Sarcopenia: how to measure, when and why Tagliafico, Alberto Stefano; Bignotti, Bianca; Torri, Lorenzo ...
Radiologia medica,
03/2022, Letnik:
127, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Sarcopenia indicates a loss of skeletal muscle mass, a condition that leads to a decline in physical performance. In 2018, the European Working Group on Sarcopenia in Older People met to update the ...original definition of sarcopenia: New scientific and clinical insights were introduced to emphasize the importance of muscle strength loss as a prime indicator of probable sarcopenia. In addition, the skeletal muscle is not only the organ related to mobility, but it is recognized as a secondary secretory organ too, with endocrine functions influencing several systems and preserving health. In this perspective, radiology could have a major role in early detection of sarcopenia and guarantee improvement in its treatment in clinical practice. We present here an update of clinical knowledge about sarcopenia and advantages and limitations of radiological evaluation of sarcopenia focusing on major body composition imaging modalities such as dual-energy X-ray absorptiometry, CT, and MRI. In addition, we discuss controversial such as the lack of consensus or standardization, different measurement methods, and diagnostic radiological cutoff points. Sarcopenia evaluation with radiological methods could enhance the role of radiologist in performing studies with relevant impact on medical and social outcome, placing radiology at the pinnacle of quality in evidence-based practice with high-level studies.
Objectives
To update the 2012 European Society of Musculoskeletal Radiology (ESSR) clinical consensus guidelines for musculoskeletal ultrasound referral in Europe.
Methods
Twenty-one musculoskeletal ...imaging experts from the ESSR participated in a consensus study based on a Delphic process. Two independent (non-voting) authors facilitated the procedure and resolved doubtful issues. Updated musculoskeletal ultrasound literature up to July 2017 was scored for shoulder, elbow, wrist/hand, hip, knee, and ankle/foot. Scoring of ultrasound elastography was included. The strength of the recommendation and level of evidence was scored by consensus greater than 67% or considered uncertain when the consensus was consensus less than 67%.
Results
A total of 123 new papers were reviewed. No evidence change was found regarding the shoulder. There were no new relevant articles for the shoulder, 10 new articles for the elbow, 28 for the hand/wrist, 3 for the hip, 7 for the knee, and 4 for the ankle/foot. Four new evidence levels of A were determined, one for the hip (gluteal tendons tears), one for the knee (meniscal cysts), one for the ankle (ankle joint instability), and one for the foot (plantar plate tear). There was no level A evidence for elastography, although for Achilles tendinopathy and lateral epicondylitis evidence level was B with grade 3 indication.
Conclusions
Four new areas of level A evidence were included in the guidelines. Elastography did not reach level A evidence. Whilst ultrasound is of increasing importance in musculoskeletal medical practice, the evidence for elastography remains moderate.
Key Points
• Evidence and expert consensus shows an increase of musculoskeletal ultrasound indications.
• Four new A evidence levels were found for the hip, knee, ankle, and foot.
• There was no level A evidence for elastography.
Blockchain usage in healthcare, in radiology, in particular, is at its very early infancy. Only a few research applications have been tested, however, blockchain technology is widely known outside ...healthcare and widely adopted, especially in Finance, since 2009 at least. Learning by history, radiology is a potential ideal scenario to apply this technology. Blockchain could have the potential to increase radiological data value in both clinical and research settings for the patient digital record, radiological reports, privacy control, quantitative image analysis, cybersecurity, radiomics and artificial intelligence.
Up-to-date experiences using blockchain in radiology are still limited, but radiologists should be aware of the emergence of this technology and follow its next developments. We present here the potentials of some applications of blockchain in radiology.
Objective
To assess the discriminative power of radiomics of peripheral nerves at 1.5T MRI, using common entrapment neuropathies of the upper limb as a model system of focal nerve injury.
Materials ...and methods
Radiomics was retrospectively done on peripheral nerve fascicles on T1-weighted 1.5T MRI of 40 patients with diagnosis of mild carpal (
n
= 25) and cubital tunnel (
n
= 15) syndrome and of 200 controls.
Z
-score normalization and Mann–Whitney
U
test were used to compare features of normal and pathological peripheral nerves. Receiver operating characteristic analysis was performed.
Results
A total of
n
= 104 radiomics features were computed for each patient and control. Significant differences between normal and pathological median and ulnar nerves were found in
n
= 23/104 features (
p
< 0.001). According to features classification,
n
= 5/23 features were shape-based,
n
= 7/23 were first-order features,
n
= 11/23 features were classified as gray level run length matrix. Nine of the selected features showed an AUC higher that 0.7: minimum AUC of 0.74 (95% CI 0.61–0.89) for sum variance and maximum AUC of 0.90 (95% CI 0.82–0.99) for zone entropy.
