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Clinical, functional, and opportunistic CT metrics of sarcopenia at the point of imaging care: analysis of all-cause mortality

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Abstract

Purpose

This study examines clinical, functional, and CT metrics of sarcopenia and all-cause mortality in older adults undergoing outpatient imaging.

Methods

The study included outpatients ≥ 65 years of age undergoing CT or PET/CT at a tertiary care institution. Assessments included screening questionnaires for sarcopenia (SARC-F) and frailty (FRAIL scale), and measurements of grip strength and usual gait speed (6 m course). Skeletal muscle area (SMA), index (SMI, area/height2) and density (SMD) were measured on CT at T12 and L3. A modified SMI was also examined (SMI-m, area/height). Mortality risk was studied with Cox proportional hazard analysis.

Results

The study included 416 patients; mean age 73.8 years [sd 6.2]; mean follow-up 2.9 years (sd 1.34). Abnormal grip, SARC-F, and FRAIL scale assessments were associated with higher mortality risk (HR [95%CI] = 2.0 [1.4–2.9], 1.6 [1.1–2.3], 2.0 [1.4–2.8]). Adjusting for age, higher L3-SMA, T12-SMA, T12-SMI and T12-SMI-m were associated with lower mortality risk (HR [95%CI] = 0.80 [0.65–0.90], 0.76 [0.64–0.90], 0.84 [0.70–1.00], and 0.80 [0.67–0.90], respectively). T12-SMD and L3-SMD were not predictive of mortality. After adjusting for abnormal grip strength and FRAIL scale assessments, T12-SMA and T12-SMI-m remained predictive of mortality risk (HR [95%CI] = 0.83 [0.70–1.00] and 0.80 [0.67–0.97], respectively).

Conclusion

CT areal metrics were weaker predictors of all-cause mortality than clinical and functional metrics of sarcopenia in our older patient cohort; a CT density metric (SMD) was not predictive. Of areal CT metrics, SMI (area/height2) appeared to be less effective than non-normalized SMA or SMA normalized by height1.

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Funding

The work was supported by the National Institutes of Health grants R61AT012187 and R01AR076088. This project was facilitated by the UC Davis Health Innovation Technology, Data Center of Excellence, and the assistance of Sharon Myers and Anna Liu.

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Authors and Affiliations

  1. Radiology and Imaging Sciences/CC/NIH, 10 Center Drive, Bethesda, MD, 20892, USA

    Lawrence Yao

  2. Mercy Medical Center, 333 Mercy Ave., Merced, CA, 95340, USA

    Anahit Petrosyan

  3. University of California, Davis 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA

    Abhijit J Chaudhari

  4. Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Leon Lenchik

  5. Stanford University School of Medicine, 300 Pasteur Drive, MC-5105, Stanford, CA, 94305, USA

    Robert D. Boutin

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  1. Lawrence Yao
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Correspondence to Lawrence Yao.

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Yao, L., Petrosyan, A., Chaudhari, A. . et al. Clinical, functional, and opportunistic CT metrics of sarcopenia at the point of imaging care: analysis of all-cause mortality. Skeletal Radiol 53, 515–524 (2024). https://doi.org/10.1007/s00256-023-04438-w

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  • DOI: https://doi.org/10.1007/s00256-023-04438-w

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