Hurtado-Oliva Javier, Zwart Aniek T, Vister Jeroen, van der Hoorn Anouk, Steenbakkers Roel J H M, Wegner Inge, Halmos Gyorgy B
Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
J Cachexia Sarcopenia Muscle. 2024 Oct;15(5):1858-1868. doi: 10.1002/jcsm.13537. Epub 2024 Jul 12.
Measuring the swallowing muscle mass with volume measurements is complex and time intensive; therefore, it is not used in clinical practice. However, it can be clinically relevant, for instance, in the case of sarcopenic dysphagia. The aim of the study was to develop a feasible and clinically applicable method to measure swallowing muscle mass.
Data from 10 head and neck cancer patients were collected from the Oncological Life Study data-biobank of the University Medical Center Groningen. The pharyngeal constrictor, genioglossus, mylohyoid and geniohyoid complex muscles, as well as the tongue complex muscles, were delineated manually on routinely performed head and neck computed tomography scans. Axial and sagittal planes were used for volume and area measurements, respectively. Muscle density measurements were performed with and without Hounsfield unit thresholding. Correlations were assessed by Pearson correlation coefficients, and interobserver reliability was measured using intra-class correlation coefficients (ICCs).
Significant differences were observed between sagittal area measurements with and without Hounsfield unit thresholds for pharyngeal constrictor, tongue complex and the sum of the swallowing muscles (t > 6; P-value < 0.001). Stronger correlations emerged without Hounsfield unit thresholding. Strong positive and significant correlations were found between the total swallowing muscle mass volume and the sagittal area of the tongue complex muscles (r = 0.87, P-value < 0.05) and the sum of the sagittal areas of the pharyngeal constrictor and tongue complex muscles (r = 0.85, P-value < 0.05). The use of the Hounsfield unit threshold weakened correlations. Interobserver reliability was assessed and found to be fair to good for the pharyngeal constrictor muscle (ICC = 0.68, P-value < 0.05), excellent for the tongue complex muscles (ICC = 0.98, P-value < 0.05) and excellent for the total swallowing muscle area (ICC = 0.96, P-value < 0.05).
Single-slice delineation of the sagittal area of tongue complex muscle and pharyngeal constrictor muscle is a promising, fast, simple and clinically applicable method for measuring the total volume of the swallowing muscle mass in head and neck cancer patients without Hounsfield unit thresholding. These advancements and findings would help in the early and accurate diagnosis of definitive sarcopenic dysphagia.
通过体积测量来测定吞咽肌肉质量复杂且耗时，因此在临床实践中未被采用。然而，它在临床上可能具有相关性，例如在肌肉减少性吞咽困难的情况下。本研究的目的是开发一种可行且临床适用的方法来测量吞咽肌肉质量。
从格罗宁根大学医学中心的肿瘤生活研究数据生物库中收集了10名头颈部癌患者的数据。在常规进行的头颈部计算机断层扫描上手动勾勒出咽缩肌、颏舌肌、下颌舌骨肌和颏舌骨肌复合体肌肉以及舌复合体肌肉。分别使用轴向和矢状面进行体积和面积测量。在有和没有亨氏单位阈值的情况下进行肌肉密度测量。通过皮尔逊相关系数评估相关性，并使用组内相关系数（ICC）测量观察者间的可靠性。
对于咽缩肌、舌复合体和吞咽肌肉总和，在有和没有亨氏单位阈值的矢状面面积测量之间观察到显著差异（t>6；P值<0.001）。在没有亨氏单位阈值的情况下出现更强的相关性。在吞咽肌肉总体积与舌复合体肌肉的矢状面面积（r = 0.87，P值<0.05）以及咽缩肌和舌复合体肌肉的矢状面面积总和（r = 0.85，P值<0.05）之间发现了强正相关且显著相关。使用亨氏单位阈值削弱了相关性。评估了观察者间的可靠性，发现对于咽缩肌为中等至良好（ICC = 0.68，P值<0.05），对于舌复合体肌肉为优秀（ICC = 0.98，P值<0.05），对于吞咽肌肉总面积为优秀（ICC = 0.96，P值<0.05）。
在没有亨氏单位阈值的情况下，对舌复合体肌肉和咽缩肌的矢状面面积进行单层面勾勒是一种有前景、快速、简单且临床适用的方法，可用于测量头颈部癌患者吞咽肌肉质量的总体积。这些进展和发现将有助于早期准确诊断明确的肌肉减少性吞咽困难。
