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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 2022ALIFs and LLIFs are now becoming more utilized for adult spinal disease. As technologies advance, so do surgical techniques, with surgeons now modifying traditional...
INTRODUCTION
ALIFs and LLIFs are now becoming more utilized for adult spinal disease. As technologies advance, so do surgical techniques, with surgeons now modifying traditional supine-ALIF and lateral-LLIF to lateral-ALIF and prone-LLIF approaches to allow for more efficient surgeries. The objective of this study is to characterize the anatomical changes in the surgical corridor that occur with changes in patient positioning.
METHODS
MRIs of ten healthy volunteers were evaluated in five positions: supine, prone with hips flexed, prone with hips extended, lateral with hips flexed, and lateral with hips extended. All lateral scans were in the left lateral decubitus position. The anatomical changes of the psoas muscles, inferior vena cava, aorta, iliac vessels were assessed with relation to fixed landmarks on the disc spaces from L1 to S1.
RESULTS
The most anteriorly elongated ipsilateral to approach psoas when compared to supine was seen in lateral-flexed position (- 5.82 mm, p < 0.001), followed by lateral-extended (- 2.23 mm, p < 0.001), then prone-flexed (- 1.40 mm, p = 0.014), and finally supine and prone-extended (- 0.21 mm, p = 0.643). The most laterally extending or "thickest" psoas was seen in prone-flexed (- 1.40 mm, p = 0.004) and prone-extended (- 1.17 mm, p = 0.002). The psoas was "thinnest" in lateral-extended (2.03 mm, p < 0.001) followed by lateral-flexed (1.11 mm, p = 0.239). The contralateral psoas did not move as anteriorly as the ipsilateral. 3D volumetric analysis showed that the greatest changes in the psoas occur at its proximal and distal poles near T12-L1 and L4-S1. In lateral-flexed compared to prone-extended, the IVC moves medially to the left (p < 0.001). The aorta moves laterally to the left (p = 0.005). The venous structures appeared more full and open in the lateral positions and flattened in the supine and prone positions. The arteries remain in full calibre.
CONCLUSION
The MRI anatomical evaluation shows that the psoas, and therefore lumbar plexus, and vasculature move significantly with changes in positioning. This is important for preoperative planning for proper intraoperative execution from preoperative supine MRI. Understanding that the psoas and vessels move the most anteriorly in the lateral-flexed position and to a least degree in the prone-extended is essential for safe and efficient utilization of techniques such as the traditional LLIF, traditional ALIF, prone-LLIF.
Topics: Adult; Humans; Lumbar Vertebrae; Lumbosacral Plexus; Magnetic Resonance Imaging; Psoas Muscles; Spinal Fusion
PubMed: 35428915
DOI: 10.1007/s00586-022-07195-x -
Journal of Cachexia, Sarcopenia and... Aug 2019Skeletal muscle glucose utilization is an important component of whole-body glucose consumption in normal humans. Fluorine-18-labelled fluoro-2-deoxy-d-glucose ( F-FDG)...
BACKGROUND
Skeletal muscle glucose utilization is an important component of whole-body glucose consumption in normal humans. Fluorine-18-labelled fluoro-2-deoxy-d-glucose ( F-FDG) is a non-invasive molecular imaging probe for evaluating tissue glucose utilization. It remains unclear whether or not F-FDG uptake by skeletal muscle has utility as a biomarker for metabolic derangement. We investigated the utility of measurement of muscle F-FDG positron emission tomography/computed tomography uptake as a surrogate marker for existing and incipient metabolic abnormalities.
METHODS
Fluorine-18-labelled fluoro-2-deoxy-d-glucose ( F-FDG) uptakes of insulin-sensitive organs (liver, pancreas, mesenteric visceral fat, psoas muscle, and abdominal subcutaneous fat) and their association with metabolic abnormalities were evaluated in an experimental group comprising 91 men and 66 women (mean age 49.9 ± 11.1 years). In this cross-sectional cohort, we assessed the predictive power of the optimal cut-off F-FDG uptake [maximum standardized uptake value (SUV )]. We confirmed its feasibility and reliability for diagnosis of existing and incipient metabolic derangement in the validation group (longitudinal cohort comprising 91 men and 67 women; mean age 52.6 ± 7.9 years).
