Sarcopenia is a common complication in patients with cirrhosis. However, research on sarcopenia in patients with noncirrhotic primary biliary cholangitis (PBC) is limited. This study aimed to investigate the prevalence of sarcopenia and the associations between concomitant sarcopenia and the biochemical response to ursodeoxycholic acid (UDCA) treatment and clinical outcomes in patients with noncirrhotic PBC.

This retrospective study enrolled consecutive patients whose baseline visits occurred between January 2009 and December 2023. Sarcopenia was assessed via pretreatment CT or MRI at the mid-L3 level through the skeletal muscle index (SMI). Baseline characteristics, response rate after UDCA administration, liver-related events were compared. And baseline liver and plasma C-reactive protein (CRP) and IL-6 levels in a subset of patients were also evaluated.

A total of 164 patients were included and sarcopenia was identified in 66 (40.2 %) patients. The median duration of follow-up was 4.75 (1.71, 6.40) years. The PBC patients with sarcopenia had a lower biochemical response rate (45.9 % vs. 65.9 %; P = 0.014) after 12 months of UDCA treatment and a higher incidence of liver-related events (24.2 % vs. 11.2 %, P = 0.027) during follow-up. Furthermore, higher levels of baseline CRP and IL-6 in the plasma and liver were also observed(P < 0.05).

Sarcopenia was highly prevalent in patients with noncirrhotic PBC. Concomitant sarcopenia may adversely affect the biochemical response to UDCA treatment and the occurrence of liver-related adverse events in PBC patients without cirrhosis.

The role of preoperative peri-hip muscles in postoperative walking ability for patients with femoral neck fractures is unclear. This study investigated the influence of these muscles on postoperative walking function using computed tomography (CT).

A retrospective analysis was conducted on 58 patients (12 male, 46 female) who underwent bipolar hemiarthroplasty for femoral neck fractures between January 2018 and July 2021. Patients were followed up for at least six months postoperatively and categorized into two groups: the independent walking group (41 patients) and the non-walking group (17 patients). Patient data, including sex, age at surgery, body mass index (BMI), and preoperative walking status, were compared. Additionally, preoperative CT scans assessed the cross-sectional areas and CT values of the gluteus medius, gluteus maximus, and rectus femoris muscles on the unaffected side. These measurements were compared between the two groups.

No significant differences were observed between the groups regarding sex, age, BMI, or preoperative walking status. The CT values of the gluteus medius and gluteus maximus were significantly lower in the non-walking group compared with the walking group (gluteus medius: 39.3 ± 7.5 Hounsfield units (HU) vs. 28.6 ± 6.9 HU; P < 0.01; gluteus maximus: 33.0 ± 8.1 HU vs. 23.3 ± 10.7 HU; P < 0.01), whereas no significant differences were found for the rectus femoris. Cross-sectional areas of all muscles did not show significant differences between the two groups. Receiver operating characteristic curve analysis revealed that the gluteus medius had an area under the curve (AUC) of 0.86, with a sensitivity of 0.78 and specificity of 0.82, using a cut-off of 33.1 HU. The gluteus maximus had an AUC of 0.77, with a sensitivity of 0.63 and specificity of 0.77, using a cut-off of 31.6 HU.

Preoperative CT values of the gluteus medius and gluteus maximus were lower in the non-walking group, suggesting that these muscles influence postoperative walking ability. Preoperative CT evaluation of these muscles can be a useful predictor of postoperative walking outcomes.

Muscle fatty infiltration (MFI) was characterized by the pathological accumulation of fat within skeletal muscle tissue. Previous studies have found that the progress of this pathological phenomenon in aging, acute muscle injury, and other conditions was triggered by the activation and adipogenic differentiation of the key cell population, fibro/adipogenic progenitors (FAPs), but there were few studies on the fat infiltration caused by disused skeletal muscle atrophy, and the regulatory role of FAPs in this situation has not been deeply explored, leaving the related molecular mechanisms still unknown. In this study, we conducted single-cell RNA sequencing on the disused skeletal muscle. The aberrant proliferation of FAPs in this state was found by subsequent analysis, along with the high expression of the ferroptosis inhibitory gene in the activated FAPs. By immunofluorescence staining, we verified the proliferation and adipogenic differentiation of FAPs, which proved the role of FAPs in fat infiltration of disused skeletal muscle. In order to further verify the relationship between ferroptosis inhibition and FAPs activation/adipogenic differentiation, we used ferrostatin-1, a commonly used ferroptosis inhibitor, to treat skeletal muscle fibroblasts and FAPs in vitro, and verified the enhancement of ferroptosis inhibition on their adipogenic/fibrogenic ability. Our study pinpointed the effect of aberrant activation of FAPs on MFI in disused skeletal muscle, and preliminarily recognized the potential effect of ferroptosis on the adipogenic differentiation of FAPs. KEY MESSAGES: • Muscle fatty infiltration (MFI) was characterized by the pathological accumulation of fat within skeletal muscle. Fibro/adipogenic progenitors (FAPs) were thought to be crucial regulators of MFI, but their correlations in disused skeletal muscle were unspecified. • In this study, we conducted single-cell RNA sequencing on the disused skeletal muscle and recognized the aberrant proliferation of FAPs along with the upregulated ferroptosis inhibition genes in this status. • Subsequently, we used ferrostatin-1 (ferroptosis inhibitor) to treat skeletal muscle fibroblasts in vitro, and verified the enhancement of ferroptosis inhibition on their adipogenic/fibrogenic ability. • Our study pinpointed the effect of aberrant activation of FAPs on MFI in disused skeletal muscle, and preliminarily recognized the potential effect of ferroptosis on the adipogenic differentiation of FAPs.

With the aging global population, the decline in muscle mass and function among the elderly has emerged as a significant concern. This systemic progressive generalized loss of muscle function and mass is referred to as sarcopenia (SP). In recent years, a growing number of studies have investigated SP, revealing that many tumor diseases, especially in the digestive system, promote its occurrence due to the influence of the disease itself, diet, and other factors. Moreover, SP patients tend to have poorer postoperative recovery. At present, many diagnostic methods have been developed for SP, but no unified standard has been established. Furthermore, the cutoff values of many diagnostic methods for different populations are still in the exploratory stage, and additional clinical studies are required to explore these issues. This article comprehensively and systematically summarizes the diagnostic methods and criteria mentioned in previous research, focusing on the impact of SP on post-surgical patients with various malignant tumors.

Parkinson's disease (PD) and sarcopenia are prevalent age-related conditions that often coexist in affected individuals. Sarcopenia is particularly common among PD patients, with severe cases affecting approximately one in five individuals with the disease. Furthermore, sarcopenia is closely linked to the accelerated progression of PD, diminished quality of life, greater susceptibility to falls and fractures, and increased mortality risk. Although the precise mechanisms remain unclear, numerous studies suggest that factors such as the accumulation of α-Synuclein in skeletal muscle, loss of motor neurons, inflammation, phosphate toxicity, hormonal dysregulation, vitamin D deficiency, intestinal flora imbalances, and dysfunction of the gut-muscle-brain axis contribute to sarcopenia in PD. Understanding these mechanisms provides valuable insights into the relationship between PD and sarcopenia and establishes a foundation for future research and therapeutic strategies. This review examines the mechanisms underlying sarcopenia in PD, methods for its screening and assessment, and potential avenues for future research, including strategies for risk reduction and treatment.

Although the reduced muscle quality is common in elderly people, its role in the development of knee osteoarthritis (OA) remains unclear. Magnetic Resonance Imaging (MRI) is considered the gold standard imaging modality to assess muscle quality, which might holistically capture the underlying pathology.

