Purpose To exploit the long 3.0T relaxation times and low flow velocity of lymphatic fluid to develop a noninvasive 3.0T lymphangiography sequence and evaluate its relevance in patients with lymphedema. Methods A 3.0T turbo-spin-echo (TSE) pulse train with long echo time (TEeffective=600ms; shot-duration=13.2ms) and TSE-factor (TSE-factor=90) was developed and signal evolution simulated. The method was evaluated in healthy adults (n=11) and patients with unilateral breast cancer treatment-related lymphedema (BCRL; n=25), with a subgroup (n=5) of BCRL participants scanned before and after manual lymphatic drainage (MLD) therapy. Maximal lymphatic vessel cross-sectional area, signal-to-noise-ratio (SNR), and results from a five point categorical scoring system were recorded. Nonparametric tests were applied to evaluate study parameter differences between controls and patients, as well as between affected and contralateral sides in patients (significance criteria: two-sided p<0.05). Results Patient volunteers demonstrated larger lymphatic cross-sectional areas in the affected (arm=12.9±6.3mm2; torso=17.2±15.6mm2) vs. contralateral (arm=9.4±3.9mm2; torso=9.1±4.6mm2) side; this difference was significant both for the arm (p=0.014) and torso (p=0.025). Affected (arm: p=0.010; torso: p=0.016) but not contralateral (arm: p=0.42; torso: p=0.71) vessel areas were significantly elevated compared with control values. Lymphatic cross-sectional areas reduced following MLD on the affected side (pre-MLD: arm=8.8±1.8mm2; torso=31.4±26.0mm2; post-MLD: arm=6.6±1.8mm2; torso=23.1±24.3mm2). This change was significant in the torso (p=0.036). The categorical scoring was found to be less specific for detecting lateralizing disease compared to lymphatic-vessel areas. Conclusion A 3.0T lymphangiography sequence is proposed, which allows for upper extremity lymph stasis to be detected in approximately 10 minutes without exogenous contrast agents.

Background Smokers have lower risk of obesity, which some consider a "beneficial" side effect of smoking. However, some studies suggest that smoking is simultaneously associated with higher central adiposity and, more specifically, ectopic adipose deposition. Little is known about the association of smoking with intermuscular adipose tissue (IMAT), an ectopic adipose depot associated with cardiovascular disease (CVD) risk and a key determinant of muscle quality and function. We tested the hypothesis that smokers have higher abdominal IMAT and lower lean muscle quality than never smokers. Methods and findings We measured abdominal muscle total, lean, and adipose volumes (in cubic centimeters) and attenuation (in Hounsfield units [HU]) along with subcutaneous (SAT) and visceral adipose tissue (VAT) volumes using computed tomography (CT) in 3,020 middle-aged Coronary Artery Risk Development in Young Adults (CARDIA) participants (age 42-58, 56.3% women, 52.6% white race) at the year 25 (Y25) visit. The longitudinal CARDIA study was initiated in 1985 with the recruitment of young adult participants (aged 18-30 years) equally balanced by female and male sex and black and white race at 4 field centers located in Birmingham, AL, Chicago, IL, Minneapolis, MN, and Oakland, CA. Multivariable linear models included potential confounders such as physical activity and dietary habits along with traditional CVD risk factors. Current smokers had lower BMI than never smokers. Nevertheless, in the fully adjusted multivariable model with potential confounders, including BMI and CVD risk factors, adjusted mean (95% CI) IMAT volume was 2.66 (2.55-2.76) cm 3 in current

Background and Objective. Sarcopenia is associated with decreased survival and increased complications in carcinoma patients. We hypothesized that sarcopenic soft-tissue sarcoma (STS) patients would have decreased survival, increased incidence of wound complications, and increased length of postresection hospital stay (LOS). Methods. A retrospective, single-center review of 137 patients treated surgically for STS was conducted. Sarcopenia was assessed by measuring the cross-sectional area of bilateral psoas muscles (total psoas muscle area, TPA) at the level of the third lumbar vertebrae on a pretreatment axial computed tomography scan. TPA was then adjusted for height (cm2/m2). The association between height-adjusted TPA and survival was assessed using Cox proportional hazard model. A logistical model was used to assess the association between height-adjusted TPA and wound complications. A linear model was used to assess the association between height-adjusted TPA and LOS. Results. Height-adjusted TPA was not an independent predictor of overall survival (p = 0.746). Patient age (p = 0.02) and tumor size (p = 0.009) and grade (p = 0.001) were independent predictors of overall survival. Height-adjusted TPA was not a predictor of increased hospital LOS (p = 0.66), greater incidence of postoperative infection (p = 0.56), or other wound complications (p = 0.14). Conclusions. Sarcopenia does not appear to impact overall survival, LOS, or wound complications in patients with STS.

Quantification of fat and muscle on clinically acquired CT scans is critical for determination of body composition, a key component of health. Manual tracing has been regarded as the gold standard method of body segmentation; however, manual tracing is time-consuming. Many semi-automated/automated algorithms have been proposed to avoid the manual efforts. Previous efforts largely focused on segmenting 2D cross-sectional images (e.g., at L3/T4 vertebra locations) rather than on the whole-body volume. In this paper, we propose a fully automated 3D body composition estimation framework for segmenting the muscle and fat from abdominal CT scans. The 3D whole body segmentations were reconstructed from a slice-wise multi-atlas label fusion (MALF) based framework. First, we used a low-dimensional atlas representation to estimate each class for each axial slice. Second, the abdominal wall and psoas muscle were segmented by combining MALF with active shape models and deformable models. Third, skeletal muscle, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured to assess the areas of muscle and fat tissue. The proposed method was compared to manual segmentation and demonstrated high accuracy. Then, we evaluated the approach on 40 CT scans comparing the new method to a prior atlas-based segmentation method and achieved 0.854, 0.740, 0.887 and 0.933 on Dice similarity index for the skeletal muscle, psoas muscle, VAT and SAT, respectively. Compared with the baseline, our method showed significantly (p < 0.001) higher accuracy on skeletal muscle, VAT and SAT estimation.

No abstract