RESULTS
Fluorine-18-labelled fluoro-2-deoxy-d-glucose ( F-FDG) uptake (SUV ) of psoas muscle was strongly correlated with clinical metabolic parameters in the experimental group. It was positively correlated with waist circumference, body mass index, fasting glucose, triglyceride, systolic and diastolic pressure, and negatively correlated with high-density lipoprotein cholesterol levels (for all, P < 0.05). SUV of the psoas muscle also showed the best area under the curve value (0.779) as a predictor of metabolic syndrome (MetS) in the experimental group. Using the optimal cut-off SUV of 1.34, the sensitivity, specificity, accuracy, positive, and negative predictive value for predicting existing MetS in the experimental group were 70.0%, 84.6%, 80.9%, 60.9%, and 89.2%, respectively. In the validation group, corresponding values were 47.6%, 92.3%, 86.1%, 50.0%, and 91.6%, respectively. Existing and incipient MetS were significantly higher in subjects with high F-FDG uptake by the psoas muscle (SUV > 1.34). Subjects with higher psoas muscle SUV had a 3.3-fold increased risk of developing MetS (P = 0.017).
CONCLUSIONS
Fluorine-18-labelled fluoro-2-deoxy-d-glucose ( F-FDG) uptake of psoas muscle is a promising surrogate marker for existing and incipient metabolic derangement.
Topics: Cross-Sectional Studies; Female; Fluorodeoxyglucose F18; Humans; Incidence; Male; Middle Aged; Psoas Muscles; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 31094095
DOI: 10.1002/jcsm.12430 -
Experimental and Clinical... Feb 2021We analyzed the nutritional condition of liver transplant recipients and the body mass index, the inner abdominal fat tissue, the outer abdominal fat tissue, the psoas...
OBJECTIVES
We analyzed the nutritional condition of liver transplant recipients and the body mass index, the inner abdominal fat tissue, the outer abdominal fat tissue, the psoas muscle size, and the psoas muscle index of the recipients and evaluated the effects of these factors on patient outcomes after liver transplant.
MATERIALS AND METHODS
We included recipients of liver transplants from January 2009 to December 2018 who had computed tomography at our center < 3 months before transplant. Preoperative, intraoperative, and postoperative data were evaluated. Outer abdominal fat tissue, inner abdominal fat tissue, and psoas muscle area were measured on the computed tomography abdominal images. We used univariate and multi-variate regression analyses to evaluate the data.
RESULTS
There were 265 patients; mean age was 54 years (SD, 13 years). The mean value for body mass index, calculated as weight in kilograms divided by height in meters squared, was 25 (SD, 5). The mean score for Model for End-Stage Liver Disease was 17 (SD, 6). All patients underwent orthotopic liver transplant by standard technique. After adjustment for multivariable analysis, the values for psoas muscle size and the psoas muscle index of the recipient were associated as independent factors for postoperative complications and duration of hospital stay. The survival rate at 1 year was 78.5%, and the rate of perioperative mortality was 16.6%. Independent factors associated with survival after liver transplant were inner abdominal fat tissue, etiology, and rate of major postoperative complications.
CONCLUSIONS
Inner abdominal fat tissue, psoas muscle size, and the psoas muscle index are significantly associated with postoperative complications and/or survival after liver transplant. Our results suggest that these prognostic factors may be useful to optimize the selection of appropriate candidates for liver transplant.
Topics: Abdominal Fat; Adult; Aged; End Stage Liver Disease; Humans; Liver Transplantation; Middle Aged; Postoperative Complications; Psoas Muscles; Severity of Illness Index; Survival Rate
PubMed: 33455566
DOI: 10.6002/ect.2020.0265 -
European Journal of Medical Research Apr 2021Surgery-related loss of muscle quantity negatively affects postoperative outcomes. However, changes of muscle quality have not been fully investigated. A perioperative...
