Söderlund Minea, Huhtamo Henni, Protto Sara, Hernesniemi Jussi A, Vakhitov Damir, Oksala Niku, Khan Niina
Minea Söderlund Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere 33520, Finland.
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Scand J Surg. 2025 Mar;114(1):44-55. doi: 10.1177/14574969241282485. Epub 2024 Oct 21.
Psoas muscle parameters estimated from computed tomography images, as surrogates for sarcopenia, have been found to be associated with post-interventional outcomes after a wide range of cardiovascular procedures. The pre-interventional assessment in patients undergoing invasive treatment for peripheral arterial disease is increasingly often carried out with magnetic resonance imaging (MRI), and we therefore sought to investigate the predictive potential of MRI-derived psoas muscle area in this cohort.
A total of 899 patients with available sufficient quality pre-interventional MRI conducted within 6 months prior to treatment undergoing open, endovascular, or hybrid revascularization procedures for claudication and/or limb-threatening ischemia at Tampere University hospital between 2010 and 2020 were retrospectively studied in this single-center cohort study. The follow-up lasted until 17 June 2021. Psoas muscle areas were measured from the magnetic resonance images at the L4 level, and the reliability of muscle parameter measurements was tested with intraclass correlation coefficient analysis. The average psoas muscle area values (mean of left and right psoas surface areas) were z-scored and analyzed separately for men and women.
The median follow-up time was 5.9 years (interquartile range (IQR) = 2.7-7.8), and the overall mortality count was 259 (28.8%) (29.5% n = 168/569 for men and 27.6% n = 91/330 for women). The intraclass correlation coefficient analysis showed excellent interrater reliability for psoas muscle measurements. The muscle surface areas were larger in men (mean = 7.58 cm) compared to women (mean = 5.27 cm) (p < 0.001). Higher psoas muscle area was associated with better survival in women (p = 0.003, hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.6-0.9 per 1 SD), whereas in men, an independent association of the muscle parameter with mortality was not found.
MRI-derived psoas muscle area may be a prognostic factor for clinical use.
从计算机断层扫描图像估计的腰大肌参数作为肌肉减少症的替代指标，已被发现与多种心血管手术后的介入治疗结果相关。对于接受外周动脉疾病侵入性治疗的患者，越来越多地采用磁共振成像（MRI）进行介入前评估，因此我们试图研究该队列中MRI衍生的腰大肌面积的预测潜力。
在这项单中心队列研究中，我们回顾性研究了2010年至2020年间在坦佩雷大学医院接受开放、血管内或混合血运重建手术治疗跛行和/或肢体威胁性缺血的899例患者，这些患者在治疗前6个月内进行了质量足够的介入前MRI检查。随访持续至2021年6月17日。从L4水平的磁共振图像测量腰大肌面积，并通过组内相关系数分析测试肌肉参数测量的可靠性。将腰大肌面积的平均值（左右腰大肌表面积的平均值）进行z评分，并分别对男性和女性进行分析。
中位随访时间为5.9年（四分位间距（IQR）=2.7 - 7.8），总死亡人数为259人（28.8%）（男性为29.5%，n = 168/569；女性为27.6%，n = 91/330）。组内相关系数分析显示腰大肌测量具有出色的评分者间可靠性。男性的肌肉表面积（平均值 = 7.58 cm）大于女性（平均值 = 5.27 cm）（p < 0.001）。较高的腰大肌面积与女性更好的生存率相关（p = 0.003，风险比（HR）= 0.71，95%置信区间（CI）= 每1标准差为0.6 - 0.9），而在男性中，未发现该肌肉参数与死亡率之间存在独立关联。
MRI衍生的腰大肌面积可能是一种可供临床使用的预后因素。
