European Radiology

, Volume 26, Issue 12, pp 4649–4655 | Cite as

Adipose tissue and muscle attenuation as novel biomarkers predicting mortality in patients with extremity sarcomas

  • Joyce Veld
  • Josephina A. Vossen
  • Karen De Amorim Bernstein
  • Elkan F. Halpern
  • Martin Torriani
  • Miriam A. BredellaEmail author



To assess CT-attenuation of abdominal adipose tissue and psoas muscle as predictors of mortality in patients with sarcomas of the extremities.


Our study was IRB approved and HIPAA compliant. The study group comprised 135 patients with history of extremity sarcoma (mean age: 53 ± 17 years) who underwent whole body PET/CT. Abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and psoas muscle attenuation (HU) was assessed on non-contrast, attenuation-correction CT. Clinical information including survival, tumour stage, sarcoma type, therapy and pre-existing comorbidities were recorded. Cox proportional hazard models were used to determine longitudinal associations between adipose tissue and muscle attenuation and mortality.


There were 47 deaths over a mean follow-up period of 20 ± 17 months. Higher SAT and lower psoas attenuation were associated with increased mortality (p = 0.03 and p = 0.005, respectively), which remained significant after adjustment for age, BMI, sex, tumor stage, therapy, and comorbidities (p = 0.002 and p = 0.02, respectively). VAT attenuation was not associated with mortality.


Attenuation of SAT and psoas muscle, assessed on non-contrast CT, are predictors of mortality in patients with extremity sarcomas, independent of other established prognostic factors, suggesting that adipose tissue and muscle attenuation could serve as novel biomarkers for mortality in patients with sarcomas.

Key Points

CT-attenuation of adipose tissue and muscle predict mortality in sarcoma patients

CT-attenuation predicts mortality independent of established prognostic factors

Patients with sarcomas often undergo CT for staging or surveillance

Adipose tissue and muscle attenuation could serve as biomarkers for mortality


Computed tomography (CT) Adipose tissue attenuation Muscle attenuation Hounsfield Units Sarcoma 



The scientific guarantor of this publication is Miriam A. Bredella. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Elkan F. Halpern, Director of Statistics of the Department of Radiology at MGH and co-author on the study kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.

Supplementary material

330_2016_4306_MOESM1_ESM.docx (184 kb)
Supplemental Figure DOCX 184 kb)


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Joyce Veld
    • 1
  • Josephina A. Vossen
    • 1
  • Karen De Amorim Bernstein
    • 2
  • Elkan F. Halpern
    • 3
  • Martin Torriani
    • 1
  • Miriam A. Bredella
    • 1
    Email author
  1. 1.Division of Musculoskeletal Imaging and Intervention, Department of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of Radiation Oncology, Francis H Burr Proton Therapy CenterMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Institute of Technology AssessmentMassachusetts General Hospital and Harvard Medical SchoolBostonUSA

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