This study aimed to apply MRI-based radiomics to assess the quality of thigh muscles comprehensively, and examine its prediction performance for incident knee OA.

The participants at risk of knee OA during the 48-month visit were selected from a multicenter cohort and analyzed using a nested case-control design. Cases were matched 1:1 to controls according to age, sex, and contralateral knee status. A multitask framework was developed to comprehensively evaluate thigh muscle quality by calculating conventional quantitative markers and radiomic features. Baseline collected thigh and knee MRI scans were respectively used for discovery and validation procedures. In each procedure, three (cross-sectional area [CSA], intramuscular adipose tissue [intra-MAT] CSA, and radiomic signature score [Rad-score]) imaging models of each muscle group (extensors, flexors, and auxiliaries) were trained and tested. The prediction performance of each muscle Rad-score was compared with conventional markers respectively. Furthermore, the incremental predictive value of clinical characteristics for Rad-score model was investigated.

448 participants (mean age 61 years, 63 % female) were identified and split into training (314 [70.1 %]) and testing (134 [29.9 %]) cohorts. In the discovery procedure, the extensors Rad-score provided superior prediction performance than extensors CSA and intra-MAT CSA (area under the curve [AUC] 0.832 [95 % CI 0.765-0.899] vs 0.595 [0.498-0.692] and 0.600 [0.503-0.697] in testing cohort; all p < 0.001). Contrarily, the performances of the Rad-score and conventional markers of flexors were relatively poor, as were those of the auxiliaries. Extensors Rad-score also outperformed auxiliaries Rad-score, flexors Rad-score, and the clinical model (AUC 0.832 [0.765-0.899] vs 0.687 [0.597-0.777], 0.634 [0.541-0.728], and 0.577 [0.483-0.671] in testing cohort; all p < 0.001). Unexpectedly, the integration of other radiomic signatures and clinical characteristics showed comparable net benefit in decision curve analysis when compared with extensors Rad-score alone. Similar findings were obtained in the validation procedure.

MRI-based radiomics could enable comprehensive assessment of muscle quality and allow exact prediction of incident knee OA, which helps uncover the precursory role of reduced extensors quality in developing knee OA. The radiomic signature from extensors would be an alternative indicator for future diagnosis and treatment in knee OA.

Body composition assessment includes the parameter skeletal muscle mass, subcutaneous and visceral adipose tissue (SAT and VAT). The purpose of this study was to elucidate associations of body composition parameters with mortality in patients with acute bleeding undergoing transarterial embolization (TAE).

A mixed cohort of patients from 2018 to 2022 with acute bleeding requiring treatment with a TAE was retrospectively evaluated. In every case, the triphasic CT to diagnose the source of bleeding was used to calculate the body composition parameters.

A total of 251 patients (93 female, 37.1%) with a mean age of 65.5 ± 14.3 years, 30-d mortality of 40.2%, and 24-h mortality of 7.6% were included in the analysis. In the Cox regression analysis, no statistically significant correlations were found between the body composition parameters and 24-h or 30-day mortality. In the subgroup analysis of patients aged older than 65 years, skeletal muscle index was associated with short-term 24-h mortality HR of 0.95 (95% CI 0.90; 0.99, P = .035).

The present study demonstrated the prognostic impact of clinical, laboratory, aniography-related, and CT-defined body composition in patients with acute haemorrhage undergoing endovascular therapy. Although the overall effect of CT-defined body composition appears to be small, skeletal muscle index was a prognostic factor in the age group over 65 years.

This is a large single-centre study to investigate the prognostic relevance of CT-defined body composition in patients undergoing TAE. The effect is overall small but might be further investigated in older patients in further trials.

This study aims to explore the prognostic value of quantitatively evaluating muscle mass using chest high resolution computed tomography (HRCT) in patients with active tuberculosis (TB).

This retrospective cohort study collected data from 309 patients with active TB diagnosed at Ningbo No.2 Hospital from 2020 to 2023. Based on the skeletal muscle index (SMI) at the T12 vertebra (with thresholds of <28.8 cm2/m2 for men and <20.8 cm2/m2 for women), patients were divided into a low muscle mass group and a normal muscle mass group. The study compared baseline characteristics, muscle mass-related indicators, body mass index (BMI), and imaging features between the two groups. The correlation between muscle mass-related indicators, BMI, and TB imaging features and prognosis was analyzed. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess the prognostic value of muscle mass-related indicators and BMI in patients undergoing anti-TB treatment.

A total of 309 patients were included in the study, divided into a normal muscle mass group (n = 229) and a low muscle mass group (n = 80). There was a significant difference in prognosis between the two groups (χ 2 test, p < 0.05). Patients in the low muscle mass group were older, had a higher proportion of males, and had a lower BMI (p < 0.05). Additionally, these patients had a higher likelihood of developing pulmonary cavities (p < 0.05). In terms of imaging features, the two groups showed significant differences in the pre-treatment proportion of pulmonary fibrotic bands, ground-glass opacities, consolidation, lesion percentage, and lesion absorption ratio (all p < 0.05). Univariate analysis indicated that both the T12 skeletal muscle index (T12 SMI) and BMI were correlated with TB imaging characteristics (p < 0.05), with T12 SMI showing a stronger correlation than BMI. Multivariable linear regression analysis revealed that after adjusting for age, gender, and T12 skeletal muscle radiation attenuation (T12 SMRA), T12 SMI remained significantly correlated with the whole-lung lesion proportion (β: - 4.56, 95% CI [-5.45 to -3.67]) and lesion absorption ratio (β:0.036, 95% CI [0.031-0.041]). Multivariable logistic regression analysis demonstrated that after accounting for age, gender, T12 SMRA, T12 SMI was significantly associated with the prognosis of TB patients (OR: 20.10, 95% CI [8.81-51.56], p < 0.05), indicating that low T12 SMI is an independent risk factor associated with poor prognosis. ROC curve analysis indicated that T12 SMI may offer advantages over BMI, with an area under the ROC curve (AUC) of T12 SMI (0.761, 95% CI [0.690-0.832]) higher than the AUC of BMI (0.700, 95% CI [0.619-0.781].

Quantitative evaluation of muscle mass using chest HRCT, particularly the T12 SMI, may provide valuable prognostic information for tuberculosis patients, potentially offering advantages over BMI in assessing patient outcomes.

Background/Objectives: Nusinersen is a disease-modifying drug for spinal muscular atrophy (SMA) that improves motor function. However, its effects on the skeletal muscles remain unclear. This study aimed to assess the intramuscular fat fraction in patients with SMA types II and III using muscle magnetic resonance imaging (MRI) and to explore the relationship between muscle tissue, lipid metabolism, and motor function during nusinersen treatment. Methods: This study included seven pediatric patients with SMA types II and III who received nusinersen treatment. Muscle MRIs were performed at three time points. Images of the central thigh were used to measure the cross-sectional area (CSA) and muscle fat area, and the intramuscular fat fraction (IMFF) was calculated. The thigh muscles were categorized into three groups: quadriceps, adductor, and hamstrings. Results: The median (range) of total IMFF for SMA type II and III at T-0, T-2, and T-4 were 18.5 (12.6-48.4), 24.4 (10.1-61.4), and 39.0 (30.0-68.6) % and increased over time. In five patients whose motor function was evaluated, a moderate negative correlation was observed between the changes in the Hammersmith Functional Motor Score Expanded (HSFME) and IMFF (r = -0.51). No significant changes in serum triglyceride or total cholesterol levels were observed during treatment. Conclusions: An increase in IMFF was associated with a decline in motor function. The baseline IMFF score was related to improvements in motor function scores, suggesting that the IMFF of the thigh muscle may serve as a novel, objective, and quantitative skeletal muscle-related biomarker for predicting the effects of nusinersen on muscle tissue.

