Related Experiment Video
Updated: Dec 31, 2025
Posterior Approach for Debridement of the Psoas Abscess
Published on: March 2, 2020
Paediatric reference values for total psoas muscle area
Eberhard Lurz1,2,3, Hiten Patel4,5, Gerald Lebovic6
1Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
This study establishes pediatric reference values for psoas muscle area (PMA) to aid in early sarcopenia identification in children. These findings provide crucial data for diagnosing muscle loss in pediatric populations.
Area of Science:
- Pediatric imaging and diagnostics
- Muscle physiology and aging
- Quantitative anatomy
Background:
- Sarcopenia, the loss of skeletal muscle mass, is linked to poor outcomes in adults.
- Children with chronic illnesses are at risk for muscle loss but lack consistent sarcopenia definitions.
- Psoas muscle area (PMA) is a key indicator for sarcopenia in adults.
Purpose of the Study:
- To generate pediatric reference values for psoas muscle area (PMA).
- To establish age-specific and sex-specific PMA percentile curves at L3-4 and L4-5 lumbar levels.
- To facilitate earlier identification and intervention for pediatric sarcopenia.
Main Methods:
- Cross-sectional analysis of abdominal CT scans from 779 children (ages 1-16) undergoing imaging for trauma.
- Exclusion of children with chronic medical conditions or spinal trauma.
- Measurement of total PMA (tPMA) at L3-4 and L4-5, followed by quantile regression to model percentile curves.
Main Results:
- High correlation between tPMA at L3-4 and L4-5 (r=0.95-0.98).
- Provided age-specific and sex-specific tPMA percentile ranges for both lumbar levels.
- Developed an online tool for calculating age- and sex-specific z-scores and percentiles.
Conclusions:
- Novel pediatric growth curves for tPMA at L3-4 and L4-5 are presented.
- These curves, along with an online tool, enable earlier identification of sarcopenia in children.
- The findings support targeted interventions for children at risk of muscle loss.
Background:
Sarcopenia, the unintentional loss of skeletal muscle mass, is associated with poor outcomes in adult patient populations. In adults, sarcopenia is often ascertained by cross-sectional imaging of the psoas muscle area (PMA). Although children with chronic medical illnesses may be at increased risk for muscle loss because of nutritional deficiencies, physical deconditioning, endocrine anomalies, and systemic inflammation, consistent quantitative definitions for sarcopenia in children are lacking. We aimed to generate paediatric reference values for PMA at two intervertebral lumbar levels, L3-4 and L4-5.
Methods:
In this cross-sectional study, we analysed abdominal computed tomography scans of consecutive children presenting to the emergency department. Participants were children 1-16 years who required abdominal cross-sectional imaging after paediatric trauma between January 1, 2005 and December 31, 2015 in a large Canadian quaternary care centre. Children with a documented chronic medical illness or an acute spinal trauma at presentation were excluded. Total PMA (tPMA) at levels L3-4 and L4-5 were measured in square millimetres (mm2 ) as the sum of left and right PMA. Age-specific and sex-specific tPMA percentile curves were modelled using quantile regression.
Results:
Computed tomography images from 779 children were included. Values of tPMA at L4-5 were significantly larger than at L3-4 at all ages, but their correlation was high for both girls (r = 0.95) and boys (r = 0.98). Amongst girls, tPMA 50th percentile values ranged from 365 to 2336 mm2 at L3-4 and from 447 to 2704 mm2 for L4-5. Amongst boys, 50th percentile values for tPMA ranged between 394 and 3050 mm2 at L3-4 and from 498 to 3513 mm2 at L4-5. Intraclass correlation coefficients were excellent at L3-4 (0.97, 95% CI 0.94 to 0.981) and L4-5 (0.99, 95% CI 0.986 to 0.995). Weight and tPMA were correlated, stratified by sex for boys (L3-4 r = 0.90; L4-5 r = 0.90) and for girls (L3-4 r = 0.87; L4-5 r = 0.87). An online application was subsequently developed to easily calculate age-specific and sex-specific z-scores and percentiles.
Conclusions:
We provide novel paediatric age-specific and sex-specific growth curves for tPMA at intervertebral L3-4 and L4-5 levels for children between the ages of 1-16 years. Together with an online tool (https://ahrc-apps.shinyapps.io/sarcopenia/), these tPMA curves should serve as a reference enabling earlier identification and targeted intervention of sarcopenia in children with chronic medical conditions.
