Van den Broeck Jona, Sealy Martine J, Brussaard Carola, Kooijman Jasmijn, Jager-Wittenaar Harriët, Scafoglieri Aldo
Experimental Anatomy Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands.
Front Nutr. 2023 Feb 23;10:1148809. doi: 10.3389/fnut.2023.1148809. eCollection 2023.
In patients with cancer, low muscle mass has been associated with a higher risk of fatigue, poorer treatment outcomes, and mortality. To determine body composition with computed tomography (CT), measuring the muscle quantity at the level of lumbar 3 (L3) is suggested. However, in patients with cancer, CT imaging of the L3 level is not always available. Thus far, little is known about the extent to which other vertebra levels could be useful for measuring muscle status. In this study, we aimed to assess the correlation of the muscle quantity and quality between any vertebra level and L3 level in patients with various tumor localizations.
Two hundred-twenty Positron Emission Tomography (PET)-CT images of patients with four different tumor localizations were included: 1. head and neck ( = 34), 2. esophagus ( = 45), 3. lung ( = 54), and 4. melanoma ( = 87). From the whole body scan, 24 slices were used, i.e., one for each vertebra level. Two examiners contoured the muscles independently. After contouring, muscle quantity was estimated by calculating skeletal muscle area (SMA) and skeletal muscle index (SMI). Muscle quality was assessed by calculating muscle radiation attenuation (MRA). Pearson correlation coefficient was used to determine whether the other vertebra levels correlate with L3 level.
For SMA, strong correlations were found between C1-C3 and L3, and C7-L5 and L3 ( = 0.72-0.95). For SMI, strong correlations were found between the levels C1-C2, C7-T5, T7-L5, and L3 ( = 0.70-0.93), respectively. For MRA, strong correlations were found between T1-L5 and L3 ( = 0.71-0.95).
For muscle quantity, the correlations between the cervical, thoracic, and lumbar levels are good, except for the cervical levels in patients with esophageal cancer. For muscle quality, the correlations between the other levels and L3 are good, except for the cervical levels in patients with melanoma. If visualization of L3 on the CT scan is absent, the other thoracic and lumbar vertebra levels could serve as a proxy to measure muscle quantity and quality in patients with head and neck, esophageal, lung cancer, and melanoma, whereas the cervical levels may be less reliable as a proxy in some patient groups.
在癌症患者中，低肌肉量与更高的疲劳风险、更差的治疗效果及死亡率相关。为了通过计算机断层扫描（CT）确定身体成分，建议在第三腰椎（L3）水平测量肌肉量。然而，在癌症患者中，并非总能获得L3水平的CT图像。到目前为止，对于其他椎骨水平在多大程度上可用于测量肌肉状态知之甚少。在本研究中，我们旨在评估不同肿瘤定位患者中任何椎骨水平与L3水平之间肌肉量和质量的相关性。
纳入了220例具有四种不同肿瘤定位患者的正电子发射断层扫描（PET）-CT图像：1. 头颈部（n = 34），2. 食管（n = 45），3. 肺（n = 54），4. 黑色素瘤（n = 87）。从全身扫描中选取24个层面，即每个椎骨水平一个层面。两名检查者独立勾勒肌肉轮廓。勾勒完成后，通过计算骨骼肌面积（SMA）和骨骼肌指数（SMI）来估计肌肉量。通过计算肌肉辐射衰减（MRA）来评估肌肉质量。使用Pearson相关系数来确定其他椎骨水平与L3水平是否相关。
对于SMA，在C1 - C3与L3以及C7 - L5与L3之间发现了强相关性（r = 0.72 - 0.95）。对于SMI，分别在C1 - C2、C7 - T5、T7 - L5和L3水平之间发现了强相关性（r = 0.70 - 0.93）。对于MRA，在T1 - L5与L3之间发现了强相关性（r = 0.71 - 0.95）。
对于肌肉量，除食管癌患者的颈椎水平外，颈椎、胸椎和腰椎水平之间的相关性良好。对于肌肉质量，除黑色素瘤患者的颈椎水平外，其他水平与L3之间的相关性良好。如果CT扫描中没有L3的图像，其他胸椎和腰椎水平可作为测量头颈部、食管、肺癌和黑色素瘤患者肌肉量和质量的替代指标，而在某些患者群体中，颈椎水平作为替代指标可能不太可靠。
