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Liver Transplantation : Official... Nov 2014
Topics: Female; Humans; Liver Diseases; Liver Transplantation; Male; Muscle, Skeletal; Psoas Muscles; Sarcopenia
PubMed: 25212893
DOI: 10.1002/lt.23995 -
Journal of Vascular Surgery Apr 2021The present study evaluated the psoas muscle area and attenuation (radiodensity), quantified by computed tomography, together with clinical risk assessment, as...
OBJECTIVE
The present study evaluated the psoas muscle area and attenuation (radiodensity), quantified by computed tomography, together with clinical risk assessment, as predictors of outcomes after fenestrated and branched endovascular aortic repair (FBEVAR).
METHODS
The present single-center study included 504 patients who had undergone elective FBEVAR for pararenal or thoracoabdominal aortic aneurysms. The clinical risk assessment included age, sex, comorbidities, body mass index, glomerular filtration rate, aneurysm size and extent, cardiac stress test results, ejection fraction, and American Society of Anesthesiologists (ASA) score. Preoperative computed tomography was used to measure the psoas muscle area and attenuation at the L3 level. The lean psoas muscle area (LPMA; area in cm multiplied by attenuation in Hounsfield units [HU]) was calculated by multiplying the area by the attenuation. The risk factors for 90-day mortality, major adverse events (MAEs), and long-term mortality were determined using multivariable analysis. MAEs included 30-day or in-hospital death, acute kidney injury, myocardial infarction, respiratory failure, paraplegia, stroke, and bowel ischemia. A novel risk stratification method was proposed according to the strongest predictors of mortality and MAEs on multivariable analysis.
RESULTS
The 30-day mortality, 90-day mortality, and MAE rates were 2.0%, 5.6%, and 20%, respectively. The independent predictors of 90-day mortality were chronic obstructive pulmonary disease, chronic kidney disease, ASA score, and LPMA. The independent predictors of MAEs were aneurysm diameter, glomerular filtration rate, and LPMA. For long-term mortality, the independent predictors were chronic kidney disease, congestive heart failure, extent I-III thoracoabdominal aortic aneurysms, ASA score, and LPMA. The patients were stratified into three groups according to the ASA score and LPMA: low risk, ASA score II or LPMA >350 cmHU (n = 290); medium risk, ASA score III and LPMA ≤350 cmHU (n = 181); and high risk, ASA score IV and LPMA ≤350 cmHU (n = 33). The 90-day mortality and MAE rates were 1.7% and 16% in the low-, 7.2% and 24% in the medium-, and 30% and 33% in the high-risk patients, respectively (P < .001 and P = .02, respectively). Patients with ASA score IV and LPMA <200 cmHU, indicating sarcopenia (n = 14) had a 43% risk of death within 90 days. The 3-year survival estimates were 80% ± 3% for the low-, 70% ± 4% for the medium-, and 35% ± 9% for the high-risk patients (P < .001). The mean follow-up time was 3.1 ± 2.3 years.
CONCLUSIONS
LPMA was a strong predictor of outcomes and the only independent predictor of both mortality and MAEs after FBEVAR. A high muscle mass was protective against complications, regardless of the ASA score. Risk stratification based on the ASA score and LPMA can be used to identify patients at excessively high operative risk.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Body Composition; Clinical Decision-Making; Endovascular Procedures; Female; Hospital Mortality; Humans; Male; Postoperative Complications; Predictive Value of Tests; Psoas Muscles; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 33002587
DOI: 10.1016/j.jvs.2020.08.141 -
ANZ Journal of Surgery Dec 2022Patients with Crohn's disease (CD) have a high likelihood of being sarcopenic. Several studies have shown a positive correlation between sarcopenia measured as skeletal...
BACKGROUND
Patients with Crohn's disease (CD) have a high likelihood of being sarcopenic. Several studies have shown a positive correlation between sarcopenia measured as skeletal muscle index (SMI) and poor surgical outcomes in patients with CD. Our primary aim was to correlate SMI with the psoas muscle index (PMI), an easier measurement of sarcopenia. Secondary aim was to correlate SMI and PMI with clinical outcomes in a cohort of CD patients requiring surgery.
METHODS
A retrospective cohort study of CD patients who underwent surgery at a public health service from January 2010 to December 2019. Using computed tomography and magnetic resonance enterography studies, skeletal muscle area was measured at the third lumbar vertebra level. SMI and PMI were calculated and correlated. Correlation between SMI and PMI with surgical outcomes was performed.