In 2008, the Society on Sarcopenia, Cachexia, and Wasting Disorders introduced a generic definition for all types of cachexia: "a complex metabolic syndrome associated with the underlying illness characterized by a loss of muscle, with or without fat loss". It is well-known that the presence of inflammatory burden in end-stage renal disease (ESRD) patients may lead to the evolution of cachexia. Since the etiology of cachexia in chronic kidney disease (CKD) is multifactorial, thus the successful treatment must involve several concomitant measures (nutritional interventions, appetite stimulants, and anti-inflammatory pharmacologic agents) to provide integrated effective therapeutic modalities to combat causative factors and alleviate the outcomes of patients. Given the high mortality rate associated with cachexia, developing new therapeutic modalities are prerequisite for ameliorating patients with CKD worldwide. The present review aims to discuss some therapeutic strategies and provide an update on advances in nutritional approaches to counteract cachexia.

Sarcopenia is an emerging determinant of oncologic patients' prognosis, but few data are available in extremities and trunk wall soft tissue sarcomas (ESTS). The aim was to evaluate sarcopenia impact on outcomes of patients affected by ESTS.

Through SliceOMatic software we selected cross-sectional skeletal muscle area (SMA), subcutaneous fat area (SFA) and visceral fat area (VFA) on a basal CT-slice at level of the third lumbar vertebra. Muscle density (MD) was computed in Hounsfield units (HU). Skeletal mass index (SMI, cm2/m2) was computed by normalizing SMA for the square of patient's height. Cut-offs for SMI were 52 and 39 cm2/m2 for men and women, respectively, while we used median values for MD, SFA and VFA. We explored the correlation of the different parameters with post-surgical complications and survival outcomes (Kaplan-Meier method).

268 patients were included. Median SMAs, SMIs and MD were 155.7 cm2, 51.2 cm2/m2, and 33.8 HU for men, 91.4 cm2, 39.2 cm2/m2, and 30.4 HU for women. Sarcopenia rate was not significantly higher in patients ≥65 years nor according to baseline prognostic factors (Sarculator app). Overall survival (OS) was significantly worse for sarcopenic patients: median OS 111.7 months (95%CI 72.8-150.6) vs not reached (NR; HR = 1.55, 95%CI:1.00-2.41, p = 0.049) for low-vs high-SMI; median OS 79.6 months (38.6-120.6) vs NR (HR 2.11, 1.34-3.34, p = 0.001) for low-vs high-MD, respectively. Sarcopenic patients showed increased post-surgical complications (30.5 % vs 17.0 %, p = 0.073).

Although retrospective, our study suggests to further explore sarcopenia as a negative prognostic factor in ESTS patients.

Chemotherapy remains a central component of breast cancer treatment, significantly improving patient survival rates. However, its toxic side effects, along with cancer-related paraneoplastic syndromes, can lead to the loss of skeletal muscle mass and function, impairing physical abilities and increasing the risk of complications during treatment. Chemotherapeutic agents directly impact skeletal muscle cells by promoting protein degradation, inhibiting protein synthesis, and triggering systemic inflammation, all of which contribute to muscle atrophy. Additionally, these drugs can interfere with the proliferation and differentiation of stem cells, such as satellite cells, disrupting muscle regeneration and repair while inducing abnormal differentiation of intermuscular tissue, thereby worsening muscle wasting. These effects not only reduce the effectiveness of chemotherapy but also negatively affect patients' quality of life and disease prognosis. Recent studies have emphasized the role of exercise as an effective non-pharmacological strategy for preventing muscle loss and preserving muscle mass in cancer patients. This review examines the clinical manifestations of muscle dysfunction following breast cancer chemotherapy, the potential mechanisms underlying these changes, and the evidence supporting exercise as a therapeutic approach for improving muscle function.

This review highlights key ultrasound applications for evaluating extra-articular involvement in rheumatic diseases, including the lungs, vessels, salivary glands, muscles, nerves, skin, and nails. It explores recent advances, emerging areas of assessment, and future research directions. Additionally, the review examines current limitations in the routine use of ultrasound for these purposes and considers the potential of new technologies, such as shear-wave elastography, contrast-enhanced ultrasound, and artificial intelligence, to enhance the early detection and monitoring of extra-articular manifestations in rheumatic diseases.

Extra-articular manifestations in patients with rheumatic diseases are crucial for diagnosis, management (including treatment strategies), and prognosis, making accurate assessment essential. Growing evidence supports the role of ultrasound in assessing these manifestations for diagnosis, monitoring, and gaining insights into disease pathogenesis. Recent studies emphasize the significant utility of ultrasound in evaluating extra-articular involvement across various organ systems, including the lungs, vessels, salivary glands, muscles, nerves, skin, and nails. Technological advances, such as shear-wave elastography, contrast-enhanced ultrasound, and artificial intelligence, are expanding the scope and precision of ultrasound applications. Despite its potential, challenges such as operator dependency, lack of standardized protocols, and the need for specialized training hinder its widespread adoption. Ultrasound is a non-invasive, cost-effective, and radiation-free imaging modality with high diagnostic accuracy, making it a valuable tool for assessing extra-articular manifestations in rheumatic diseases. Emerging technologies may further enhance its clinical utility. However, efforts to standardize techniques and improve accessibility are necessary to optimize its integration into routine practice.

Fatty infiltration of skeletal muscle (Myosteatosis) is associated with increased frailty, decreased muscle and mobility function, which seems fairly prevalent in multiple myeloma (MM) patients. This study aimed to determine the prognostic value of myosteatosis assessed by CT for progression-free survival (PFS) and overall survival (OS).

This IRB-approved cohort study included patients with newly diagnosed MM who were treated at a single university hospital and received CT at baseline. Geriatric assessment was performed via International Myeloma Working Group frailty score and Revised Myeloma Comorbidity Index. Myosteatosis was determined through measurement of paravertebral muscle radiodensity. Statistical analyses included uni- and multivariable Cox proportional hazard models and the Kaplan-Meier-method.

A total of 226 newly diagnosed MM patients (median age: 65 years [range: 29-89], 63% males, mean BMI: 25 [14-42]) were analyzed. The prevalence of myosteatosis was 51%. Muscle radiodensity was significantly decreased in individuals with International Staging System stage III vs. I (p < 0.001), indicating higher fatty muscle infiltration in patients with advanced disease. Both PFS and OS were significantly decreased in patients with myosteatosis (PFS: median 32.0 months (95% CI 20.5.5-42.2) vs. 66.4 months without myosteatosis (95% CI 42.5-not reached), p < .001); OS: median 58.6 (95% CI 51.3-90.2) vs. not reached, p < .001). Myosteatosis remained an independent predictor of OS in multivariable analyses (HR: 1.98; 95%-CI: 1.20-3.27).

Myosteatosis seems fairly prevalent in patients with newly diagnosed MM and associated with impaired overall survival. Prospective clinical trials are required to better understand the role of myosteatosis in MM patients.

Infliximab is a first-line biologic agent for the treatment of Crohn's disease (CD), in which loss of response (LOR) remains a challenge in the treatment of patients with CD. The study aimed to explore the association between body composition parameters and LOR to infliximab in CD patients.

118 patients with CD admitted to the First Affiliated Hospital of Wenzhou Medical University and treated with infliximab from June 2015 to December 2021 were retrospectively enrolled. The body composition of patients was analyzed by computed tomography (CT). The primary outcome measure was the one-year LOR. Patients were divided into the Remission group and the LOR group to analyze the association between body composition parameters and the LOR to infliximab.

