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Magnetic Resonance in Medicine Jan 2020To develop and test in animal studies ex vivo and in vivo, an intravascular (IV) MRI-guided high-intensity focused ultrasound (HIFU) ablation method for targeting...
PURPOSE
To develop and test in animal studies ex vivo and in vivo, an intravascular (IV) MRI-guided high-intensity focused ultrasound (HIFU) ablation method for targeting perivascular pathology with minimal injury to the vessel wall.
METHODS
IV-MRI antennas were combined with 2- to 4-mm diameter water-cooled IV-ultrasound ablation catheters for IV-MRI on a 3T clinical MRI scanner. A software interface was developed for monitoring thermal dose with real-time MRI thermometry, and an MRI-guided ablation protocol developed by repeat testing on muscle and liver tissue ex vivo. MRI thermal dose was measured as cumulative equivalent minutes at 43°C (CEM ). The IV-MRI IV-HIFU protocol was then tested by targeting perivascular ablations from the inferior vena cava of 2 pigs in vivo. Thermal dose and lesions were compared by gross and histological examination.
RESULTS
Ex vivo experiments yielded a 6-min ablation protocol with the IV-ultrasound catheter coolant at 3-4°C, a 30 mL/min flow rate, and 7 W ablation power. In 8 experiments, 5- to 10-mm thick thermal lesions of area 0.5-2 cm were produced that spared 1- to 2-mm margins of tissue abutting the catheters. The radial depths, areas, and preserved margins of ablation lesions measured from gross histology were highly correlated (r ≥ 0.79) with those measured from the CEM = 340 necrosis threshold determined by MRI thermometry. The psoas muscle was successfully targeted in the 2 live pigs, with the resulting ablations controlled under IV-MRI guidance.
CONCLUSION
IV-MRI-guided, IV-HIFU has potential as a precision treatment option that could preserve critical blood vessel wall during ablation of nonresectable perivascular tumors or other pathologies.
Topics: Animals; Blood Vessels; Chickens; High-Intensity Focused Ultrasound Ablation; In Vitro Techniques; Liver; Magnetic Resonance Imaging; Muscle, Skeletal; Psoas Muscles; Swine; Temperature; Thermometry; Vena Cava, Inferior
PubMed: 31402512
DOI: 10.1002/mrm.27932 -
Journal of Bodywork and Movement... Apr 2024Chronic nonspecific low back pain (CNLBP) is a common disorder in people of active ages and significantly affects their quality of life. Different structures in the...
BACKGROUND
Chronic nonspecific low back pain (CNLBP) is a common disorder in people of active ages and significantly affects their quality of life. Different structures in the lumbar area can cause LBP. The lumbar muscle disorders, including the psoas major (PM) muscles, have an essential role in LBP. Magnetic Resonance Imaging (MRI) has been introduced as a safe and useful instrument for investigating the morphological properties of skeletal muscle. In general, PM morphology changes may be one reason for the pain and disability experienced in CNLBP patients. Thus, this study aimed to assess the relationship among the PM's Cross-sectional area (CSA), medial-lateral (ML), and anterior-posterior (AP) diameters, with disability index and pain score in patients with CNLBP.
METHOD
One hundred twenty patients with CNLBP (60 men and 60 women) participated in this cross-sectional study. Axial MRIs were obtained from L3/L4 and L4/L5 disc levels. Then, patients filled out Rolland Morris Disability Questionnaires, demographic data forms, and the Numeric Pain Rating Scale (NPRS). Image J software was used to analyze the images. Using Linear Regression and the Pearson test, the correlation between muscle CSA and diameters, as well as data obtained from questionnaires and NPRS, was analyzed.
RESULTS
Results from the statistical analysis showed no statistically significant relationship among morphological characteristics of the psoas major muscle in L3/L4 and L4/L5 disc levels with disability index and pain score (p < 0.05).
CONCLUSIONS
There is no significant relationship between the PM morphological characteristics and disability index and pain score. Therefore, muscle CSA and diameters are insufficient to determine the cause of CNLBP.