RESULTS
Seventy-six patients were included. Median length of stay (LOS) was 6 days (IQR, 5 to 9). Eleven patients (14.5%) required ICU admission, nine patients (11.8%) required TPN and thirteen patients (17.1%) had complications. The prevalence of sarcopenia was 63.2% based on the SMI threshold of 52.4 and 38.5 cm /m for men and women, respectively. A positive correlation between SMI and PMI was found (r = 0.72, P < 0.0001). Sarcopenia status based on reported thresholds for SMI and for PMI showed no significant correlation with outcomes (LOS, ICU admission and complications).
CONCLUSIONS
SMI and PMI show good correlation but there is insufficient evidence to suggest that sarcopenia status using either measurement has a significant impact on predicting clinical outcomes.
Topics: Male; Humans; Female; Sarcopenia; Crohn Disease; Retrospective Studies; Psoas Muscles; Muscle, Skeletal; Tomography, X-Ray Computed
PubMed: 36156838
DOI: 10.1111/ans.18063 -
Nederlands Tijdschrift Voor Geneeskunde Jul 2022An ilio-psoas hematoma is a spontaneous or traumatic retroperitoneal hemorrhage in the ilio-psoas muscle. It is an uncommon condition, occurring in patients with...
BACKGROUND
An ilio-psoas hematoma is a spontaneous or traumatic retroperitoneal hemorrhage in the ilio-psoas muscle. It is an uncommon condition, occurring in patients with bleeding disorders or patients on anticoagulant therapy. It has a high mortality and presents itself with non-specific symptoms like pain in de lower back, hip or upper leg.
CASE DESCRIPTION
We present the case of a 70-year-old women, on anticoagulant therapy, presenting with atraumatic pain in de left hip. On clinical exam she complained of pain with active hip flexion and passive hip extension. On CT angiography an iliac hematoma was visible on the left side with an arterial component. She underwent an urgent pelvic arterial embolization.
CONCLUSION
Timely recognition and treatment of an iliopsoas hematoma can reduce mortality and morbidity. In elderly patients on anticoagulant therapy or with underlying bleeding disorders, this entity should always be considered in unexplained lumbar or hip pain.
Topics: Aged; Anticoagulants; Female; Hematoma; Humans; Pain; Psoas Muscles; Retroperitoneal Space
PubMed: 35899753
DOI: No ID Found -
Abdominal Radiology (New York) May 2022Low muscle mass and quality is associated with poor surgical outcomes. Psoas muscle density (PMD)is a validated surrogate for muscle quality that can be easily measured...
OBJECTIVE
Low muscle mass and quality is associated with poor surgical outcomes. Psoas muscle density (PMD)is a validated surrogate for muscle quality that can be easily measured from a clinical computed tomography (CT) scan. The objective of this study was to investigate the association between PMD and short-term postoperative outcomes in patients with acute mesenteric ischemia (AMI).
METHODS
From April 2006 and September 2019, the clinical data of all patients who underwent surgical intervention with a preoperative diagnosis of AMI and had preoperative non-contrast CT images available were retrospectively reviewed. PMD was measured by CT at the third lumbar vertebra. The lowest quartile of PMD for men and women in all patients was used as sex-specific cut-off values for low PMD. Univariate and multivariate analyses evaluating risk factors of postoperative complications and 30-day mortality were performed.
RESULTS
The cohort consisted of 88 patients with a mean age of 58.8 ± 16.2 years, of whom 21 (23.9%) patients had low PMD based on the diagnostic cut-off values (40.5 HU for men and 28.4 HU for women), 35 (39.8%) patients developed complications within 30 days of the operation, and 10 (11.3%) patients died within 30 days of surgery. Low PMD patients had a higher risk of postoperative complications and 30-day mortality than patients without low PMD patients. In a multivariate analysis, low PMD and low psoas muscle area (PMA) were independent predictors of postoperative complications. However, only low PMD remained an independent risk factor for 30-day mortality.
CONCLUSIONS
Preoperative assessment of the PMD on CT can be a practical method for identifying AMI patients at risk for postoperative complications and 30-day mortality.
Topics: Adult; Aged; Female; Humans; Male; Mesenteric Ischemia; Middle Aged; Postoperative Complications; Psoas Muscles; Retrospective Studies; Risk Factors
PubMed: 32892241
DOI: 10.1007/s00261-020-02714-0 -
Weak correlation between total psoas muscle area and sarcopenia index for children with brain tumor.Nutrition in Clinical Practice :... Aug 2023The aim of this study is to determine whether the sarcopenia index (SI) is a viable measure of muscle mass in pediatric patients with brain tumors.
OBJECTIVE
The aim of this study is to determine whether the sarcopenia index (SI) is a viable measure of muscle mass in pediatric patients with brain tumors.
