Dual-Energy CT Muscle Fat Fraction As a New Imaging Biomarker of Body Composition and Survival Predictor in Critically Ill Patients

Overview

Journal Eur Radiol

Specialty Radiology

Date 2024 May 22

PMID 38777903

Authors

Jennifer Erley

Kevin Roedl

Ann-Kathrin Ozga

Geraldine de Heer

Niklas Schubert

Julia Breckow

Christoph Burdelski

Enver Tahir

Stefan Kluge

Tobias B Huber

Jin Yamamura

Gerhard Adam

Isabel Molwitz

Affiliations

Soon will be listed here.

Abstract

Objective: To analyze changes in the muscular fat fraction (FF) during immobilization at the intensive care unit (ICU) using dual-energy CT (DECT) and evaluate the predictive value of the DECT FF as a new imaging biomarker for morbidity and survival.

Methods: Immobilized ICU patients (n = 81, 43.2% female, 60.3 ± 12.7 years) were included, who received two dual-source DECT scans (CT1, CT2) within a minimum interval of 10 days between 11/2019 and 09/2022. The DECT FF was quantified for the posterior paraspinal muscle by two radiologists using material decomposition. The skeletal muscle index (SMI), muscle radiodensity attenuation (MRA), subcutaneous-/ visceral adipose tissue area (SAT, VAT), and waist circumference (WC) were assessed. Reasons for ICU admission, clinical scoring systems, therapeutic regimes, and in-hospital mortality were noted. Linear mixed models, Cox regression, and intraclass correlation coefficients were employed.

Results: Between CT1 and CT2 (median 21 days), the DECT FF increased (from 20.9% ± 12.0 to 27.0% ± 12.0, p = 0.001). The SMI decreased (35.7 cm/m ± 8.8 to 31.1 cm/m ± 7.6, p < 0.001) as did the MRA (29 HU ± 10 to 26 HU ± 11, p = 0.009). WC, SAT, and VAT did not change. In-hospital mortality was 61.5%. In multivariable analyses, only the change in DECT FF was associated with in-hospital mortality (hazard ratio (HR) 9.20 [1.78-47.71], p = 0.008), renal replacement therapy (HR 48.67 [9.18-258.09], p < 0.001), and tracheotomy at ICU (HR 37.22 [5.66-245.02], p < 0.001). Inter-observer reproducibility of DECT FF measurements was excellent (CT1: 0.98 [0.97; 0.99], CT2: 0.99 [0.96-0.99]).

Conclusion: The DECT FF appears to be suitable for detecting increasing myosteatosis. It seems to have predictive value as a new imaging biomarker for ICU patients.

Clinical Relevance Statement: The dual-energy CT muscular fat fraction appears to be a robust imaging biomarker to detect and monitor myosteatosis. It has potential for prognosticating, risk stratifying, and thereby guiding therapeutic nutritional regimes and physiotherapy in critically ill patients.

Key Points: The dual-energy CT muscular fat fraction detects increasing myosteatosis caused by immobilization. Change in dual-energy CT muscular fat fraction was a predictor of in-hospital morbidity and mortality. Dual-energy CT muscular fat fraction had a predictive value superior to established CT body composition parameters.

Citing Articles

Abdominal myosteatosis measured with computed tomography predicts poor outcomes in patients with glioblastoma.

Rahmani F, Camps G, Mironchuk O, Atagu N, Ballard D, Benzinger T Neurooncol Adv. 2025; 7(1):vdae209.

PMID: 39791017 PMC: 11713020. DOI: 10.1093/noajnl/vdae209.

References

Zopfs D, Theurich S, Grosse Hokamp N, Knuever J, Gerecht L, Borggrefe J . Single-slice CT measurements allow for accurate assessment of sarcopenia and body composition. Eur Radiol. 2019; 30(3):1701-1708. DOI: 10.1007/s00330-019-06526-9. View

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007; 335(7624):806-8. PMC: 2034723. DOI: 10.1136/bmj.39335.541782.AD. View

Cruz-Jentoft A, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T . Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2018; 48(1):16-31. PMC: 6322506. DOI: 10.1093/ageing/afy169. View

Miljkovic I, Zmuda J . Epidemiology of myosteatosis. Curr Opin Clin Nutr Metab Care. 2010; 13(3):260-4. PMC: 2872135. DOI: 10.1097/MCO.0b013e328337d826. View

Ahn H, Kim D, Ko Y, Ha J, Shin Y, Lee J . Updated systematic review and meta-analysis on diagnostic issues and the prognostic impact of myosteatosis: A new paradigm beyond sarcopenia. Ageing Res Rev. 2021; 70:101398. DOI: 10.1016/j.arr.2021.101398. View