Topics: Humans; Low Back Pain; Female; Male; Psoas Muscles; Cross-Sectional Studies; Magnetic Resonance Imaging; Adult; Middle Aged; Disability Evaluation; Pain Measurement; Chronic Pain
PubMed: 38763592
DOI: 10.1016/j.jbmt.2023.11.065 -
Hip International : the Journal of... May 2021We performed a computed tomography analysis of muscle composition characteristics in hip fracture patients and non-hip fracture controls.
INTRODUCTION
We performed a computed tomography analysis of muscle composition characteristics in hip fracture patients and non-hip fracture controls.
METHODS
In total, 43 patients (9 men, 34 women) were included in the hip fracture group, matched 1 to 1 with non-hip fracture controls. Muscle cross-sectional areas were measured in axial CT scan at the body level of the 4th lumbar vertebra (L4), intervertebral disc level between the 5th lumbar vertebra and the 1st sacral vertebra (L5-S1) and just below level of the lesser trochanter (LT). Attenuation was also evaluated through the mean Hounsfield unit (HU) in these areas.
RESULTS
The cross-sectional area per weight (CSA/Wt, mm/kg) of psoas muscle and extensor muscles of the spine showed a significant difference between the 2 groups at both L4 (9.7 vs. 12.4, 0.001 and 26.3 vs. 29.2, 0.025) and L5-S1 (9.6 vs. 11.5, 0.001 and 8.8 vs. 10.3, 0.041) levels. In addition, the HU of these muscles differed significantly between the 2 groups at both L4 (33.3 vs. 47.6, 0.001 and 13.7 vs. 30.2, 0.001) and L5-S1 (39.7 vs. 52.6, 0.001 and 3.8 vs. 15.1, 0.012) levels. There was no difference in abdominal wall, gluteal, or thigh compartment musculature between the groups.
CONCLUSIONS
Poorer quantity and quality of psoas muscle and extensor muscles of the spine rather than whole body muscles may contribute to falls and were characteristic features of the hip fracture patients in this series. These findings should be considered when recommending a preventive exercise and rehabilitation protocol.
Topics: Female; Hip Fractures; Humans; Lumbar Vertebrae; Male; Psoas Muscles; Thigh; Tomography, X-Ray Computed
PubMed: 31997667
DOI: 10.1177/1120700020904337 -
European Spine Journal : Official... Sep 2023This study aimed to investigate the changes of the posterior paraspinal muscles (PPM) and psoas muscle in patients with low back pain (LBP) over time.
PURPOSE
This study aimed to investigate the changes of the posterior paraspinal muscles (PPM) and psoas muscle in patients with low back pain (LBP) over time.
METHODS
Patients with LBP who had a repeat lumbar MRI with a minimum of 3-years apart at a tertiary referral center were analyzed. MRI-based quantitative assessments of the PPM and the psoas muscle were conducted for the baseline and follow-up MRI. The cross sectional area (CSA), the functional cross sectional area (fCSA) and the fat area (FAT) were calculated using a dedicated software program. The fatty infiltration (FI,%) of the regions of interest was calculated. Differences between the 1st and 2nd MRI were calculated for all assessed muscular parameters.
RESULTS
A total of 353 patients (54.4%female) with a median age of 60.1 years and BMI of 25.8 kg/m at baseline were analyzed. The mean time between the 1st and 2nd MRI was 3.6 years. The fCSA declined in both sexes significantly from the 1st to the 2nd MRI, whereas the FAT increased. In line with this result, the FI increased in both males (29.9%) and females (19.4%). Females had a higher FI and FI than males in both MRIs. In females, no significant changes were found for the psoas muscle. The CSA and fCSA in males were significantly smaller in the 2nd MRI. With increasing age, a significant trend in a decrease in ∆FI was observed for both sexes.
CONCLUSION
The study revealed significant quantitatively muscular changes in males and females, especially in the posterior paraspinal muscles in only three years' time.