The rate of sarcopenia in the LOR group was higher than in the Remission group (83.7% vs. 60.0%, P=0.008). Multivariate analysis showed that females had a lower risk of sarcopenia than males (OR=0.30, 95% CI 0.11-0.81, P =0.017); BMI was significantly associated with sarcopenia (OR=0.68, 95% CI 0.56-0.83, P <0.001); L1 CD and L2 CD had a lower risk of sarcopenia than L3 CD (OR=0.29, 95% CI 0.10-0.83, P =0.021; OR=0.25, 95% CI 0.07-0.87, P=0.028).

Sarcopenia was identified as a risk factor for developing LOR in infliximab-treated patients.

The objective of this study is to evaluate the potential of rectus femoris shear wave elastography (RF-SWE) in assessing its impact on frailty and physical performance parameters, using a comparative analysis with rectus femoris muscle thickness (RF-MT).

A total of 149 participants aged 60 and above were included in this research. All participants underwent a comprehensive geriatric assessment, frailty status assessment (using the frailty phenotype [FFP]), and evaluation of physical performance parameters (utilizing the short physical performance battery score [SPPB] and handgrip strength measurement). RF-MT and RF-SWE were measured by a radiologist with participants in a prone and relaxed position.

The mean age of participants was 73.8 ± 6.5, with 61.7% (n = 92) being female. Participants were divided into 2 groups based on their frailty status, with 40 (26.8%) identified as frail and 109 (73.2%) as non-frail. RF-MT exhibited a significant correlation with frailty and the SPPB, while RF-SWE did not exhibit significant associations except for handgrip strength. In regression analyses, RF-MT was found to be significantly and independently associated with physical frailty. The optimal cutoff value for RF-MT was determined to be ≤ 17.74 (area under the ROC curve [AUC], 0.752; 95% CI 0.675-0.819; p < 0.001). In contrast, RF-SWE did not show a significant relationship.

RF-MT is more strongly associated with physical performance and physical frailty than the muscle quality assessed by RF-SWE. Measuring RF-MT, rather than RF-SWE, proves to be an effective tool for predicting frailty in the geriatric population.

Patients with Type 2 diabetes mellitus (T2DM) have elevated late-night cortisol levels and a flattened circadian rhythm. Cortisol oversecretion mediates muscle breakdown and reduces muscle strength and mass, thus possibly leading to sarcopenia. This study first investigated the association between cortisol circadian rhythm and sarcopenia in patients with T2DM.

Patients with T2DM and adrenal nodules were screened for eligibility. Skeletal muscle index (SMI) and skeletal muscle density (SMD) were obtained by analysing computed tomography images at Lumbar 3 level. Sarcopenia was defined as the presence of both myopenia and myosteatosis. Cortisol and adrenocorticotropic hormone levels at 8 AM, 4 PM and 0 AM were measured. The cumulative logit models and receiver operating characteristic (ROC) curve analyses were performed to evaluate the association between cortisol circadian rhythm and sarcopenia.

In total, 128 patients with T2DM and nonfunctional adrenal adenomas were enrolled in this study, of whom 25 were diagnosed with sarcopenia. The mean age was 54.4 years, and 83 (64.8%) patients were male. Patients with sarcopenia showed higher nighttime cortisol levels at 0 AM (Cor 0 AM) (4.91 [4.05, 9.95] vs. 2.44 [1.55, 4.77] μg/dL, p < 0.001) than those without. The Cor 0 AM was negatively correlated with both SMI and SMD (r = -0.318, p < 0.001 and -0.284, p < 0.001, respectively). As the Cor 0 AM tertiles increased, the odds ratios (ORs) for sarcopenia consistently increased (OR = 4.69 [0.93, 23.53], p = 0.061, for the intermediate group and OR = 11.39 [2.41, 53.84], p = 0.002, for the high group). After adjustment for multiple risk factors, the high Cor 0 AM group still showed a significantly higher risk of sarcopenia than the low group (OR = 7.92 [1.45, 43.29], p = 0.017). ROC curve analyses showed that Cor 0 AM had the highest predictive power for sarcopenia, with an area under the ROC curve (AUC) of 0.760, compared to haemoglobin, age, alanine transaminase and sex (AUC = 0.703, 0.695, 0.679, and 0.633, respectively).

The cortisol circadian rhythm is associated with sarcopenia in patients with T2DM. Patients with higher levels of nighttime cortisol, rather than morning or afternoon cortisol, have a higher risk of sarcopenia. This result offers a new strategy for the further research of sarcopenia.

Sarcopenia, characterized by reduced skeletal muscle mass (RMM), is increasingly recognized as a significant factor influencing outcomes in various health conditions, including stroke. Although most studies focus on sarcopenia developing during stroke rehabilitation, the impact of sarcopenia present at the onset of acute ischemic stroke remains underexplored. This study aims to evaluate the effect of RMM at stroke onset on 3-month functional outcomes in acute ischemic stroke patients.

We prospectively enrolled acute ischemic stroke patients admitted between May 2019 and December 2019. Muscle mass was accessed early during hospitalization using whole-body dual-energy X-ray absorptiometry (DXA), and patients were categorized into RMM and normal muscle mass (NMM) groups based on the Asian Working Group for Sarcopenia (AWGS) criteria. Functional outcomes at 3 months were assessed using the modified Rankin Scale (mRS), with unfavorable outcomes defined as mRS scores 2-5. Multivariable logistic regression and SHAP (Shapley Additive exPlanations) analyses were used to evaluate the independent impact of RMM on 3-months functional outcomes.

A total of 99 patients were analyzed. The RMM group had a significantly higher prevalence of unfavorable outcomes at 3 months compared to the NMM group (p < 0.001). Patients with RMM were older and presented with more severe strokes. Multivariable analysis confirmed RMM as an independent predictor of unfavorable outcomes (adjusted OR: 8.07, 95% CI: 1.603-40.66, p = 0.011), even after adjusting for age and initial stroke severity. SHAP analysis ranked RMM as the second most influential predictor of unfavorable outcomes, following NIHSS on admission. These findings indicate that RMM not only worsens initial stroke severity but also independently hinders post-stroke recovery.

Reduced muscle mass at the onset of acute ischemic stroke is a significant, independent predictor of unfavorable outcomes at 3 months. In addition to its impact on recovery, RMM is linked to older age and more severe strokes, worsening prognosis. Maintaining muscle mass is also crucial for stroke prevention, as it supports cardiovascular health and resilience. Early identification and intervention for sarcopenia can improve recovery and reduce future stroke risk.

Research has demonstrated that individuals with sarcopenia or sarcopenic obesity who experience fractures or undergo major surgical interventions exhibit a poorer prognosis compared to the general population. However, few studies have investigated the relationship between the skeletal muscle and adipose tissue indices, as measured at the 12th thoracic spine level, and adverse outcomes following orthopedic surgery. Therefore, this study aimed to prove whether skeletal muscle and adipose tissue index measured by computed tomography (CT) images based on a single layer are associated with one-year postoperative mortality in elderly hip fracture patients.

A total of 334 participants from two institutions were enrolled in this study to obtain skeletal muscle index (SMI), subcutaneous fat index (SFI), visceral fat index (VFI), and the visceral-to-subcutaneous ratio of the fat area (VSR) at T12 levels and divide them into death and survival groups based on the results of follow-up after 1 year. Propensity score matching (PSM) was employed to evaluate one-year postoperative mortality.

