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Muscle Reference Values From Thoracic and Abdominal CT for Sarcopenia Assessment: The Framingham Heart Study
P Erik Tonnesen1, Nathaniel D Mercaldo, Ismail Tahir
1From the Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA (P.E.T., N.D.M., I.T., A.-S.W.D., W.A., A.G., F.J.F.); Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany (P.E.T.); Department of Medicine (D.P.K.), Harvard Medical School, Boston, MA (M.L.B., N.D.M., E.J.S., D.P.K., F.J.F.); Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA (B.A., M.L.B.); Department of Orthopedic Surgery, Harvard Medical School, Boston, MA (M.L.B.); Endocrine Division, Massachusetts General Hospital, Boston, MA (M.L.B.); Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA (E.J.S., D.P.K.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.J.S., D.P.K.).
Background:
Loss of muscle mass is a known feature of sarcopenia and predicts poor clinical outcomes. Although muscle metrics can be derived from routine computed tomography (CT) images, sex-specific reference values at multiple vertebral levels over a wide age range are lacking.
Objective:
The aim of this study was to provide reference values for skeletal muscle mass and attenuation on thoracic and abdominal CT scans in the community-based Framingham Heart Study cohort to aid in the identification of sarcopenia.
Materials And Methods:
This secondary analysis of a prospective trial describes muscle metrics by age and sex for participants from the Framingham Heart Study without prior history of cancer who underwent at least 1 CT scan between 2002 and 2011. Using 2 previously validated machine learning algorithms followed by human quality assurance, skeletal muscle was analyzed on a single axial CT image per level at the 5th, 8th, 10th thoracic, and 3rd lumbar vertebral body (T5, T8, T10, L3). Cross-sectional muscle area (cm 2 ), mean skeletal muscle radioattenuation (SMRA, in Hounsfield units), skeletal muscle index (SMI, in cm 2 /m 2 ), and skeletal muscle gauge (SMRA·SMI) were calculated. Measurements were summarized by age group (<45, 45-54, 55-64, 65-74, ≥75 years), sex, and vertebral level. Models enabling the calculation of age-, sex-, and vertebral-level-specific reference values were created and embedded into an open access online Web application.
Results:
The cohort consisted of 3804 participants (1917 [50.4%] males; mean age, 55.6 ± 11.8 years; range, 33-92 years) and 7162 CT scans. Muscle metrics qualitatively decreased with increasing age and female sex.
Conclusions:
This study established age- and sex-specific reference values for CT-based muscle metrics at thoracic and lumbar vertebral levels. These values may be used in future research investigating the role of muscle mass and attenuation in health and disease, and to identify sarcopenia.
