicities. The best cut-point value of SMI variation (between D0 and D60) for OS prediction obtained with a log-rank maximisation method was -14%. The decrease in SMI > 14%, with a median follow-up of 23 months, was significantly associated with shorter PFS (6 vs 9 mo; HR 1.8, 95%CI 1.1-3.1, p = 0.02) and OS (8.5 vs 26 mo; HR 2.4, 95%CI 1.3-4.4, p = 0.004), independently of hypoalbuminemia and malnutrition defined by PG-SGA, in multivariate analysis. 40% of patients with a SMI decrease > 14%, and 22% of patients with a SMI increase or stable or decrease < 14% developed grade ≥ 2 clinical toxicities (OR 3.0, 95%CI 1.2-7.7, p = 0.02), but the difference was not statistically significant in multivariate analysis (OR 2.3. 95%CI 0.8-6.7, p = 0.1). Conclusions: To our knowledge, this study is the first study assessing the association of skeletal muscle loss with survival and treatment toxicities in patients with mCRC prospectively. In our population of non pre-treated mCRC patients, baseline sarcopenia was not associated with poor survival outcomes, but the decrease in SMI > 14% during the first two months of treatment was significantly associated with decreased PFS and OS, independently of other prognostic and nutritional factors.

scholarly journals Predictors of Discordance in the Assessment of Skeletal Muscle Mass between Computed Tomography and Bioimpedance Analysis

2019 ◽  
Vol 8 (3) ◽  
pp. 322 ◽  
Author(s):  
Min Jo ◽  
Tae Lim ◽  
Mi Jeon ◽  
Hye Lee ◽  
Beom Kim ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Skeletal Muscle ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Female Gender ◽  
Albumin Level ◽  
Advanced Age ◽  
Bioimpedance Analysis ◽  
Skeletal Muscle Index ◽  
Cutoff Values

Computed tomography (CT) and bioimpedance analysis (BIA) can assess skeletal muscle mass (SMM). Our objective was to identify the predictors of discordance between CT and BIA in assessing SMM. Participants who received a comprehensive medical health check-up between 2010 and 2018 were recruited. The CT and BIA-based diagnostic criteria for low SMM are as follows: Defined CT cutoff values (lumbar skeletal muscle index (LSMI) <1 standard deviation (SD) and means of 46.12 cm2/m2 for men and 34.18 cm2/m2 for women) and defined BIA cutoff values (appendicular skeletal muscle/height2 <7.0 kg/m2 for men and <5.7 kg/m2 for women). A total of 1163 subjects were selected. The crude and body mass index (BMI)-adjusted SMM assessed by CT were significantly associated with those assessed by BIA (correlation coefficient = 0.78 and 0.68, respectively; p < 0.001). The prevalence of low SMM was 15.1% by CT and 16.4% by BIA. Low SMM diagnosed by CT was significantly associated with advanced age, female gender, and lower serum albumin level, whereas low SMM diagnosed by BIA was significantly associated with advanced age, female gender, and lower BMI (all p < 0.05). Upon multivariate analysis, age >65 years, female and BMI <25 kg/m2 had significantly higher risks of discordance than their counterparts (all p < 0.05). We found a significant association between SMM assessed by CT and BIA. SMM assessment using CT and BIA should be interpreted cautiously in older adults (>65 years of age), female and BMI <25 kg/m2.

scholarly journals The Value of Thoracic Computed Tomography Scans in Clinical Diagnosis: A Prospective Study

2006 ◽  
Vol 13 (6) ◽  
pp. 311-316 ◽  
Author(s):  
Mark O Turner ◽  
John R Mayo ◽  
Nestor L Müller ◽  
Michael Schulzer ◽  
J Mark FitzGerald
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Clinical Diagnosis ◽  
Waiting Times ◽  
Tertiary Care ◽  
Ct Scans ◽  
Thoracic Ct ◽  
Chest Disease ◽  
Before And After ◽  
The Impact