Institution 1's results identified that a lower SMI significantly heightened the risk of one-year postoperative mortality (OR = 0.799,95%CI 0.677-0.943, P = 0.008), making SMI an independent predictor. Institution 2's results identified that age (OR = 1.081, 95%CI 1.005-1.163, P = 0.036), SMI (OR = 0.881, 95%CI 0.784-0.991, P = 0.035) as independent predictors of one-year postoperative mortality in elderly hip fracture. Receiver operator characteristics analysis revealed area under the curve (AUC) values for institution 1: SMI (0.738 (95%CI 0.626-0.851), significant), VFI (0.605 (95%CI 0.476-0.734)), VSR (0.583 (95%CI 0.451-0.715)); and for institution 2: SMI (0.742 (95%CI 0.612-0.872), significant) and Age (0.775 (95%CI 0.677-0.874), significant). Collectively, these results underscore that SMI serves as an independent predictor of one-year postoperative mortality in elderly hip fracture patients.

This study demonstrated that the T12-based SMI was independently associated with one-year mortality following hip fracture in geriatric patients, with lower preoperative SMI correlating with higher mortality rates post-surgery.

Osteoporosis and sarcopenia usually coexist in older population. The concept of osteosarcopenia has been proposed in recent years. However, studies on the relationship between osteosarcopenia and the risk of fracture are rare, and the association is unclear at present. This study aimed to investigate the association between osteosarcopenia evaluated based on chest computed tomography (CT) and osteoporotic vertebral fracture (OVF).

This study recruited 7906 individuals aged 50 years and older who did not have OVFs and underwent chest CT for physical examination between July 2016 and September 2019. Subjects were followed up annually until June 2023. Osteosarcopenia was defined by a low muscle area of the erector spinae (< 25.4 cm2) and the bone attenuation (Hounsfield unit, HU < 135). Genant's grades were used to define OVFs. Control subjects were selected by Propensity Score Matching at a ratio 20:1. Cox proportional hazards models were used to assess the associations between osteosarcopenia and OVFs.

Of the 7906 participants included, 95 had a new OVF within a median follow-up of 3 years. A total of 1900 control subjects were matched. Individuals in the osteosarcopenia group had a higher prevalence of spinal fractures than those in normal group (16.4% vs. 0.4%, P < 0.001). Osteosarcopenia was independently associated with OVF (adjusted hazard ratio (aHR): 12.67, 95% confidence interval (CI) 3.79-42.40) and severe OVF (aHR = 14.07, 95% CI 1.84-107.66). Similar trends were observed in males, females and those subjects aged older than 60 years. Osteosarcopenia had good predictive efficacy for OVF (area under the curve = 0.836). A nomogram was also developed for clinical application.

Osteosarcopenia assessed based on chest CT was associated with OVF, and osteosarcopenia has good performance for vertebral fracture prediction.

In this retrospective cohort study, we investigated the prognostic value of sarcopenia evaluated by Computed Tomography (CT)-based indices for adverse hospitalization outcomes in patients with acute infections. We analyzed data from 225 patients admitted to the hospital for acute infections between 2019 and 2020. Patients who had undergone an abdominal CT scan either up to 1 month before or within the first 3 days of hospitalization were included. CT image analysis was used to evaluate skeletal muscle mass (by skeletal muscle index (SMI)) and muscle quality (by psoas muscle density, pMD). Low pMD was associated with higher in-hospital mortality (31% vs 11.4% p < 0.001) as well as higher longer-term mortality rates (p = 0.008 for 30 days and <0.001 for 90- and 1-year mortality). Low pMD remained an independent poor prognostic factor after controlling for confounders, with an adjusted odds ratio (aOR) of 2.74, (95% CI 1.33-5.67, p = 0.006) for 1-year mortality, and aOR of 2.61, (95% CI 1.23-5.55) for a prolonged hospital stay. Low SMI was associated with adverse outcomes, although this association was not independent after controlling for confounders. Notably, patients with both low SMI and pMD exhibited the poorest hospitalization outcomes: aOR for 1-year mortality 5.015 (95% CI 1.767-14.23, p = 0.002), and prolonged length of stay aOR 3.197, (95% CI 1.159-8.821, p = 0.025). CT-based muscle indices serve as independent prognostic factors in medical patients admitted with acute infection. Incorporating radiological assessments of sarcopenia into routine care for hospitalized patients with acute infection may enable risk stratification and early intervention in reversible conditions.

The pelvic floor muscle (PFM) plays a major role in sexual and urinary functions. No objective method exists to measure the PFM in male. This study evaluated the reliability of male PFM volume using three-dimensional computed tomography (3D-CT).

PFMs of five patients aged 43-83 years were selectively extracted from thin-slice CT using a workstation to reconstruct stereoscopic images and measure PFM volume. Two raters measured the PFM volume three times in all patients to confirm the reliability of PFM volume measurement. Intra- and inter-rater correlation coefficients, i.e., intraclass correlation coefficient, were determined. The CT attenuation of PFMs was also evaluated.

Raters 1 and 2 reported an average PFM volume of 46.4 ± 11.5 cm3 and 46.1 ± 12.5 cm3, respectively. The intra- and inter-rater correlation coefficients were 0.99 and 0.98, respectively. The average CT value of PFMs had a minimum of 13.7 Hounsfield Unit (HU) in the eldest male and a maximum of 38.9 HU in the youngest male.

Male PFMs could be selectively extracted using a workstation to reconstruct a stereoscopic image. The PFM volume measurement is feasible and highly reproducible. To our knowledge, this is the first study that standardizes the method for measuring the male PFM volume using 3D-CT and examines its reliability.

The present study leverages the comprehensive data from the National Health and Nutrition Examination Survey (NHANES) to examine the Influencing factors of sarcopenia (SA) and sarcopenic obesity (SO). The investigation is designed to a non-invasive, cost-effective, and convenient method that is applicable to the adult population, enabling the accurate and simultaneous detection of risks associated with SA and SO. Furthermore, this research will evaluate the critical values of effective anthropometric indicators, providing early warning for risk management in self-health care and offering valuable insights for subsequent research and clinical practice. The data pertaining to NHANES participants were meticulously selected from the databases of six cycles, spanning from 2001 to 2004 and 2011 to 2018. Utilizing the diagnostic criteria established by the American Foundation for the National Institutes of Health (FNIH), anthropometric measurement data were extracted to construct composite indices. These indices were then cross-referenced with diagnostic assessments from dual-energy X-ray absorptiometry and bioelectrical impedance analysis to examine the correlations between various metrics and the incidence of diseases. R software (version 4.3.3) was used for analysis, and the primary analytical methods employed included logistic regression, restricted cubic splines (RCS), and the Receiver Operating Characteristic (ROC) curve analysis (AUC). Sarcopenia and sarcopenic obesity are commonly observed in individuals within the middle-aged and elderly demographics. The prevalence of these conditions is higher among middle-aged men of a given age when contrasted with women at the age of 40. All anthropometric indexes demonstrated a positive correlation with the onset of SA and SO, with the association with waist-to-height ratio (WHtR) showcasing a heightened strength subsequent to the adjustment for all covariates. The predictive models of all ROC curves performed commendably, particularly with the body roundness index and WHtR forecasting models exhibiting superior performance, the area under the AUC curve is 0.87 (95 CI% 0.85, 0.88) and 0.86 (95 CI% 0.85, 0.88), respectively. The RCS curve delineated a distinctive J-shaped distribution for each physical index in concurrence with SA and SO, signifying an optimal value at which the incidence of these conditions is minimal; conversely, deviations from this optimal value entailed an escalated risk of disease. Diverse anthropometric index metrics bear a strong correlation with adult onset of sarcopenia and sarcopenic obesity, each displaying commendable predictive capability. Notably, the body roundness index and waist-to-height ratio may harbor heightened potential as indicative anthropometric indexes. Furthermore, the dose-effect relationship analysis inferred that the lowest disease risk is manifested among individuals with specific index profiles, thereby advocating for autonomous health monitoring to promote physical activity and bolster nutrient intake, thus mitigating the risk of sarcopenia and sarcopenic obesity.