BACKGROUND
Surgery-related loss of muscle quantity negatively affects postoperative outcomes. However, changes of muscle quality have not been fully investigated. A perioperative intervention targeting identified risk factors could improve postoperative outcome. This study investigated risk factors for surgery-related loss of muscle quantity and quality and outcomes after liver resection for colorectal liver metastasis (CRLM).
METHODS
Data of patients diagnosed with CRLM who underwent liver resection between 2006 and 2016 were analysed. Muscle quantity (psoas muscle index [PMI]), and muscle quality, (average muscle radiation attenuation [AMA] of the psoas), were measured using computed tomography. Changes in PMI and AMA of psoas after surgery were assessed.
RESULTS
A total of 128 patients were analysed; 67 (52%) had surgery-related loss of muscle quantity and 83 (65%) muscle quality loss. Chronic obstructive pulmonary disease (COPD) (P = 0.045) and diabetes (P = 0.003) were risk factors for surgery-related loss of muscle quantity. A higher age (P = 0.002), open resection (P = 0.003) and longer operation time (P = 0.033) were associated with muscle quality loss. Overall survival was lower in patients with both muscle quantity and quality loss compared to other categories (P = 0.049). The rate of postoperative complications was significantly higher in the group with surgery-related loss of muscle quality.
CONCLUSIONS
Risk factors for surgery-related muscle loss were identified. Overall survival was lowest in patients with both muscle quantity and quality loss. Complication rate was higher in patients with surgery-related loss of muscle quality.
Topics: Aged; Colorectal Neoplasms; Colorectal Surgery; Female; Follow-Up Studies; Humans; Liver Neoplasms; Male; Postoperative Complications; Prognosis; Psoas Muscles; Retrospective Studies; Risk Factors; Sarcopenia; Survival Rate
PubMed: 33892809
DOI: 10.1186/s40001-021-00507-9 -
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 -
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 -
Asian Journal of Endoscopic Surgery Oct 2021Preoperative psoas muscle index (PMI) and body mass index (BMI) are relevant to postoperative outcomes. We investigated the associations of PMI, BMI, and preoperative...
INTRODUCTION
Preoperative psoas muscle index (PMI) and body mass index (BMI) are relevant to postoperative outcomes. We investigated the associations of PMI, BMI, and preoperative nutritional and muscular score with postoperative outcomes in patients with esophageal cancer who underwent video-assisted surgery.
METHODS
We examined 150 patients (124 men, 26 women) who underwent video-assisted esophagectomy from February 2002 to March 2016. We used the Clavien-Dindo (CD) classification to analyze postoperative complications. Because skeletal muscle volume differs significantly between male and female patients, all analyses were performed separately. In male patients, we used the following cut-off values to categorize patients into three groups: PMI = 600 mm /m , BMI = 18.5 kg/m , and preoperative nutritional and muscular (PNM) scores 0 to 2.
RESULTS
Two patients were converted to open thoracotomy. Among male patients, PMI and PNM scores were significant risk factors for complications. Among male patients, in the high PMI group, the number of CD ≥ IIIa complications was significantly lower. In the PNM score 0 group (both PMI and BMI values exceeded the cut-off values), the number of complications was significantly lower. In both genders, PMI and BMI were not significantly associated with survival.
CONCLUSIONS
PMI and PNM scores can be useful for predicting postoperative outcomes in male patients with esophageal cancer having undergone video-assisted surgery.
Topics: Body Mass Index; Esophageal Neoplasms; Esophagectomy; Female; Humans; Male; Postoperative Complications; Postoperative Period; Psoas Muscles; Retrospective Studies
PubMed: 33759373
DOI: 10.1111/ases.12933 -
Hip International : the Journal of... Sep 2023Sarcopenia is defined as a progressive loss of muscle mass and function with increased age. The measurement of muscle mass and attenuation on the axial computed...
