Sarcopenia: how to measure, when and why Tagliafico, Alberto Stefano; Bignotti, Bianca; Torri, Lorenzo ...
La 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.
Diagnosis of early invasive breast cancer relies on radiology and clinical evaluation, supplemented by biopsy confirmation. At least three issues burden this approach: a) suboptimal sensitivity and ...suboptimal positive predictive power of radiology screening and diagnostic approaches, respectively; b) invasiveness of biopsy with discomfort for women undergoing diagnostic tests; c) long turnaround time for recall tests. In the screening setting, radiology sensitivity is suboptimal, and when a suspicious lesion is detected and a biopsy is recommended, the positive predictive value of radiology is modest. Recent technological advances in medical imaging, especially in the field of artificial intelligence applied to image analysis, hold promise in addressing clinical challenges in cancer detection, assessment of treatment response, and monitoring disease progression. Radiomics include feature extraction from clinical images; these features are related to tumor size, shape, intensity, and texture, collectively providing comprehensive tumor characterization, the so-called radiomics signature of the tumor. Radiomics is based on the hypothesis that extracted quantitative data derives from mechanisms occurring at genetic and molecular levels. In this article we focus on the role and potential of radiomics in breast cancer diagnosis and prognostication.
•In the screening setting, radiology sensitivity is suboptimal.•Artificial intelligence hold promise in cancer diagnosis and prognostication.•Radiomics include feature extraction from clinical images.
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.
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.
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.
Peripheral nerve imaging is recognized as a complement to clinical and neurophysiological assessment in the evaluation of peripheral nerves with the ability to impact patient management, even for ...small and difficult nerves. The European Society of Musculoskeletal Radiology,suggest to use ultrasound(US) for nerve evaluation due to the fact that, in sever anatomical area, magnetic resonance imaging is not able to give additional in-formations. US could be considered the first-choice approach for the assessment of peripheral nerves. The relative drawback of peripheral nerve US is the long learning curve and the deep anatomic competence to evaluate even small nerves. In the recent years, the role of US in peripheral nerve evaluation has been widened. In the past, nerve US was mainly used to assess nerve-cross sectional area, but now more advanced mea-surements and considerations are desirable and can boost the role of peripheral nerve US. Nerve echotexture evaluation was defined in 2010: The ratio between the hypoechoic and hyperechoic areas of peripheral nerves on US was called 'nerve density'. For evaluation of patients who have peripheral neuropathies, the role of peripheral nerve is US wider than simple cross-sectional area evaluation. Quantitative measurements describing the internal fascicular echotexture of peripheral nerves introduce the concept of considering US as a possible quantitative imaging biomarker technique. The potential of nerve US has started to be uncovered. It seems clear that only cross-sectional area measurement is no more sufficient for a comprehensive US evaluation of peripheral nerves.
Background
Breast density is an independent risk factor for breast cancer. Mammography is supplemented with handheld ultrasound (HHUS) to increase sensitivity. Automatic breast ultrasound (ABUS) is ...an alternative to HHUS. Our study wanted to assess the difference in execution and reading time between ABUS and HHUS.
Methods and materials
N
= 221 women were evaluated consecutively between January 2019 and June 2019 (average age 53 years; range 24–89). The execution and reading time of ABUS and HHUS was calculated with an available stopwatch. Time started for both procedures when the patient was ready on the examination table to be examined to the end of image acquisition and interpretation.
Results
No patients interrupted the exam due to pain or discomfort.
N
= 221 women underwent ABUS and HHUS;
N
= 11 patients refused to undergo both procedures due to time constraints and refused ABUS; therefore, 210 patients were enrolled with both ABUS and HHUS available. The average time to perform and read the exam was 5 min for HHUS (DS ± 1.5) with a maximum time of 11 min and a minimum of 2 min. The average time with ABUS was 17 min (DS ± 3.8, with a maximum time of 31 min and a minimum time of 9 min). The ABUS technique took longer to be performed in all patients, with an average difference of 11 min (range 3–23 min) per patient,
P
< 0,001. Separating ABUS execution from reading time we highlighted as ABUS execution is more time-consuming respect HHUS. In addition, we can underline that time required by radiologists is longer for ABUS even only considering the interpretation time of the exam.
Conclusion
A significant difference was observed in the execution and reading time of the two exams, where the HHUS method was more rapid and tolerated.
Objectives
The loss of skeletal muscle mass is widely considered a predictor of poor survival and toxicity in breast cancer patients. The aim of this study is to evaluate if there is pectoralis ...muscle area (PMA) variation, reflecting loss of skeletal muscle mass, on consecutive MRI examinations after neoadjuvant chemotherapy.
Methods
The retrospective study protocol was approved by our institutional review board. A total of
n
= 110 consecutive patients (mean age 56 ± 11 years) who were treated with neoadjuvant chemotherapy (NAC) for histologically proven primary breast cancer between January 2017 and January 2019 and in whom tumor response was checked with standard breast MRI were included. Two radiologists calculated the pectoralis muscle cross-sectional area before and after NAC.
Results
Time between the MRI examinations, before starting NAC and after completing NAC, was 166.8 ± 50 days. PMA calculated pre-NAC (8.14 cm
2
) was larger than PMA calculated post-NAC (7.03 cm
2
) (
p
< 0.001). According to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria, there were no significant differences between responders (complete or partial response) and non-responders (
p
= 0.362). The multivariate regression analysis did not show any significant relationships between ΔPMA and age, time between MRI exams, estrogen and progesterone receptor status, human epidermal growth factor receptor status (HER-2), Ki-67 expression, lymph node status, RECIST criteria, histological type, average lesion size, molecular categories, and grade. Inter-reader (
k
= 0.72) and intra-reader agreement (0.69 and 0.71) in PMA assessment were good.
Conclusions
Pectoralis muscle mass varies in breast cancer patients undergoing NAC and this difference can be estimated directly on standard breast MRI.
Key Points
• Pectoralis muscle area variation reflects loss of skeletal muscle mass.
• Pectoralis muscle area on MRI is reduced after NAC.
• Pectoralis muscle mass loss seems independent from other variables.
Objectives
Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of ...the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected.
Methods
We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications.
Results
A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus.
Conclusions
Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee.
Key Points
• A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR.
• Strong consensus with 100% agreement was obtained for all statements.
• Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments.
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