This study aimed to investigate the effects of resistance training (RT) on knee extensor muscle hypertrophy in adults 65 years and older.

A systematic search was carried out in PubMed, Embase, and Scopus to review randomized controlled trials that assessed the effects of supervised RT on 1) muscle size, 2) fiber area, and 3) leg lean mass (LLM). Random-effects meta-analyses of standardized mean difference (SMD) and raw mean difference (RMD) for LLM were calculated. We performed a meta-regression to examine the interference of age, training volume, and duration on the results related to hypertrophy at muscle and fiber levels.

Thirty-two studies were included in the review, and 28 were meta-analyzed. The meta-analysis found a significant effect of RT on muscle size (SMD = 0.34; 95 % CI: 0.16-0.52; p < 0.001) and fiber area (SMD = 0.54; 95 % CI: 0.24-0.84; p < 0.001), but not on LLM (RMD = 0.22; 95 % CI: -0.22-0.66 p = 0.321). A subanalysis of studies that assessed quadriceps femoris size (excluding isolated quadriceps femoris muscles from the analysis) also revealed a significant effect of RT (95 % CI: 0.20-0.69; p < 0.001). Regression analysis indicated a significant influence of intervention duration on type II fiber area (p = 0.034), while no significant influence was detected for weekly sets or age for any outcome measure.

RT promotes muscle hypertrophy in older adults at both whole-muscle and fiber levels, with training duration potentially influencing the response. Measures of leg lean mass may not capture RT-induced adaptation.

The aim of this narrative mini review was to investigate the potential association of the diabetic foot (DF) with sarcopenia and frailty. Data is still limited, but it appears that DF patients may be more prone to frailty. In addition, patients with DF and sarcopenia exhibit more frequently foot ulcers and amputations, as well as increased mortality rates post-operatively. Further studies are now needed to see how these realizations may be used in clinical practice, aiming to improve DF outcomes.

It has been shown that in patients with liver cirrhosis, sarcopenia is a predictor of acute decompensation (AD), acute-on-chronic liver failure (ACLF) and death. However, computer tomography (CT), as a suggested standard method for diagnosing sarcopenia, is resource intensive and involves radiation exposure. Therefore, in this study, we evaluate the muscle thickness of quadriceps femoris measured by ultrasound (US) as a prognostic parameter for AD and all-cause mortality in chronic liver disease.

Sixty-three patients with chronic liver disease and signs of portal hypertension were analysed in this prospective monocentric study for the occurrence of acute decompensation such as hepatic encephalopathy, ascites, haemorrhage and liver-related death within 1 year. We assessed muscle thickness at three different heights in terms of suitability as a predictor.

Among all 63 patients, 15 patients experienced acute decompensation, and 9 patients died due to liver-related death. We found the upper third of the muscle, measured without applying pressure with the transducer, to be the most significant for predicting AD/ACLF [AUC 0.739 (confidence interval (CI) 0.604-0.874, p = 0.006]. A cut-off value of US-defined muscle thickness standardized per height for identifying sarcopenia was determined (1.83 cm/m). Patients with US-defined sarcopenia showed significantly higher rates of AD (38.9% vs. 3.7%, p = 0.001) and all-over 1-year mortality (27.8% vs. 3.7%, p = 0.013). The mean AD free survival time is 8.3 months (95% CI 6.6-9.9) for sarcopenic patients and 11.8 months (95% CI 11.0-12.6) for the non-sarcopenic cohorts. Corresponding CT analysis displayed similar results for AD free survival for both groups (40% AD rate in the sarcopenic group vs. 7% AD rate in the non-sarcopenic group, p = 0.001). The risk for AD was significantly higher in the sarcopenic cohort compared with those without sarcopenia in both US and CT (US: HR 16.6; p = 0.009; 95% CI 2.0-136.0; CT: HR 8.7; p = 0.017; 95% CI 1.5-51.0). CT and US displayed a moderate agreement (p = 0.006; κ = 0.379).

Sarcopenia classification based on US measurements is shown to be an independent predictor of AD occurrence within 1 year. This pilot study is the first to suggest that screening for sarcopenia by ultrasonography may be useful for risk assessment in patients with chronic liver disease and signs of portal hypertension.

Low muscle mass (MM) is significant in cancer patients, and computed tomography (CT) is considered the reference standard for MM assessment. We investigated the consistency of CT and multifrequency bioelectrical impedance analysis (mBIA) in detecting body composition at baseline and during anticancer treatment and the relationship between MM and malnutrition as well as complications in lung and cervical cancer patients.

Abdominal CT and mBIA were conducted to assess body composition at baseline for all patients and repeated for patients with cervical cancer after 4 wk of chemoradiotherapy. Concordance was compared by intraclass correlation coefficient and Bland-Altman plots. Receiver operating characteristic analysis was used to assess the diagnostic efficacy of mBIA for low MM. Correlation analysis was conducted to assess the relationship between MM and Nutritional Risk Screening 2002 and Global Leadership Initiative on Malnutrition. Furthermore, we assessed whether there was a difference in the incidence of chemoradiotherapy side effects in the low MM group derived by CT or mBIA.

A total of 77 cervical and 73 lung cancer patients were enrolled. mBIA showed fair discriminative capacity (area under the curve = 0.651) for detecting low MM, the concordance of skeletal MM and visceral fat area between CT and mBIA was good (intraclass correlation coefficient = 0.712 and 0.698, respectively), and mBIA and CT had consistent observations of muscle and fat changes (P = 0.051 and 0.124, respectively). There was no difference in the incidence of chemoradiotherapy side effects in the low MM group compared with controls regardless of whether derived by CT or mBIA (P > 0.05). MM was correlated with Nutritional Risk Screening 2002 and Global Leadership Initiative on Malnutrition but showed unsatisfactory prediction of malnutrition (area under the curve <0.7).

mBIA- and CT-derived body composition was highly correlated, and agreement was reached on body composition changes during treatment.

To investigate the association between sarcopenia, as appraised with CT-derived muscle metrics, and cardiovascular status, as assessed via coronary CT angiography (CCTA) using the Coronary Artery Disease-Reporting and Data System (CAD-RADS) and with pericoronary adipose tissue (pCAT) metrics.

A retrospective observational study conducted on patients who underwent CCTA. The cross-sectional area (CSA) and attenuation values of the paravertebral muscles at the T8 level and the pectoralis major muscles at the T6 level were measured. The patient height was employed for the normalization of the skeletal muscle CSA. The pCAT attenuation around the coronary arteries was assessed, and the CAD severity was graded using the CAD-RADS reporting system. Regression analyses were performed to assess the impact of demographics, clinical factors, and CT variables on the CAD-RADS and pCAT.

A total of 220 patients were included (132 males, median age 65 years). Regression analyses showed the associations of CAD with age and sex (p < 0.001). Familiarity with CAD was related to the left anterior descending artery pCAT (p = 0.002) and circumflex artery pCAT (p = 0.018), whereas age was related to the left anterior descending artery pCAT (p = 0.032). Weak positive correlations were found between the lower muscle density and lower pCAT attenuation (ρ = 0.144-0.240, p < 0.039).

This study demonstrated weak associations between the sarcopenia indicators and the cardiovascular risk, as assessed by the CAD severity and pCAT inflammation. However, these correlations were not strong predictors of CAD severity, as age and traditional cardiovascular risk factors overshadowed the impact of sarcopenia in the cardiovascular risk assessment.