Kemper M, Melling N, Krause L, Kuhn K, Grass J, Izbicki J . Muscle quality, not quantity, is associated with outcome after colorectal cancer surgery. Eur J Surg Oncol. 2023; 49(12):107098. DOI: 10.1016/j.ejso.2023.107098. View

Penton C, Thomas-Ahner J, Johnson E, Mcallister C, Montanaro F . Muscle side population cells from dystrophic or injured muscle adopt a fibro-adipogenic fate. PLoS One. 2013; 8(1):e54553. PMC: 3545954. DOI: 10.1371/journal.pone.0054553. View

Peterson S, Braunschweig C . Prevalence of Sarcopenia and Associated Outcomes in the Clinical Setting. Nutr Clin Pract. 2015; 31(1):40-8. DOI: 10.1177/0884533615622537. View

Aleixo G, Shachar S, Nyrop K, Muss H, Malpica L, Williams G . Myosteatosis and prognosis in cancer: Systematic review and meta-analysis. Crit Rev Oncol Hematol. 2019; 145:102839. DOI: 10.1016/j.critrevonc.2019.102839. View

10.

Li C, Yu K, Shyh-Chang N, Jiang Z, Liu T, Ma S . Pathogenesis of sarcopenia and the relationship with fat mass: descriptive review. J Cachexia Sarcopenia Muscle. 2022; 13(2):781-794. PMC: 8977978. DOI: 10.1002/jcsm.12901. View

11.

Gassenmaier S, Kahm K, Walter S, Machann J, Nikolaou K, Bongers M . Quantification of liver and muscular fat using contrast-enhanced Dual Source Dual Energy Computed Tomography compared to an established multi-echo Dixon MRI sequence. Eur J Radiol. 2021; 142:109845. DOI: 10.1016/j.ejrad.2021.109845. View

12.

Molwitz I, Leiderer M, Ozden C, Yamamura J . Dual-Energy Computed Tomography for Fat Quantification in the Liver and Bone Marrow: A Literature Review. Rofo. 2020; 192(12):1137-1153. DOI: 10.1055/a-1212-6017. View

13.

Molwitz I, Leiderer M, McDonough R, Fischer R, Ozga A, Ozden C . Skeletal muscle fat quantification by dual-energy computed tomography in comparison with 3T MR imaging. Eur Radiol. 2021; 31(10):7529-7539. PMC: 8452571. DOI: 10.1007/s00330-021-07820-1. View

14.

Somerson J, Hsu J, Gorbaty J, Gee A . Classifications in Brief: Goutallier Classification of Fatty Infiltration of the Rotator Cuff Musculature. Clin Orthop Relat Res. 2015; 474(5):1328-32. PMC: 4814439. DOI: 10.1007/s11999-015-4630-1. View

15.

Coletta G, Phillips S . An elusive consensus definition of sarcopenia impedes research and clinical treatment: A narrative review. Ageing Res Rev. 2023; 86:101883. DOI: 10.1016/j.arr.2023.101883. View

16.

Cox M, Booth M, Ghita G, Wang Z, Gardner A, Hawkins R . The impact of sarcopenia and acute muscle mass loss on long-term outcomes in critically ill patients with intra-abdominal sepsis. J Cachexia Sarcopenia Muscle. 2021; 12(5):1203-1213. PMC: 8517344. DOI: 10.1002/jcsm.12752. View

17.

Timmers S, Schrauwen P, de Vogel J . Muscular diacylglycerol metabolism and insulin resistance. Physiol Behav. 2008; 94(2):242-51. DOI: 10.1016/j.physbeh.2007.12.002. View

18.

Engel H, Needham D, Morris P, Gropper M . ICU early mobilization: from recommendation to implementation at three medical centers. Crit Care Med. 2013; 41(9 Suppl 1):S69-80. DOI: 10.1097/CCM.0b013e3182a240d5. View

19.

Witteveen E, Sommers J, Wieske L, Doorduin J, van Alfen N, Schultz M . Diagnostic accuracy of quantitative neuromuscular ultrasound for the diagnosis of intensive care unit-acquired weakness: a cross-sectional observational study. Ann Intensive Care. 2017; 7(1):40. PMC: 5382120. DOI: 10.1186/s13613-017-0263-8. View

20.

Rollins K, Javanmard-Emamghissi H, Awwad A, Macdonald I, Fearon K, Lobo D . Body composition measurement using computed tomography: Does the phase of the scan matter?. Nutrition. 2017; 41:37-44. DOI: 10.1016/j.nut.2017.02.011. View