Pelvic muscle size and myosteatosis: Relationship with age, gender, and obesity

Abstract

Purpose: To evaluate interreader performance in the measurement of the cross-sectional area and myosteatosis of pelvic skeletal muscles using fat quantification magnetic resonance imaging (MRI) and correlate with patient anthropomorphic characteristics. Materials and Methods: A Health Insurance Portability and Accountability Act–compliant retrospective cross-sectional study was performed. Between January and April 2016, 61 patients (26 males and 35 females) underwent a lumbosacral plexus 3T MRI with a modified three-dimensional spoiled gradient echo sequence dedicated to fat quantification (mDixon Quant; Philips Healthcare). Two independent reviewers outlined muscle cross-sectional area on axial images using a freehand region of interest tool and documented proton-density fat fraction (FF) and muscle area (cm²) of the psoas, gluteus medius, gluteus maximus, and rectus femoris muscles on each side. Interreader agreement was assessed by intraclass correlation coefficient (ICC), and correlation between the measurements and subject’s age, gender, and body mass index (BMI) was assessed using multiple linear regression analysis. Results: Excellent interreader agreement was obtained (ICC ≥0.74) for all muscle groups except for the left gluteus medius area and right psoas FF which showed good agreement (0.65 and 0.61, respectively). Statistically significant (P ≤ 0.05) positive correlation was seen between the gluteal muscle FF and area with BMI, and rectus muscle FF with age and BMI. Statistically significant negative correlation between the rectus femoris area and age was also observed. Conclusion: Fat quantification MRI is a highly reproducible imaging technique for the assessment of myosteatosis and muscle size. Intramuscular FF and cross-sectional area were correlated with age and BMI across multiple muscle groups.