Sarcopenia is a prevalent condition with significant clinical implications, and it is expected to escalate globally, demanding for effective diagnostic strategies, possibly at an early stage of the disease. Imaging techniques play a pivotal role in comprehensively evaluating sarcopenia, offering insights into both muscle quantity and quality. Among all the imaging techniques currently used for the diagnosis and follow up of sarcopenia, it is possible to distinguish two classes: Rx based techniques, using ionizing radiations, and non-invasive techniques, which are based on the use of safe and low risk diagnostic procedures. Dual-energy x-ray Absorptiometry and Computed Tomography, while widely utilized, entail radiation exposure concerns. Ultrasound imaging offers portability, real-time imaging, and absence of ionizing radiation, making it a promising tool Magnetic Resonance Imaging, particularly T1-weighted and Dixon sequences, provides cross- sectional and high-resolution images and fat-water separation capabilities, facilitating precise sarcopenia quantification. Bioelectrical Impedance Analysis (BIA), a non-invasive technique, estimates body composition, including muscle mass, albeit influenced by hydration status. Standardized protocols, such as those proposed by the Sarcopenia through Ultrasound (SARCUS) Working Group, are imperative for ensuring consistency across assessments. Future research should focus on refining these techniques and harnessing the potential of radiomics and artificial intelligence to enhance diagnostic accuracy and prognostic capabilities in sarcopenia.

During the COVID-19 pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected millions of people worldwide, with acute respiratory distress syndrome (ARDS) being the most common severe condition of pulmonary involvement. Despite its involvement in the lungs, SARS-CoV-2 causes multiple extrapulmonary manifestations, including manifestations in the musculoskeletal system. Several cases involving bone, joint, muscle, neurovascular and soft tissues were reported shortly after pandemic onset. Even after the acute infection has resolved, many patients experience persistent symptoms and a decrease in quality of life, a condition known as post-COVID syndrome or long COVID. COVID-19 vaccines have been widely available since December 2020, preventing millions of deaths during the pandemic. However, adverse reactions, including those involving the musculoskeletal system, have been reported in the literature. Therefore, the primary goal of this article is to review the main imaging findings of SARS-CoV-2 involvement in the musculoskeletal system, including acute, subacute, chronic and postvaccination manifestations.

This narrative review highlights the degree to which new antiobesity medications based on gut-derived nutrient-stimulated hormones (incretins) cause loss of lean mass, and the importance of resistance exercise to preserve muscle. Glucagon-like peptide 1 receptor agonists (GLP-1RA) induce substantial weight loss in randomized trials, effects that may be enhanced in combination with glucose-dependent insulinotropic polypeptide (GIP) receptor agonists. Liraglutide and semaglutide (GLP-1RA), tirzepatide (GLP-1 and GIP receptor dual agonist), and retatrutide (GLP-1, GIP, and glucagon receptor triple agonist) are peptides with incretin agonist activity that induce ∼15-24% weight loss in adults with overweight and obesity, alongside beneficial impacts on blood pressure, cholesterol, blood glucose, and insulin. However, these agents also cause rapid and significant loss of lean mass (∼10% or ∼6 kg), comparable to a decade or more of aging. Maintaining muscle mass and function as humans age is crucial to avoiding sarcopenia and frailty, which are strongly linked to morbidity and mortality. Studies indicate that supervised resistance exercise training interventions with a duration >10 weeks can elicit large increases in lean mass (∼3 kg) and strength (∼25%) in men and women. After a low-calorie diet, combining aerobic exercise with liraglutide improved weight loss maintenance compared with either alone. Retaining lean mass during incretin therapy could blunt body weight (and fat) regain on cessation of weight loss pharmacotherapy. We propose that tailored resistance exercise training be recommended as an adjunct to incretin therapy to optimize changes in body composition by preserving lean mass while achieving fat loss.

This review discusses the quantitative assessment of tissue composition in the human body (body composition, BC) using radiological methods. Such analyses are gaining importance, in particular, for oncological and metabolic problems. The aim is to present the different methods and definitions in this field to a radiological readership in order to facilitate application and dissemination of BC methods. The main focus is on radiological cross-sectional imaging.

The review is based on a recent literature search in the US National Library of Medicine catalog (pubmed.gov) using appropriate search terms (body composition, obesity, sarcopenia, osteopenia in conjunction with imaging and radiology, respectively), as well as our own work and experience, particularly with MRI- and CT-based analyses of abdominal fat compartments and muscle groups.

Key post-processing methods such as segmentation of tomographic datasets are now well established and used in numerous clinical disciplines, including bariatric surgery. Validated reference values are required for a reliable assessment of radiological measures, such as fatty liver or muscle. Artificial intelligence approaches (deep learning) already enable the automated segmentation of different tissues and compartments so that the extensive datasets can be processed in a time-efficient manner - in the case of so-called opportunistic screening, even retrospectively from diagnostic examinations. The availability of analysis tools and suitable datasets for AI training is considered a limitation.

· Radiological imaging methods are increasingly used to determine body composition (BC).. · BC parameters are usually quantitative and well reproducible.. · CT image data from routine clinical examinations can be used retrospectively for BC analysis.. · Prospectively, MRI examinations can be used to determine organ-specific BC parameters.. · Automated and in-depth analysis methods (deep learning or radiomics) appear to become important in the future..

· Linder N, Denecke T, Busse H. Body composition analysis by radiological imaging - methods, applications, and prospects. Fortschr Röntgenstr 2024; 196: 1046 - 1054.

Sarcopenia is the age-related loss of skeletal muscle mass and function. Computed tomography (CT) assessments of sarcopenia utilize measurements of skeletal muscle cross-sectional area (SMA), radiation attenuation (SMRA), and intramuscular adipose tissue (IMAT). Unadjusted SMA is strongly correlated with both height and body mass index (BMI); therefore, SMA must be adjusted for body size to assess sarcopenic low muscle mass fairly in individuals of different heights and BMI. SMA/height (rather than S M A / h e i g h t 2 ) provides optimal height adjustment, and vertebra-specific relative muscle index (RMI) equations optimally adjust for both height and BMI. Since L3 measurement is not available in all CT scans, sarcopenic low muscle mass may be assessed using other levels. Both a mid-vertebral slice and an inferior slice have been used to define 'L3 SMA', but the effect of vertebral slice location on SMA measurements is unexplored. Healthy reference values for skeletal muscle measures at mid- and inferior vertebra slices between T10 and L5, have not yet been reported. We extracted T10 through L5 SMA, SMRA, and IMAT at a mid-vertebral and inferior slice using non-contrast-enhanced CT scans from healthy, adult kidney donor candidates between age 18 and 73. We compared paired differences in SMA between the mid-vertebral slice versus the inferior slice. We calculated the skeletal muscle gauge as S M G HT = S M R A ∗ S M I HT . We used allometric analysis to find the optimal height scaling power for SMA. To enable comparisons with other published reference cohorts, we computed two height-adjusted measures; S M I HT = S M A / h e i g h t (optimal) and S M I H T 2 = S M A / h e i g h t 2 (traditional). Using the young, healthy reference cohort, we utilized multiple linear regression to calculate relative muscle index z-scores ( R M I HT , R M I H T 2 ), which adjust for both height and BMI, at each vertebra level. We assessed Pearson correlations of each muscle area measure versus age, height, weight, and BMI separately by sex and vertebra number. We assessed the differences in means between age 18-40 versus 20-40 as the healthy, young adult reference group. We reported means, standard deviations, and sarcopenia cutpoints (mean-2SD and 5th percentile) by sex and age group for all measures. Sex-specific allometric analysis showed that height to the power of one was the optimal adjustment for SMA in both men and women at all vertebra levels. Differences between mid-vertebra and inferior slice SMA were statistically significant at each vertebra level, except for T10 in men. S M I HT was uncorrelated with height, whereas S M I H T 2 was negatively correlated with height at all vertebra levels. Both S M I HT and S M I H T 2 were positively correlated with BMI at all vertebra levels. R M I HT was uncorrelated with BMI, weight, and height (minimal positive correlation in women at L3 inf , L4 mid , and L5 inf ) whereas R M I H T 2 was uncorrelated with BMI, but negatively correlated with height and weight at all levels. There were no significant differences in SMA between 18-40 versus 20-40 age groups. Healthy reference values and sarcopenic cutpoints are reported stratified by sex, vertebra level, and age group for each measure. Height to the power of one (SMA/height) is the optimal height adjustment factor for SMA at all levels between T10 mid through L5 inf . The use of S M A / h e i g h t 2 should be discontinued as it retains a significant negative correlation with height and is therefore biased towards identifying sarcopenia in taller individuals. Measurement of SMA at a mid-vertebral slice is significantly different from measurement of SMA at an inferior aspect slice. Reference values should be used for the appropriate slice. We report sarcopenic healthy reference values for skeletal muscle measures at the mid-vertebral and inferior aspect slice for T10 through L5 vertebra levels. Relative muscle index (RMI) equations developed here minimize correlation with both height and BMI, producing unbiased assessments of relative muscle mass across the full range of body sizes. We recommend the use of these RMI equations in other cohorts.

