Psoas Cross-Sectional Measurements Using Manual CT Segmentation before and after Endovascular Aortic Repair (EVAR)

Abstract

Sarcopenia has been associated with an increased incidence of adverse outcomes, including higher mortality, after endovascular aortic repair (EVAR). We aim to use computed tomography (CT) to quantify changes in total psoas muscles area (PMA) and psoas muscle density (PMD) after EVAR, and to evaluate the reproducibility of both measurements. PMA and PMD were assessed via manual segmentation of the psoas muscle on pre- and post-operative CT scans belonging to consecutive patients who underwent EVAR. Wilcoxon test was used to compare PMA and PMD before and after EVAR, and inter- and intra-reader agreements of both methods were evaluated through Bland–Altman analysis. A total of 50 patients, 42 of them males (84%), were included in the study. PMA changes from 1243 mm2 (1006–1445 mm2) to 1102 mm2 (IQR 937–1331 mm2), after EVAR (p < 0.001). PMD did not vary between pre-EVAR (33 HU, IQR 26.5–38.7 HU) and post-EVAR (32 HU, IQR 26–37 HU, p = 0.630). At inter-reader Bland–Altman analysis, PMA showed a bias of 64.0 mm2 and a coefficient of repeatability (CoR) of 359.2 mm2, whereas PMD showed a bias of −2.43 HU and a CoR of 6.19 HU. At intra-reader Bland–Altman analysis, PMA showed a bias of −81.1 mm2 and a CoR of 394.6 mm2, whereas PMD showed a bias of 1.41 HU and a CoR of 6.36 HU. In conclusion, PMA decreases after EVAR. A good intra and inter-reader reproducibility was observed for both PMA and PMD. We thus propose to use PMA during the follow-up of patients who underwent EVAR to monitor muscle depletion after surgery.

Four-Dimensional Flow MRI for the Evaluation of Aortic Endovascular Graft: A Pilot Study

“…Therefore, 4D flow MRI may represent the ideal tool to follow up with both healthy subjects deemed to be at an increased risk, based on their anatomical characteristics, or patients submitted to TEVAR for whom a surveillance protocol with computed tomography angiography would be cumbersome and unjustified. On the other hand, with computed tomography angiography, it is possible to evaluate other new parameters, such as sarcopenia, which could be useful to identify patients with a lower long-term survival rate, irrespective of the patient’s age or gender [ 29 , 30 ].…”

The Changing Complementary Role of Multimodality Imaging in Clinical Cardiology

“…Sarcopenia is a progressive and generalized disorder characterized by the accelerated loss of skeletal muscle mass, strength and functionality. It was found to be associated with an increase in morbidity and mortality in various conditions, such as cancer and orthopaedic and abdominal surgery [ 16 ]. The use of psoas cross-sectional measurements using manual CT segmentation before and after an endovascular aortic repair of an abdominal aortic aneurysm has been suggested for the monitoring of muscle depletion after surgery [ 16 ].…”

“…It was found to be associated with an increase in morbidity and mortality in various conditions, such as cancer and orthopaedic and abdominal surgery [ 16 ]. The use of psoas cross-sectional measurements using manual CT segmentation before and after an endovascular aortic repair of an abdominal aortic aneurysm has been suggested for the monitoring of muscle depletion after surgery [ 16 ]. This interesting preliminary approach could also be of value and could possibly be further tested in aging frailty and end-stage heart failure and cachexia.…”