METHODS
Retrospectively enrolled patients (1-16 years) who had serum creatinine (Cr) and cystatin C (CysC) levels evaluated within 28 days of an abdomen magnetic resonance imaging scan for the lumbar vertebrae 3-4 total psoas muscle area (tPMA) were studied. Variables were compared using their z scores calculated from age- and sex-dependent reference. We hypothesized that a low SI indicated less skeletal muscle, and therefore potentially indicated sarcopenia.
RESULTS
The SI z score had no correlation with tPMA z score (r = 0.004). Both Cr and CysC levels were positively correlated with tPMA in z scores (r = 0.249 and 0.320). tPMA strongly correlated with body mass index in z scores (r = 0.582). The z scores of tPMA, Cr and CysC decreased with elevated World Health Organization grades of tumor, but the z scores of SI showed no significant dependence on WHO grades.
CONCLUSION
The correlation of SI to muscle mass is very weak in our sample of pediatric patients with brain tumor. Its viability as biomarker for sarcopenia needs more study.
Topics: Humans; Child; Sarcopenia; Psoas Muscles; Retrospective Studies; Biomarkers; Brain Neoplasms
PubMed: 37087682
DOI: 10.1002/ncp.10996 -
Journal of the College of Physicians... Jun 2024To examine the effect of sarcopenia on osteoporotic vertebral compression fracture with psoas muscle measurements.
OBJECTIVE
To examine the effect of sarcopenia on osteoporotic vertebral compression fracture with psoas muscle measurements.
STUDY DESIGN
Cross-sectional study. Place and Duration of the Study: Department of Radiology, Sivas Cumhuriyet University, Sivas, Turkiye, from January 2020 to March 2023.
METHODOLOGY
Measurements evaluating psoas muscle area (PMA), psoas muscle index (PMI), and psoas muscle density (PMD) were made at L2 vertebral corpus level for the diagnosis of sarcopenia from muscle mass with computed tomography (CT). The association between sarcopenia and osteoporotic compression fracture was examined with significance at p <0.05.
RESULTS
Osteoporotic patients with 37 compression fractures and 37 without compression fractures were examined. PMA and PMI were statistically significantly lower in the study group (p <0.01). PMD was also found to be statistically significantly lower in the study group (p <0.05). Diagnostic performance (DP) was good for the discrimination of patients and control groups for psoas area (AUC = 0.88; 95% confidence interval (CI) 0.807 - 0.956 and PMI (AUC = 0.83; 95% CI 0.734 - 0.917. It was poor for psoas density (AUC = 0.66, 95% CI 0.531 - 0.782).
CONCLUSION
Sarcopenia is an important risk factor for osteoporotic compression fracture. Psoas measurements show a significant association with osteoporosis and vertebral fracture and can be easily determined on CT scan.
KEY WORDS
Sarcopenia, Osteoporotic compression fracture, Psoas muscle.
Topics: Humans; Sarcopenia; Psoas Muscles; Female; Cross-Sectional Studies; Fractures, Compression; Male; Aged; Spinal Fractures; Osteoporotic Fractures; Tomography, X-Ray Computed; Middle Aged; Aged, 80 and over
PubMed: 38840357
DOI: 10.29271/jcpsp.2024.06.713 -
Medicine and Science in Sports and... Oct 2018We aimed to examine the morphological characteristics of the thigh and psoas major muscles in sprinters as well as interrelations among their muscularity, hip joint...
PURPOSE
We aimed to examine the morphological characteristics of the thigh and psoas major muscles in sprinters as well as interrelations among their muscularity, hip joint mechanics, and running speed during maximal running.
METHODS
T1-weighted magnetic resonance images of the thigh and trunk were obtained from 15 male sprinters (best 100-m sprint times, 10.63-11.57 s) and 12 untrained men. From the magnetic resonance images, the volumes of each of the quadriceps femoris and hamstrings, total adductors, sartorius, tensor fasciae latae, gracilis, and psoas major were determined. For sprinters, the kinetic and kinematic data were measured using a three-dimensional motion capture system and force plates during maximal running. The data for one step from the foot strike of the stance leg to that of the swing leg were analyzed. The center of gravity (CG) velocity and hip joint kinetics were quantified.
RESULTS
Compared with untrained men, sprinters had significantly greater thigh muscle volumes of the hip flexors and extensors, total adductors, gracilis, and psoas major, whereas the monoarticular knee extensor and flexor thigh muscle volumes were similar between the two groups. The CG velocity was positively correlated with the hip flexion angular impulse. Only the rectus femoris volume was significantly correlated with the CG velocity and peak hip flexion moment for the swing leg (r = 0.66-0.69).