This study aimed to examine the potential correlation between myosteatosis and the prognosis of patients diagnosed with liver cirrhosis by a meta-analysis.

Cohort studies of relevance were acquired through comprehensive searches of the Medline, Web of Science, and Embase databases. To account for heterogeneity, a random-effects model was employed to combine the findings.

The meta-analysis included 10 retrospective and four prospective cohort studies, encompassing a total of 4287 patients diagnosed with cirrhosis. The pooled findings indicated a notable decline in transplant-free survival (TFS) among individuals with liver cirrhosis and myosteatosis compared to those without this condition (risk ratio: 1.94; 95% confidence interval: 1.61 to 2.34, p < 0.001; I2 = 49%). The predefined subgroup analyses demonstrated consistent findings across various categories, including Asian and non-Asian studies, prospective and retrospective cohort studies, patients with cirrhosis overall and those who underwent transjugular intrahepatic portosystemic shunt, studies with different follow-up durations (< or ≥ 24 months), studies employing univariate and multivariate analyses, and studies with and without an adjustment for sarcopenia (p > 0.05 for all subgroup differences). Additionally, Egger's regression test indicated the presence of significant publication bias (p = 0.044). However, trim-and-fill analysis by including three hypothesized studies showed consistent results.

The presence of myosteatosis in individuals diagnosed with liver cirrhosis may potentially be linked to a poor TFS prognosis. Further investigations are required to ascertain whether enhancing myosteatosis could potentially yield a survival advantage for this particular patient population.

To develop and validate a predictive model for sarcopenia.

A total of 240 subjects who visited our hospital between August 2021 and May 2023 were randomly divided by time of entry into a training set containing 2/3 of patients and a validation set containing 1/3 of patients. The muscle thickness (MT), echo intensity (EI), and shear wave velocity (SWV) of the medial gastrocnemius muscle were measured. Indicators that were meaningful in the univariate analysis in the training set were included in a binary logistic regression to derive a regression model, and the model was evaluated using a consistency index, calibration plot, and clinical validity curve. Diagnostic efficacy and clinical applicability were compared between the model and unifactorial indicators.

Four meaningful variables, age, body mass index (BMI), MT, and SWV, were screened into the predictive model. The model was Logit Y = 21.292 + 0.065 × Age - 0.411 × BMI - 0.524 × MT - 3.072 × SWV. The model was well differentiated with an internally validated C-index of 0.924 and an external validation C-index of 0.914. The calibration plot predicted probabilities against actual probabilities showed excellent agreement. The specificity, sensitivity, and Youden's index of the model were 73.80%, 97.40%, and 71.20%, respectively, when using the diagnostic cut-off value of >0.279 for sarcopenia. The logistic model had higher diagnostic efficacy (p < 0.001) and higher net clinical benefit (p < 0.001) over the same threshold range compared to indicators.

The logistic model of sarcopenia has been justified to have good discriminatory, calibrated, and clinical validity, and has higher diagnostic value than indicators.

Malabsorption and malnutrition are common gastrointestinal manifestations clinicians face, requiring diagnostic workup for effective diagnosis and management of the underlying cause. This review discusses recent advances in diagnostic approaches to malabsorption and maldigestion of macronutrients - lipids, proteins, and carbohydrates. We highlight underrecognized causes, available testing modalities, and ongoing diagnostic unmet needs.

Innovations in the diagnostic landscape are enhancing our understanding of malabsorption syndromes. Stool collection and handling is uncomfortable and commonly avoided. The objective quantification of stool lipids, bile acids, and gut enzymes is therefore underused in the diagnosis and management of common disorders such as exocrine pancreatic insufficiency, bile acid diarrhea, protein-losing enteropathy, and more. We review the recent advancements in spot quantification of stool fat and bile acid content, endoscopic imaging techniques such as endocytoscopy, confocal laser endomicroscopy, and optical coherence tomography and the future place in clinical practice.

Malabsorption and maldigestion represent significant challenges in clinical nutrition and gastroenterology. Through the integration of advanced diagnostic techniques, clinicians will be better equipped to tailor therapy and monitor treatment response, ultimately improving patient health outcomes. This review underscores the critical role of innovative diagnostic tools in accurately detecting and effectively managing gastrointestinal disorders linked to nutritional status.

Iatrogenic pneumothorax is a relevant complication of computed tomography (CT)-guided percutaneous lung biopsy. The aim of the present study was to analyze the prognostic significance of texture analysis, emphysema score and muscle mass derived from CT-imaging to predict postinterventional pneumothorax after CT-guided lung biopsy. Consecutive patients undergoing CT-guided percutaneous lung biopsy between 2012 and 2021 were analyzed. Multivariate logistic regression analysis included clinical risk factors and CT-imaging features to detect associations with pneumothorax development. Overall, 479 patients (178 females, mean age 65 ± 11.7 years) underwent CT-guided percutaneous lung biopsy of which 180 patients (37.5%) developed pneumothorax including 55 patients (11.5%) requiring chest tube placement. Risk factors associated with pneumothorax were chronic-obstructive pulmonary disease (COPD) (p = 0.03), age (p = 0.02), total lung capacity (p < 0.01) and residual volume (p = 0.01) as well as interventional parameters needle length inside the lung (p < 0.001), target lesion attached to pleura (p = 0.04), and intervention duration (p < 0.001). The combined model demonstrated a prediction accuracy of the occurrence of pneumothorax with an AUC of 0.78 [95%CI: 0.70-0.86] with a resulting sensitivity 0.80 and a specificity of 0.66. In conclusion, radiomics features of the target lesion and the lung lobe CT-emphysema score are predictive for the occurrence of pneumothorax and need for chest insertion after CT-guided lung biopsy.

Osteoporosis is the most prevalent skeletal disorder, a condition that is associated with significant social and healthcare burden. In the elderly, osteoporosis is commonly associated with sarcopenia, further increasing the risk of fracture. Several imaging techniques are available for a non-invasive evaluation of osteoporosis and sarcopenia. This review focuses on dual-energy X-ray absorptiometry (DXA), as this technique offers the possibility to evaluate bone mineral density and body composition parameters with good precision and accuracy. DXA is also able to evaluate the amount of aortic calcification for cardiovascular risk estimation. Additionally, new DXA-based parameters have been developed in recent years to further refine fracture risk estimation, such as the Trabecular Bone Score and the Bone Strain Index. Finally, we describe the recent advances of a newly developed ultrasound-based technology known as Radiofrequency Echographic Multi-Spectrometry, which represent the latest non-ionizing approach for osteoporosis evaluation at central sites.