Topics: Male; Humans; Female; Middle Aged; Low Back Pain; Longitudinal Studies; Psoas Muscles; Lumbar Vertebrae; Lumbosacral Region; Paraspinal Muscles; Magnetic Resonance Imaging
PubMed: 37378708
DOI: 10.1007/s00586-023-07814-1 -
PloS One 2021Little is known about the muscle condition in children with obesity.
BACKGROUND
Little is known about the muscle condition in children with obesity.
OBJECTIVES
To investigate the effect of obesity and fatty liver on muscle area and muscle fat in children and young adults.
MATERIALS AND METHODS
We evaluated consecutive liver fat quantification MRIs in children and young adults between June 2015 and April 2019. We obtained hepatic fat and paraspinal muscle fat at mid L2 from the fat map, psoas muscle area (PMA) at mid L3, and z-score of PMA. The patient's age, height and weight at the time of the MRI were recorded. Body mass index (BMI) z-score was also calculated. Spearman correlation and partial correlation analyses were performed. Univariate and multivariate regression analyses were also performed using significant variables.
RESULTS
A total of 132 patients (97 male) were included with a median age of 13.0 years (interquartile range 11-16 years). The median BMI was 23.7 kg/m2 (interquartile range 21.2-27.7 kg/m2). The weight, BMI, liver fat, and z-score of PMA were all higher in male patients than they were in female patients. The amount of liver fat had no correlation with muscle fat or PMA z-score after adjusting BMI. However, the BMI z-score was positively correlated with the PMA z-score (ρ = 0.432, p<0.001) even after adjusting for liver fat. On regression analyses, the BMI z-score had linear positive relationship with PMA z-score (β = 0.289, p<0.001) and muscle fat (β = 0.218, p = 0.016).
CONCLUSIONS
Male children and young adults have greater PMA than do female children and young adults. Obesity is associated with higher PMA and paraspinal muscle fat. However, liver fat is not related with the muscle condition in children and young adults.
Topics: Adolescent; Child; Fatty Liver; Female; Humans; Male; Obesity; Paraspinal Muscles; Psoas Muscles; Young Adult
PubMed: 34788336
DOI: 10.1371/journal.pone.0259948 -
American Journal of Nephrology 2022Kidney transplantation is the treatment of choice for patients with renal failure. It is crucial to select which patients may benefit from renal transplantation and...
INTRODUCTION
Kidney transplantation is the treatment of choice for patients with renal failure. It is crucial to select which patients may benefit from renal transplantation and which are at high risk for post-transplant complications. Sarcopenia is associated with poor outcome in various conditions, including in chronic kidney disease patients. The gold standard for measuring sarcopenia is computed tomography (CT) imaging to estimate muscle mass and quality since it is objective, reproducible, and reflects the overall health condition. The data regarding those measurements among kidney transplant recipients are limited, therefore we aimed to describe it in patients before kidney transplantation, assess the parameters associated with sarcopenia, and evaluate the clinical significance of those markers on outcomes following transplantation.
METHODS
We retrospectively analyzed 183 kidney transplant recipients who had a CT scan 90 days prior to transplant. Sarcopenia was assessed by measuring the cross-sectional area (CSA) and mean muscle density of the psoas muscle at the third and fourth lumbar vertebrae levels and paravertebral muscles at the 12th thoracic vertebra level.
RESULTS
There was a strong linear correlation between muscle size measured as CSA of the psoas muscle at the L3 and L4 vertebral body level and the CSA of the paravertebral muscles at the D12 vertebra level, and a moderate correlation to muscle density at those levels. Age was independently associated with risk of sarcopenia, defined as psoas CSA in the lowest tertile, with every year of age increasing the risk by 5%. CSA at the L3 level had a significant independent association with post kidney transplantation mortality, with an adjusted hazard ratio of 0.86 per cm2. There was a significantly longer hospitalization period postoperation in kidney recipients in the lower tertile of psoas CSA and density.
