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Updated: Jun 17, 2025
Segmentation and Linear Measurement for Body Composition Analysis using Slice-O-Matic and Horos
Published on: March 21, 2021
AI-based volumetric six-tissue body composition quantification from CT cardiac attenuation scans enhances mortality
Jirong Yi1, Anna M Michalowska1,2, Aakash Shanbhag1,3
1Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Background:
Computed tomography attenuation correction (CTAC) scans are routinely obtained during cardiac perfusion imaging, but currently only utilized for attenuation correction and visual calcium estimation. We aimed to develop a novel artificial intelligence (AI)-based approach to obtain volumetric measurements of chest body composition from CTAC scans and evaluate these measures for all-cause mortality (ACM) risk stratification.
Methods:
We applied AI-based segmentation and image-processing techniques on CTAC scans from a large international image-based registry (four sites), to define chest rib cage and multiple tissues. Volumetric measures of bone, skeletal muscle (SM), subcutaneous, intramuscular (IMAT), visceral (VAT), and epicardial (EAT) adipose tissues were quantified between automatically-identified T5 and T11 vertebrae. The independent prognostic value of volumetric attenuation, and indexed volumes were evaluated for predicting ACM, adjusting for established risk factors and 18 other body compositions measures via Cox regression models and Kaplan-Meier curves.
Findings:
End-to-end processing time was <2 minutes/scan with no user interaction. Of 9918 patients studied, 5451(55%) were male. During median 2.5 years follow-up, 610 (6.2%) patients died. High VAT, EAT and IMAT attenuation were associated with increased ACM risk (adjusted hazard ratio (HR) [95% confidence interval] for VAT: 2.39 [1.92, 2.96], p<0.0001; EAT: 1.55 [1.26, 1.90], p<0.0001; IMAT: 1.30 [1.06, 1.60], p=0.0124). Patients with high bone attenuation were at lower risk of death as compared to subjects with lower bone attenuation (adjusted HR 0.77 [0.62, 0.95], p=0.0159). Likewise, high SM volume index was associated with a lower risk of death (adjusted HR 0.56 [0.44, 0.71], p<0.0001).
Interpretations:
CTAC scans obtained routinely during cardiac perfusion imaging contain important volumetric body composition biomarkers which can be automatically measured and offer important additional prognostic value.
