<i>Psoas</i> as a sentinel muscle for sarcopenia: a flawed premise

Baracos, Vickie E.

doi:10.1002/jcsm.12221

Cited by 181 publications

(160 citation statements)

References 13 publications

(18 reference statements)

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“…Recently, other researchers evaluating the use of practical strategies for measuring psoas area with a digital ruler on CT images obtained in cancer populations have reported mixed results . The measurement of psoas area alone as a surrogate of whole‐body skeletal muscle depletion, as well as a predictor of adverse clinical outcomes, has been criticized . In our cohort, psoas CSA measured using the conventional CT image analysis method constitutes 11.5% ± 3.3% of the total L3 skeletal muscle CSA, whereas the erector spinae and multifidus muscles correspond to 31.2% ± 5.6%.…”

Section: Discussionmentioning

confidence: 74%

Clinically Practical Approach for Screening of Low Muscularity Using Electronic Linear Measures on Computed Tomography Images in Critically Ill Patients

Avrutin

Moisey

Zhang

et al. 2017

J Parenter Enteral Nutr

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Section: Discussionmentioning

confidence: 74%

Clinically Practical Approach for Screening of Low Muscularity Using Electronic Linear Measures on Computed Tomography Images in Critically Ill Patients

Avrutin

Moisey

Zhang

et al. 2017

J Parenter Enteral Nutr

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“…Rutten et al [55] found a weak correlation between PMI and SMI in the assessment of sarcopenia in ovarian cancer, pointing out that psoas muscle was prone to be focally affected by degenerative diseases of the lumbar spine and this affection might be confused the muscle atrophy caused by cancer. Baracos [56] also indicated that psoas muscle alone does not reveal the muscle condition of the whole body. The characteristic of PMI as a reflection of the skeletal muscle condition of the whole body may need further discussion.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

et al. 2018

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Background: Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different indexes and studies remain controversial. Aim: The purpose of this meta-analysis was to evaluate various CT-assessed sarcopenia indexes as predictors of risk for major complications in patients undergoing hepatopancreatobiliary surgery for malignancy. Methods: Medline/PubMed, Web of Science, and Embase databases were systematically searched to identify relevant studies published before June 2018. PRISMA guidelines for systematic reviews were followed. The pooled risk ratio (RR) for major postoperative complications (Clavien-Dindo ≥III) was estimated in patients with sarcopenia versus patients without sarcopenia. Data extracted were meta-analyzed using Review Manager (version 5.3). Results: Twenty-eight studies comprising 6,656 patients were included in this study. CT-assessed sarcopenia indexes, such as skeletal muscle index (SMI, RR 1.36; 95% CI 1.14–1.63; p = 0.0008; I² = 24%), psoas muscle index (PMI, RR 1.35; 95% CI 1.15–1.58; p = 0.0002; I² = 0%), muscle attenuation (MA, RR 1.40; 95% CI 1.14–1.73; p = 0.002; I² = 4%), and intramuscular adipose tissue content (IMAC, RR 1.63; 95% CI 1.28–2.09; p < 0.0001; I² = 0%) were all predictors of postoperative major complications, although moderate heterogeneity existed and cutoffs for these indexes to define sarcopenia varied. Conclusions: All commonly used CT-assessed sarcopenia indexes, such as SMI, PMI, MA, and IMAC can predict the risk of major postoperative complications; however, a consensus on the cutoffs for these indexes to define sarcopenia is still lacking.

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“…Two recent studies among cancer patients have evaluated abbreviated methods for assessing skeletal muscle using digital rulers; both have focused on the psoas muscle alone, without quantifying the paraspinal muscle groups as done here 25, 47. The psoas represents only 10% of the total cross‐sectional muscle area measurable at L3 and may be an inadequate marker of whole body muscle in cancer patients 47.…”

Section: Discussionmentioning

confidence: 99%

“…The psoas represents only 10% of the total cross‐sectional muscle area measurable at L3 and may be an inadequate marker of whole body muscle in cancer patients 47. Rutten et al .…”

Section: Discussionmentioning

confidence: 99%

Screening for low muscularity in colorectal cancer patients: a valid, clinic‐friendly approach that predicts mortality

Feliciano

Avrutin

Caan

et al. 2018

J cachexia sarcopenia muscle

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BackgroundLow skeletal muscle quantified using computed tomography (CT) scans is associated with morbidity and mortality among cancer patients. However, existing methods to assess skeletal muscle from CT are time‐consuming, expensive, and require training. Clinic‐friendly tools to screen for low skeletal muscle in cancer patients are urgently needed.MethodsWe included 807 scans from non‐metastatic colorectal cancer patients. With the digital ruler available in most radiological software, we implemented an abbreviated method to assess skeletal muscle area at the third lumbar vertebra (L3), which consisted of assessing the height and width of the psoas and paraspinal muscles and computing their combined ‘linear area’ in centimetres squared (cm2). A subset of CT scans was assessed twice by two analysts to compute intra‐rater and inter‐rater reliability. We derived cut‐points for ‘low’ linear area using optimal stratification and then calculated the sensitivity and specificity of these cut‐points relative to standard methods (total L3 cross‐sectional area assessed with Slice‐O‐Matic research software). We further evaluated the association of low linear area with death from any cause after colorectal cancer diagnosis in Cox proportional hazards models adjusting for demographics, smoking, body mass index category, and tumour characteristics.ResultsThe linear area was highly correlated with total cross‐sectional area assessed using standard methods [r = 0.92; 95% confidence interval (CI): 0.91, 0.93] overall and within subgroups defined by age, sex, and body mass index group. Intra‐rater and inter‐rater reliability were equally high (both intra‐class correlations = 0.98). Cut‐points for low linear area were sensitive (0.75; 95% CI: 0.70, 0.80) and specific (0.77; 95% CI: 0.73, 0.80) for identifying low skeletal muscle relative to the standard of total L3 cross‐sectional area. The hazard ratio and 95% CI for death associated with a low linear area were hazard ratio = 1.66; 95% CI: 1.22, 2.25.ConclusionsClinic‐friendly methods that assess linear area from CT scans are an accurate screening tool to identify low skeletal muscle among non‐metastatic colorectal cancer patients. These linear measures are associated with mortality after colorectal cancer, suggesting they could be clinically useful both to improve prognostication and to provide a practical screening tool to identify cancer patients who require nutrition or exercise intervention.

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Psoas as a sentinel muscle for sarcopenia: a flawed premise

Cited by 181 publications

References 13 publications

Clinically Practical Approach for Screening of Low Muscularity Using Electronic Linear Measures on Computed Tomography Images in Critically Ill Patients

Clinically Practical Approach for Screening of Low Muscularity Using Electronic Linear Measures on Computed Tomography Images in Critically Ill Patients

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

Screening for low muscularity in colorectal cancer patients: a valid, clinic‐friendly approach that predicts mortality

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