Association of CT-Derived Skeletal Muscle Radiodensity and Index With Cerebral Small Vessel Disease: A...

Skeletal muscle composition is linked to metabolic health, but its association with cerebral small vessel disease (CSVD) remains unclear. We examined associations of CT-derived skeletal muscle radiodensity (SMD) and skeletal muscle index (SMI) with CSVD.

This cross-sectional analysis included 2395 adults from the PRECISE study. SMD and SMI were measured on abdominal CT at L3. CSVD was assessed using Wardlaw and Rothwell scores. Individual MRI markers included lacunes, white matter hyperintensities, basal ganglia enlarged perivascular spaces (BG-EPVS) and cerebral microbleeds (CMBs). Logistic and ordinal logistic regression models were used, with additional covariate adjustment examined in sensitivity analyses. False discovery rate correction was applied to marker-specific analyses.

The mean age was 60.9 ± 6.6 years (56.8% women). In primary multivariable analyses, each 1-SD decrement in SMD was associated with CSVD presence (Wardlaw: OR: 1.16, 95% CI: 1.03-1.31; Rothwell: OR: 1.12, 95% CI: 1.00-1.25) and burden (total: cOR: 1.19, 95% CI: 1.06-1.33; modified total: cOR: 1.14, 95% CI: 1.03-1.27). With broader covariate adjustment, most of these associations were attenuated, with only Wardlaw total burden remaining statistically significant. The SMD-BG-EPVS association was similarly attenuated. Lower SMI was associated with CMB presence and burden, whereas no consistent association with overall CSVD was observed across models.

Lower SMD was associated with overall CSVD in primary analyses, but most associations were attenuated after broader adjustment. Lower SMI was consistently associated with CMBs, whereas its association with overall CSVD was less consistent across models.