CONCLUSIONS
The sprinters in this study presented greater muscularity of the thigh and psoas major but not the monoarticular knee extensor or flexor muscles. The rectus femoris, in particular, may play an important role during the swing phase of sprinting.
Topics: Athletes; Athletic Performance; Biomechanical Phenomena; Case-Control Studies; Hip Joint; Humans; Magnetic Resonance Imaging; Male; Psoas Muscles; Quadriceps Muscle; Running; Thigh; Torso; Young Adult
PubMed: 30222688
DOI: 10.1249/MSS.0000000000001678 -
World Neurosurgery Jul 2017This review seeks to synthesize emerging literature on the effects of back muscle size on outcomes in spine surgery. Risk factors that contribute to poor surgical... (Review)
Review
BACKGROUND
This review seeks to synthesize emerging literature on the effects of back muscle size on outcomes in spine surgery. Risk factors that contribute to poor surgical outcomes continue to be an area of interest in spine surgery because proper risk stratification can result in reduction in morbidity and enhanced patient care. However, the impact of muscle size on spine surgical outcomes is an understudied avenue with paucity of data evaluating the relationship among back muscles and surgical outcomes, patient's quality of life, and functional improvement postoperatively.
METHODS
This review was centered around identifying studies that assessed the impact of back muscle size on spine surgery outcomes.
RESULTS
Five retrospective studies were selected for review. All studies set out to see if differences in muscle size existed in patients with disparate post-operative outcomes as a primary objective. The studies support the association between larger back muscles and improved outcomes. The size and relative cross sectional area of paraspinal muscles and the size of the psoas muscle were associated with functional outcomes, incidence of complications and also fusion rates.
CONCLUSION
With reduction in surgical complications and improvement in postoperative functional outcomes, back muscle morphometry ought to be included in the preoperative surgical planning as a predictor of outcomes.
Topics: Back Muscles; Humans; Neurosurgical Procedures; Organ Size; Paraspinal Muscles; Postoperative Complications; Prognosis; Psoas Muscles; Recovery of Function; Risk Assessment; Spinal Diseases; Treatment Outcome
PubMed: 28366754
DOI: 10.1016/j.wneu.2017.03.097 -
International Journal of Computer... Feb 2022The psoas major muscle (PMM) volume serves as an opportunistic imaging marker in cross-sectional imaging datasets for various clinical applications. Since manual...
PURPOSE
The psoas major muscle (PMM) volume serves as an opportunistic imaging marker in cross-sectional imaging datasets for various clinical applications. Since manual segmentation is time consuming, two different automated segmentation methods, a generative adversarial network architecture (GAN) and a multi-atlas segmentation (MAS), as well as a combined approach of both, were investigated in terms of accuracy of automated volumetrics in given CT datasets.
MATERIALS AND METHODS
The bilateral PMM was manually segmented by a radiologist in 34 abdominal CT scans, resulting in 68 single 3D muscle segmentations as training data. Three different methods were tested for their ability to generate automated image segmentations: a GAN- and MAS-based approach and a combined approach of both methods (COM). Bilateral PMM volume (PMMV) was calculated in cm by each algorithm for every CT. Results were compared to the corresponding ground truth using the Dice similarity coefficient (DSC), Spearman's correlation coefficient and Wilcoxon signed-rank test.
RESULTS
Mean PMMV was 239 ± 7.0 cm and 308 ± 9.6 cm, 306 ± 9.5 cm and 243 ± 7.3 cm for the CNN, MAS and COM, respectively. Compared to the ground truth the CNN and MAS overestimated the PMMV significantly (+ 28.9% and + 28.0%, p < 0.001), while results of the COM were quite accurate (+ 0.7%, p = 0.33). Spearman's correlation coefficients were 0.38, 0.62 and 0.73, and the DSCs were 0.75 [95%CI: 0.56-0.88], 0.73 [95%CI: 0.54-0.85] and 0.82 [95%CI: 0.65-0.90] for the CNN, MAS and COM, respectively.
CONCLUSION
The combined approach was able to efficiently exploit the advantages of both methods (GAN and MAS), resulting in a significantly higher accuracy in PMMV predictions compared to the isolated implementations of both methods. Even with the relatively small set of training data, the segmentation accuracy of this hybrid approach was relatively close to that of the radiologist.
Topics: Algorithms; Humans; Image Processing, Computer-Assisted; Machine Learning; Psoas Muscles; Tomography, X-Ray Computed
PubMed: 34928445
DOI: 10.1007/s11548-021-02539-2