Conclusion
Features analysis demonstrated statistically significant differences between normal and pathological nerve. The results suggested that radiomics analysis could assess the median and ulnar nerve inner structure changes due to the loss of the fascicular pattern, intraneural edema, fibrosis or fascicular alterations in mild carpal tunnel and mild cubital tunnel syndromes even when the nerve cross-sectional area does not change.
ABSTRACT
Introduction
We prospectively compared ultrasound (US) and MRI in patients with common fibular neuropathy.
Methods
Forty adult patients with clinical suspicion of common fibular neuropathy ...and 40 healthy controls underwent both US and MRI. US and MRI datasets were randomized for prospective reading.
Results
The overall sensitivity of US and MRI for diagnosing fibular neuropathy was 90% (95% confidence interval CI, 79.7%‐97.3%) and 87.5% (95% CI, 71.55%‐93.1%), respectively. The overall specificity of US and MRI was 92% (95% CI, 77.45%‐96.1%) and 85% (95% CI, 73.3%‐94.4%), respectively. The overall sensitivity and specificity of US combined with MRI were 94% (95% CI, 0.80%‐0.99%) and 84% (95% CI, 0.70%‐0.91%), respectively. Overall intra‐ and inter‐observer agreements among 3 readers were 0.76% (95% CI, 0.62%‐0.85%) and 0.74% (95% CI, 0.65%‐0.81%).
Conclusions
US diagnostic accuracy for common fibular neuropathy was slightly higher than that of MRI. Muscle Nerve 55: 849–857, 2017
•Post procedure, increase of tendon thickness and Doppler signal was seen.•Post procedure, no cross-sectional area, signal intensity, echotexture variation was seen.•None of the pre-treatment ...parameters predicted treatment outcome.
To assess the correlation between magnetic resonance and ultrasound findings and clinical outcome after intratendinous injection of leucocyte-rich platelet-rich plasma or adipose-derived stromal vascular fraction in patients with non-insertional Achilles tendinopathy.
Forty-three patients (age: 47.8±5.1, range 29–55) with unilateral or bilateral non-insertional Achilles tendinopathy (58 tendons overall) were randomly assigned to platelet-rich plasma (22 patients, 28 tendons) or adipose-derived stromal vascular fraction (21 patients, 30 tendons) injection group. All patients underwent magnetic resonance (tendon cross-sectional area, signal intensity, maximum anteroposterior thickness were measured), ultrasound (maximum anteroposterior thickness, power Doppler signal, ultrasound gray scale echotexture were measured), and visual analogue scale (VAS) pain evaluation at baseline and at six months from treatment. Wilcoxon, intraclass correlation coefficient, repeated measure ANOVA tests were used.
There was a significant (P<0.001) decrease of mean VAS from pre-treatment (6.4±1.4) to six-month evaluation (1.8±1.7). Significant increase of tendon thickness measured using magnetic resonance (P=0.013) and ultrasound (P=0.012) and power Doppler signal (P=0.027) was seen. There was no significant difference between pre- and post-treatment cross sectional area, signal intensity, and echotexture (P>0.217). None of the pre-treatment parameters was a predictor of treatment outcome (P>0.104). There was an excellent agreement between tendon thickness measurement between magnetic resonance and ultrasound (intraclass correlation coefficient=0.986)
Both treatments seem to allow for clinical benefit, associated to early slight increase of tendon size and power Doppler signal. Imaging cannot be used as a predictor of clinical outcome.
Introduction: In peripheral nerve ultrasound, the healthy contralateral side may be used as internal control. Therefore, inherent side‐to‐side differences must be minimal. The goal of this study was ...to assess intrastudy, intraobserver, and interobserver reproducibility of ultrasound in comparative side‐to‐side evaluation of lower limb nerves. Methods: Lower limb nerves of 60 normal subjects were evaluated by 3 radiologists. Bilateral sciatic, tibial, common fibular, sural, lateral femoral cutaneous, femoral, obturator, and saphenous nerves were evaluated. Results: Overall, side‐to‐side differences were not statistically significant at any level. In the lower limb nerves, in a between‐limb comparison, the minimum detectable difference of cross‐sectional area ranged from 16.4 mm2 (sciatic nerve at the level of piriformis muscle) to 0.4 mm2 (saphenous nerve). Conclusion: In general, the healthy contralateral side can be used as an internal control. Muscle Nerve 46: 717–722, 2012
Hospitalized patients with COVID-19 can be classified into different clinical phenotypes based on their demographic, clinical, radiology, and laboratory features
In this study, we externally ...confirmed the prognostic impact of clinical phenotypes previously identified by Gutierrez-Gutierrez and colleagues in a Spanish cohort of hospitalized patients with COVID-19, and the usefulness of their simplified probabilistic model for phenotypes assignment
This could indirectly support the validity of both phenotype's development and their extrapolation to other hospitals and countries for management decisions during other possible future viral pandemics
Hospitalized patients with coronavirus disease 2019 (COVID-19) can be classified into different clinical phenotypes based on their demographic, clinical, radiology, and laboratory features. We aimed to validate in an external cohort of hospitalized COVID-19 patients the prognostic value of a previously described phenotyping system (FEN-COVID-19) and to assess the reproducibility of phenotypes development as a secondary analysis.