CONCLUSIONS
Sarcopenia as measured by psoas CSA is associated with poor short- and long-term outcomes following kidney transplantation and should be included as part of the assessment of kidney transplantation candidates.
Topics: Humans; Kidney Transplantation; Proportional Hazards Models; Psoas Muscles; Retrospective Studies; Sarcopenia
PubMed: 35584614
DOI: 10.1159/000524774 -
Journal of Orthopaedic Surgery and... Feb 2023This study was performed to quantify the morphological characteristics of the psoas major muscle in patients with symptomatic multilevel degenerative lumbar spinal...
OBJECTIVE
This study was performed to quantify the morphological characteristics of the psoas major muscle in patients with symptomatic multilevel degenerative lumbar spinal stenosis (SMLSS) and assess the correlations of these morphological characteristics with function and clinical symptoms.
METHODS
One hundred fourteen patients diagnosed with SMLSS (≥ 3 segments) were included. The patients' presenting symptoms were assessed with the Oswestry Disability Index (ODI), and visual analogue scale (VAS) scores were recorded. The morphology of the psoas major was evaluated at the L3/4 intervertebral disc level in three ways: by measuring (i) the psoas muscle mass index (PMI); (ii) the mean muscle attenuation (Hounsfield units, HU); and (iii) the morphologic change of the psoas major (mean ratios of the short axis to the long axis of the bilateral psoas major).
RESULTS
Men had a higher PMI than women (p = 0.001). Patients with severe disability had a significantly lower PMI (p = 0.002) and muscle attenuation (p = 0.001). The PMI and muscle attenuation were significantly higher in the patients with no or mild back pain (both p < 0.001). In the univariable and multivariable analyses, a greater HU value was associated with a higher functional status as assessed by the ODI (p = 0.002), and a higher PMI was associated with less severe back pain as measured by the VAS score (p < 0.001).
CONCLUSION
This study showed that muscle attenuation of psoas major positively correlated with the functional status and PMI negatively correlated with low back pain severity in patients diagnosed with SMLSS. Future prospective studies are needed to evaluate whether improvement in such muscle parameters through physiotherapy programs can alleviate the clinical symptoms and improve the functional status of patients with SMLSS.
Topics: Male; Humans; Female; Spinal Stenosis; Psoas Muscles; Back Pain; Intervertebral Disc Degeneration; Lumbar Vertebrae; Muscles; Retrospective Studies; Treatment Outcome
PubMed: 36793071
DOI: 10.1186/s13018-023-03596-w -
The Annals of Thoracic Surgery May 2017Frailty assessment can help predict which older adults will experience adverse events after cardiac surgical procedures. Low muscle mass is a core component of frailty...
BACKGROUND
Frailty assessment can help predict which older adults will experience adverse events after cardiac surgical procedures. Low muscle mass is a core component of frailty that is suboptimally captured by self-reported weight loss; refined measures using computed tomographic (CT) images have emerged and are predictive of outcomes in noncardiac surgical procedures. The objective of this study was to evaluate the association between CT muscle area and length of stay (LOS) after cardiac surgical procedures.
METHODS
Frail patients who had a perioperative abdominal or thoracic CT scan were identified. The CT scans were analyzed to measure cross-sectional lean muscle area at the L4 vertebra (psoas muscle area [PMA], lumbar muscle area [LMA]) and the T4 vertebra (thoracic muscle area [TMA]). The associations of PMA, LMA, and TMA with frailty markers and postoperative LOS were investigated.
RESULTS
Eighty-two patients were included; the mean age was 69.2 ± 9.97 years. Low muscle area was correlated with lower handgrip strength and short physical performance battery (SPPB) scores indicative of physical frailty. Postoperative LOS was correlated with PMA (R = -0.47, p = 0.004), LMA (R = -0.41, p = 0.01), and TMA (R = -0.29, p = 0.03). After adjustment for the predicted risk of prolonged LOS, age, sex, and body surface area, PMA remained significantly associated with LOS (β = -2.35, 95% CI -4.48 to -0.22). The combination of low PMA and handgrip strength, indicative of sarcopenia, yielded the greatest incremental value in predicting LOS.