INTRODUCTION
Sarcopenia is defined as a progressive loss of muscle mass and function with increased age. The measurement of muscle mass and attenuation on the axial computed tomography (CT) scan has been reported to be a good indicator for sarcopenia in previous literature. This study aimed to compare muscle mass between the intertrochanteric fracture and femoral neck fracture groups by accurately measuring muscle mass around the hip joint using a CT scan.
METHODS
The cases were matched according to age and gender on a 1-to-1 basis. As a result, a total of 400 patients, 200 patients in each group with the same age and gender characteristics, were included in the study. At the disc of L4-L5 level, the cross-sectional area (CSA) of the psoas muscle was evaluated, and at the disc of L5-S1 level, the CSA of the psoas, iliacus and gluteus medius muscles were evaluated. In addition, attenuation was evaluated using the average Hounsfield Unit (HU) for the specific area.
RESULTS
The mean age of 400 patients (262 females, 138 male) included in the study was 78.49 ± 7.67 years. It was observed that the mean HU values of the patients in the femoral neck fracture group were significantly higher than the intertrochanteric fracture group ( < 0.001, = 0.008; respectively). At the same time, the mean HU values of the gluteus medius muscle were higher in the femoral neck fracture group ( < 0.001), but in contrast with the psoas muscle, the CSA values of gluteus medius muscle were significantly higher in the intertrochanteric fracture group ( = 0.017).
CONCLUSIONS
Fatty degeneration of the psoas muscle among the muscles around the hip may affect the type of hip fracture. Elderly patients with strong psoas muscles may experience femoral neck fracture due to contraction and torsion during falling.
Topics: Female; Humans; Male; Aged; Sarcopenia; Arthroplasty, Replacement, Hip; Muscle, Skeletal; Psoas Muscles; Hip Fractures; Femoral Neck Fractures
PubMed: 35658691
DOI: 10.1177/11207000221101169 -
Skeletal Radiology Oct 2020CT segmentation of psoas muscles at L3 level is used to measure sarcopenia status, but it is not feasible when L3 is not included in the examination. We tested the...
OBJECTIVE
CT segmentation of psoas muscles at L3 level is used to measure sarcopenia status, but it is not feasible when L3 is not included in the examination. We tested the correlation of psoas muscle mass and quality estimation at L3 with that of hip muscles, which could be opportunistically used in patients undergoing hip surgery.
MATERIALS AND METHODS
Unenhanced abdominal CT performed in 50 patients (29 males, mean/median age 69/72 years) were reviewed. Regions of interest were drawn to assess cross-sectional area (CSA) and attenuation of psoas muscles at L3. These values were correlated with CSA and attenuation of iliopsoas, rectus femoris, sartorius, and tensor fascia latae at the level of the hip, separately on each side. After applying Bonferroni correction for multiple comparisons, statistical significance was set as P < .002.
RESULTS
Attenuation of each psoas at L3 and ipsilateral hip muscles was significantly correlated (P ≤ .001, r = .491-.754). A significant correlation was observed between CSA of right psoas and ipsilateral muscles (P ≤ .00, r = .432-.525). We observed a significant correlation between CSA of left psoas and ipsilateral rectus femoris, iliopsoas, tensor fascia latae at the apex of the femoral head, and sartorius at the level of the lesser trochanter (P ≤ .001, r = .431-.502). Average time to measure CSA and attenuation of psoas muscles at L3 was 41 s, that of hip muscles was 2 min 12 s.
CONCLUSION
Measurements of mass and quality of hip muscles are feasible and correlate to those of psoas muscles at L3, being potentially used in future works on the association of sarcopenia and outcomes after hip surgery.
Topics: Abdominal Muscles; Aged; Hip; Humans; Male; Psoas Muscles; Sarcopenia; Tomography, X-Ray Computed
PubMed: 32476068
DOI: 10.1007/s00256-020-03475-z