Keywords

Adults - fat - measurement - MRI - muscular

Publication History

Article published online:
22 July 2021

• References

• 1 Centers for Disease Prevention. The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2013
• 2 Evans WJ, Campbell WW. Sarcopenia and age-related changes in body composition and functional capacity. J Nutr 1993; 123 Suppl (02) 465-8
• 3 Hamrick MW, McGee-Lawrence ME, Frechette DM. Fatty infiltration of skeletal muscle: Mechanisms and comparisons with bone marrow adiposity. Front Endocrinol 2016; 7: 69
• 4 Zhao Y, Chen SY, Lee YC, Wu N. Clinical and economic characteristics of hip fracture patients with and without muscle atrophy/weakness in the United States. Arch Osteoporos 2013; 8: 127
• 5 Hamaguchi Y, Kaido T, Okumura S, Kobayashi A, Fujimoto Y, Ogawa K. et al. Muscle steatosis is an independent predictor of postoperative complications in patients with hepatocellular carcinoma. World J Surg 2016; 40: 1959-68
• 6 Bokshan SL, DePasse JM, Daniels AH. Sarcopenia in orthopedic surgery. Orthopedics 2016; 39: e295-300
• 7 Lang T, Cauley JA, Tylavsky F, Bauer D, Cummings S, Harris TB. Computed tomographic measurements of thigh muscle cross-sectional area and attenuation coefficient predict hip fracture: The health, aging, and body composition study. J Bone Miner Res 2010; 25: 513-9
• 8 Inacio M, Ryan AS, Bair W-N, Prettyman M, Beamer BA, Rogers MW. Gluteal muscle composition differentiates fallers from non-fallers in community dwelling older adults. BMC Geriatr 2014; 14: 37
• 9 Mhuiris ÁN, Volken T, Elliott JM, Hoggarth M, Samartzis D, Crawford RJ. Reliability of quantifying the spatial distribution of fatty infiltration in lumbar paravertebral muscles using a new segmentation method for T1-weighted MRI. BMC Musculoskelet Disord 2016; 17: 234
• 10 Agten CA, Rosskopf AB, Gerber C, Pfirrmann CW. Quantification of the rotator cuff muscles: Comparison of multi-echo Dixon with single-voxel MR spectroscopy. Eur Radiol 2016; 26: 3719-27
• 11 Lee S, Lucas RM, Lansdown DA, Nardo L, Lai A, Link TM. et al. Magnetic resonance rotator cuff fat fraction and its relationship with tendon tear severity and subject characteristics. J Shoulder Elbow Surg 2015; 24: 1442-51
• 12 Marcon M, Berger N, Manoliu Fischer MA, Nanz D, Andreisek G. et al. Normative values for volume and fat content of the hip abductor muscles and their dependence on side, age and gender in a healthy population. Skeletal Radiol 2016; 45: 465-474
• 13 Crawford RJ, Filli L, Elliot JM, Nanz D, Fischer MA, Marcon M. et al. Age- and level-dependence of fatty infiltration in lumbar paravertebral muscles of healthy volunteers. Am J Neuroradiol 2016; 37: 742-8
• 14 Morrow JM, Sinclair CDJ, Fischmann A, Machado PM, Reilly MM, Yousry TA. et al. MRI biomarker assessment of neuromuscular disease progression: A prospective observational cohort study. Lancet Neurol 2016; 15: 65-77
• 15 Lee S, Lucas RM, Lansdown DA, Nardo L, Lai A, Link TM. et al. Magnetic resonance rotator cuff fat fraction and its relationship with tendon tear severity and subject characteristics. J Shoulder Elbow Surg 2015; 24: 1442-51
• 16 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-74
• 17 Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F. et al. Sarcopenia: European consensus on definition and diagnosis. Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412-23
• 18 Zhao Q, Zmuda JM, Kupers AL, Jonnalagadda P, Bunker CH, Patrick AL. et al. Greater skeletal muscle fat infiltration is associated with higher all cause mortality among men of African-American ancestry. Age-Aging 2016; 45: 529-34
• 19 Montano-Loza AJ, Angulo P, Meza-Junco J, Prado CM, Sawyer MB, Beaumont C. et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle 2016; 7: 126-35
• 20 Montano-Loza AJ, Duarte-Rojo A, Meza-Junco J, Baracos VE, Sawyer MB, Pang JX. et al. Inclusion of sarcopenia within MELD (MELD-Sarcopenia) and the prediction of mortality in patients with cirrhosis. Clin Transl Gastroenterol 2015; 6: e102
• 21 Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM. et al. Muscle mass, muscle strength and muscle fat infiltration as predictors of incident mobility limitations in well functioning older persons. J Gerontol A Sci Med Sci 2005; 60: 324-33
• 22 Visser M, Kritchevsky SB, Goodpaster BH, Newman AB, Nevitt M, Stamm EB. et al. Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: The Health, Aging and Body Composition Study. J Am Geriatr Soci 2002; 50: 897-904
• 23 Morrell G, Ikizler T, Chen X, Heilbrun ME, Wei G, Boucher R. et al. Psoas muscle cross-sectional area as a measure of whole-body lean muscle mass in maintenance hemodialysis patients. J Gen Nutr 2016; 26: 259-64
• 24 Jones KI, Doleman D, Scott S, Lund JN, Williams JP. Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications. Colorectal Dis 2015; 17: O20-6
• 25 Zhuang C-L, Huang D-D, Pang W-Y, Zhou CJ, Wang SL, Lou N. et al. Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer: Analysis from a large-scale cohort. Medicine 2016; 95: e3164
• 26 Noble JJ, Keevil SF, Totman J, Charles-Edwards GD. In vitro and in vivo comparison of two-, three- and four-point Dixon techniques for clinical intramuscular fat quantification at 3 T. Br J Radiol 2014; 87: 20130761
• 27 Gaeta M, Scribano E, Mileto A, Mazziotti S, Rodolico C, Toscano A. et al. Muscle fat fraction in neuromuscular disorders: Dual-echo dual-flip-angle spoiled gradient-recalled MR imaging technique for quantification – A feasibility study. Radiology 2011; 259: 487-94
• 28 Horiuchi S, Nozaki T, Tasaki A, Yamakawa A, Kaneko Y, Hara T. et al. Reliability of MR quantification of rotator cuff muscle fatty degeneration using a 2-point Dixon technique in comparison with the Goutallier classification: Validation study by multiple readers. Acad Radiol 2017; 24: 1343-51
• 29 Nozaki T, Tasaki A, Horiuchi S, Osakabe C, Ohde S, Saida Y. et al. Quantification of fatty degeneration within the supraspinatus muscle by using a 2-point Dixon method on 3-T MRI. AJR Am J Roentgenol 2015; 205: 116-22
• 30 Kim H, Serai S, Merrow A, Wang L, Horn P, Laor T. Objective measurement of minimal fat in normal skeletal muscles of healthy children using T2 relaxation time mapping (T2 maps) and MR spectroscopy. Pediatr Radiol 2014; 44: 149-57
• 31 Miljkovic I, Kuipers AL, Cvejkus R, Bunker CH, Patrick AL, Gordon CL. et al. Myosteatosis increases with aging and is associated with incident diabetes in African ancestry men. Obesity 2016; 24: 476-82
• 32 Zacharias A, Pizzari T, English DJ, Kapakoulakis T, Green RA. Hip abductor muscle volume in hip osteoarthritis and matched controls. Osteoarthritis Cartilage 2016; 24: 1727-35