BACKGROUND: Computed tomography (CT) scans are used extensively to investigate chest disease because of their cross-sectional perspective and superior contrast resolution compared with chest radiographs. These advantages lead to a more accurate imaging assessment of thoracic disease. The actual use and evaluation of the clinical impact of thoracic CT has not been assessed since scanners became widely available.OBJECTIVE: To identify patterns of utilization, waiting times and the impact of CT scan results on clinical diagnoses.DESIGN: A before and after survey of physicians who had ordered thoracic CT scans.SETTING: Vancouver General Hospital – a tertiary care teaching centre in Vancouver, British Columbia.SUBJECTS: Physicians who had ordered CT scans.INTERVENTION: Physicians completed a standard questionnaire before and after the CT scan result was available.MEASUREMENTS: Changes in the clinical diagnosis, estimates of the probabilities for the diagnosis both before and after the CT scan, and waiting times.RESULTS: Four hundred fifty-four thoracic CT cases had completed questionnaires, of whom 80% were outpatients. A change in diagnosis was made in 48% of cases (25% with a normal CT scan and 23% with CT scan findings that indicated a different diagnosis). The largest change in probability scores for the clinical diagnosis before and after the CT scan was 43.9% for normal scans, while it was 36.3% for a different diagnosis and 26.3% for the same diagnosis. High-priority scans were associated with decreased waiting time (−7.89 days for each unit increase in priority).CONCLUSIONS: The CT scan results were associated with a change in diagnosis in 48% of cases. Normal scans constituted 25% of the total and had the greatest impact scores. Waiting times were highly correlated with increased urgency of the presenting problem.

Prevalence of low computed tomography–measured skeletal muscle index and handgrip strength in a general medical population

2021 ◽  
Author(s):  
Amanda Van Jacobs ◽  
Anne Coltman ◽  
Sandra L. Gomez‐Perez ◽  
Benjamin Bienia ◽  
Joy S. Sclamberg ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Skeletal Muscle ◽  
Handgrip Strength ◽  
Skeletal Muscle Index ◽  
Medical Population

Quantitative Analysis of the Transcondylar Approach to the Foramen Magnum

Neurosurgery ◽  
2001 ◽  
Vol 49 (4) ◽  
pp. 934-943 ◽  
Author(s):  
John E. Wanebo ◽  
Michael R. Chicoine
Keyword(s):  
Computed Tomography ◽  
Quantitative Analysis ◽  
Ct Images ◽  
Foramen Magnum ◽  
Ct Scans ◽  
Computed Tomographic ◽  
Suboccipital Craniotomy ◽  
Before And After ◽  
Skull Measurements ◽  
C 50

Abstract OBJECTIVE Condylar resection with suboccipital craniotomy increases foramen magnum exposure, but guidelines for when this is necessary are not defined. Cadaveric and computed tomography evaluations were completed to guide decision-making regarding the use and extent of condylar resection. METHODS Quantitative analysis of foramen magnum surgical exposures was performed on 32 skulls (64 sides) and 6 cadaveric dissections (12 sides). Computed tomographic (CT) scans were performed on cadaveric heads before and after condylar resections. Digitized images of dry skulls and CT images of cadaver heads were quantitatively analyzed. Predissection CT measurements of cadaveric heads guided extent of condylar resections, and resection accuracy was assessed with postdissection CT scans. RESULTS Skull measurements (means in parentheses) included the foramen magnum area (7.8 cm2), length (3.6 cm), width (3.1 cm), anteroposterior condylar length (2.3 cm), and axial condylar length (2.5 cm). Mean widths of potential surgical exposures for skulls were obtained for A) suboccipital craniotomy (2.3 cm), B) with 25% (2.6 cm), and C) 50% condylar resection (3.0 cm). Mean angles of exposure were as follows: A, 38.4 degrees; B, 49.1 degrees; and C, 54.3 degrees. CT scans of cadaveric heads before and after dissections yielded measurements of exposure equivalent to measurements found on the dry skulls. CONCLUSION On average, lateral exposure increases by 3 mm (13%) and 7 mm (30%) for 25 and 50% condylar resection, respectively, compared with suboccipital craniotomy alone. Angles of exposure increase by 10.7 degrees (28%) and 15.9 degrees (41%). Measurements of CT images can be used preoperatively to help analyze the need for condylar resection and intraoperatively to guide the extent of condylar resection.

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