Patients were classified in phenotypes A, B or C according to the severity of oxygenation impairment, inflammatory response, hemodynamic and laboratory tests according to the FEN-COVID-19 method.
Overall, 992 patients were included in the study, and 181 (18%), 757 (76%) and 54 (6%) of them were assigned to the FEN-COVID-19 phenotypes A, B, and C, respectively. An association with mortality was observed for phenotype C vs. A (hazard ratio HR 3.10, 95% confidence interval CI 1.81-5.30, p < 0.001) and for phenotype C vs. B (HR 2.20, 95% CI 1.50-3.23, p < 0.001). A non-statistically significant trend towards higher mortality was also observed for phenotype B vs. A (HR 1.41; 95% CI 0.92-2.15, p = 0.115). By means of cluster analysis, three different phenotypes were also identified in our cohort, with an overall similar gradient in terms of prognostic impact to that observed when patients were assigned to FEN-COVID-19 phenotypes.
The prognostic impact of FEN-COVID-19 phenotypes was confirmed in our external cohort, although with less difference in mortality between phenotypes A and B than in the original study.
Background To perform a radiomics analysis in local recurrence (LR) surveillance of limb soft tissue sarcoma (STS) Patients and methods This is a sub-study of a prospective multicenter study with ...Institutional Review Board approval supported by ESSR (European Society of Musculoskeletal Radiology). radiomics analysis was done on fast spin echo axial T1w, T2w fat saturated and post-contrast T1w (T1wGd) 1.5T MRI images of consecutively recruited patients between March 2016 and September 2018. Results N = 11 adult patients (6 men and 5 women; mean age 57.8 ± 17.8) underwent MRI to exclude STS LR: a total of 33 follow-up events were evaluated. A total of 198 data-sets per patients of both pathological and normal tissue were analyzed. Four radiomics features were significantly correlated to tumor size (p < 0.02) and four radiomics features were correlated with grading (p < 0.05). ROC analysis showed an AUC between 0.71 (95%CI: 0.55-0.87) for T1w and 0.96 (95%CI: 0.87-1.00) for post-contrast T1w. Conclusions radiomics features allow to differentiate normal tissue from pathological tissue in MRI surveillance of local recurrence of STS. radiomics in STS evaluation is useful not only for detection purposes but also for lesion characterization.
Background
To investigate whether quantitative radiomic features extracted from digital breast tomosynthesis (DBT) are associated with Ki-67 expression of breast cancer.
Materials and methods
This is ...a prospective ethically approved study of 70 women diagnosed with invasive breast cancer in 2018, including 40 low Ki-67 expression (Ki-67 proliferation index <14%) cases and 30 high Ki-67 expression (Ki-67 proliferation index ≥ 14%) cases. A set of 106 quantitative radiomic features, including morphological, grey/scale statistics, and texture features, were extracted from DBT images. After applying least absolute shrinkage and selection operator (LASSO) method to select the most predictive features set for the classifiers, low
versus
high Ki-67 expression was evaluated by the area under the curve (AUC) at receiver operating characteristic analysis. Correlation coefficient was calculated for the most significant features.
Results
A combination of five features yielded AUC of up to 0.698. The five most predictive features (sphericity, autocorrelation, interquartile range, robust mean absolute deviation, and short-run high grey-level emphasis) showed a statistical significance (
p
≤ 0.001) in the classification. Thirty-four features were significantly (
p
≤ 0.001) correlated with Ki-67, and five of these had a correlation coefficient of > 0.5.
Conclusion
The present study showed that quantitative radiomic imaging features of breast tumour extracted from DBT images are associated with breast cancer Ki-67 expression. Larger studies are needed in order to further evaluate these findings.
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