Clin Exp Otorhinolaryngol.  2019 Aug;12(3):317-324. 10.21053/ceo.2018.01613.

Diagnosis of Sarcopenia in Head and Neck Computed Tomography: Cervical Muscle Mass as a Strong Indicator of Sarcopenia

• Ufuk F
• Herek D
• Yüksel D

• KMID: 2455374
• DOI: http://doi.org/10.21053/ceo.2018.01613

Abstract

OBJECTIVES
Patients with head and neck cancer (HNC) have a high risk of sarcopenia, which is associated with poor prognosis. Skeletal-muscle area and index at the third lumbar (L3) vertebra level (L3MA and L3MI) are recommended for the detection of sarcopenia. However, L3 level is not included in many imaging protocols and there are no data for optimal levels and cutoffs for the diagnosis of sarcopenia in head and neck computed tomography (HNCT) scans. Our aim was to assess the relationship between cervical paravertebral muscle values and L3MI and to investigate optimal level to diagnose sarcopenia on HNCTs.
METHODS
Patients with HNC (n=159) who underwent positron emission tomography-CT for tumor staging were retrospectively analyzed. On CT images, paravertebral and sternocleidomastoid muscle areas at second (C2), third (C3), and fourth (C4) cervical vertebrae levels (C2MA, C3MA, C4MA, SCMA) and L3MA were measured. Cross-sectional areas were normalized for stature (muscle area/height square) and muscle index (C2MI, C3MI, C4MI, SCMI, L3MI) values were obtained. Spearman correlation and linear regression analyses were used for assessing correlations. To calculate the diagnostic performance of SCMI, C2MI, C3MI, and C4MI for the diagnosis of sarcopenia with respect to the cutoffs of L3MI, receiver operating characteristic (ROC) analysis was used.
RESULTS
Males had significantly higher muscle areas than females. Although C2MI, C3MI, C4MI, and SCMI values all showed very strong and significant correlation with L3MI (P<0.001). According to the ROC analysis, the best discriminative for sarcopenia was C3MI in males (area under curve [AUC], 0.967) and SCMI in females (AUC, 0.898).
CONCLUSION
C2MI, C3MI, C4MI, and SCMI values can be used as alternatives for the diagnosis of sarcopenia in routine HNCT examinations.

Keyword

Sarcopenia; Computed Tomography; Head and Neck Neoplasms; Computer-Assisted Image Analysis; Body Mass Index

MeSH Terms

Body Mass Index
Cervical Vertebrae
Diagnosis*
Electrons
Female
Head and Neck Neoplasms
Head*
Humans
Image Processing, Computer-Assisted
Linear Models
Male
Neck*
Neoplasm Staging
Prognosis
Retrospective Studies
ROC Curve
Sarcopenia*
Spine

Figure

• 

  Fig. 1. Paravertebral and sternocleidomastoid muscle areas measurements. The paravertebral muscle area measurements at second (C2, A), third (C3, B), and fourth (C4, C) cervical vertebrae levels. The sternocleidomastoid muscle area measurements at C2 (D), C3 (E), and C4 (F) levels.

• 

  Fig. 2. Example of skeletal muscle area measurement at the lower part of the third lumbar vertebrae (L3) level.

• 

  Fig. 3. Receiver operation characteristic curve for prediction of sarcopenia for the assessment of C2MI, C3MI, C4MI, and SCMI in the study total population (males and females). C2MI–C4MI, normalized paravertebral skeletal muscle areas at the level of C2–C4 vertebrae values for stature; SCMI, normalized sum of the bilateral sternocleidomastoid muscle areas at the levels of C2, C3, and C4 vertebrae values for stature.

• 

  Fig. 4. Receiver operation characteristic curve for prediction of sarcopenia for the assessment of C3MI in males (A) and C4MI in females (B). AUC, area under the curve; CI, confidence interval; C2MI–C4MI, normalized paravertebral skeletal muscle areas at the level of C2–C4 vertebrae values for stature; SCMI, normalized sum of the bilateral sternocleidomastoid muscle areas at the levels of C2, C3, and C4 vertebrae values for stature.

• 

  Fig. 5. Bland-Altman plots show the agreement of the L3MI and cervical paravertebral muscle indexes (C2MI, C3MI, C4MI, and SCMI) measurements. C2MI–C4MI, normalized paravertebral skeletal muscle areas at the levels of second (C2), third (C3), and fourth (C4) cervical vertebrae values for stature; SCMI, normalized sum of the bilateral sternocleidomastoid muscle areas at the levels of C2, C3, and C4 vertebrae values for stature; L3MI, normalized sum of the all skeletal muscle area at the lower part of L3 level value for stature.

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