CONCLUSIONS
Low PMA is a marker of physical frailty associated with increased LOS in older adults undergoing cardiac surgical procedures. Further research is necessary to validate PMA as a prognostic marker and therapeutic target in this vulnerable population.
Topics: Aged; Aged, 80 and over; Body Surface Area; Cardiac Valve Annuloplasty; Cohort Studies; Coronary Artery Bypass; Female; Frail Elderly; Hand Strength; Heart Valve Prosthesis Implantation; Humans; Length of Stay; Male; Middle Aged; Muscle Strength; Muscular Atrophy; Postoperative Complications; Predictive Value of Tests; Prospective Studies; Psoas Muscles; Risk Assessment; Statistics as Topic; Tomography, X-Ray Computed
PubMed: 27863730
DOI: 10.1016/j.athoracsur.2016.09.005 -
Skeletal Radiology Jun 2022The aim of this study was to investigate the properties of psoas muscle in osteoporotic patients in lumbar magnetic resonance imaging (MRI) scan and their relationship...
OBJECTIVE
The aim of this study was to investigate the properties of psoas muscle in osteoporotic patients in lumbar magnetic resonance imaging (MRI) scan and their relationship with hip fracture.
MATERIALS AND METHODS
One hundred seventy-seven patients with osteoporosis (63.69 ± 9.677, 105 female) who had received lumbar spine MRI and dual-energy X-ray absorptiometry (DXA) examinations were retrospectively included. Thickness (PMT), cross-sectional areas (CSA), and index (PMI) values were measured for psoas muscle at L3 level and psoas muscle characteristics were compared between hip fracture and control groups.
RESULTS
PMT, CSA, and PMI values were statistically significantly different between hip fracture and control groups (respectively p < .001, p < .05, p < .01). The results showed that there was a significant association between being sarcopenic and having hip fracture (χ (1, n = 117) = 4.57, p < .05, phi = .20).
CONCLUSION
PMT, CSA, and PMI might be associated with hip fracture in osteoporotic patients. However, this association is independent of bone mineral density (BMD). Psoas muscle features including PMT, CSA, and PMI should be used as significant predictors of falls and fractures in osteoporotic patients.
Topics: Absorptiometry, Photon; Bone Density; Female; Hip Fractures; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Osteoporosis; Osteoporotic Fractures; Psoas Muscles; Retrospective Studies
PubMed: 34859280
DOI: 10.1007/s00256-021-03967-6 -
The American Surgeon Jun 2023Sarcopenia and frailty have both emerged as risk factors for elderly falls. We investigated whether radiologic sarcopenia or frailty are associated with falls in a... (Review)
Review
Sarcopenia and frailty have both emerged as risk factors for elderly falls. We investigated whether radiologic sarcopenia or frailty are associated with falls in a high-risk geriatric outpatient population. We reviewed 114 patients followed at the Center for Healthy Senior Living who had undergone a computerized tomography (CT) of the abdomen and pelvis for any reason from 2013 to 2019. Sarcopenia was determined by psoas muscle cross-sectional area at L3 on CT scan. Their individual frailty score was calculated. The primary outcome was admission to hospital for falls. There were no statistical differences in frailty score or sarcopenia between the 2 groups (left/right psoas muscle: no hospital admission = 6.8 ± 2.4/6.4 ± 2.5 vs falls requiring hospital admission 6.5 ± 2.3/6.5 ± 2.3 cm). We concluded that neither frailty score nor sarcopenia predicted the occurrence of falls in our high-risk geriatric outpatient population.
Topics: Humans; Aged; Frailty; Sarcopenia; Risk Factors; Hospitalization; Tomography, X-Ray Computed; Psoas Muscles; Retrospective Studies
PubMed: 35142564
DOI: 10.1177/00031348221075593