Kristina Imeen Ringe1, Alena Levers1, Judith Pantke1, Henrike Lenzen2, Daniel Düx1, Filip Klimes1, Richard Taubert2, Hans-Heinrich Wedemeyer2, and Frank Wacker1
1Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany, 2Gastroenterlogy, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
Synopsis
Keywords: Liver, Liver
Motivation: Sarcopenia has been associated with a higher risk of adverse outcomes in patients with chronic diseases.
Goal(s): To evaluate sarcopenia as a prognostic biomarker in patients with primary sclerosing cholangitis (PSC).
Approach: Muscle mass was measured in 231 PSC patients at the level of L3 and correlated with patient demographics, clinical scores and clinical endpoints.
Results: Sarcopenia was more prevalent in women and in patients without concomitant inflammatory bowel disease. Muscle mass significantly correlated negatively with the MELD score, but not with solid clinical endpoints.
Impact: While sarcopenia is highly prevalent in PSC
patients, imaging-based quantification of muscle mass seems to be of limited
prognostic value.
Introduction
Muscle dysfunction is often observed in
individuals with advanced chronic liver disease, including primary sclerosing
cholangitis (PSC)1. Sarcopenia, characterized by a progressive decline
in muscle mass and function2, is a common factor in this condition. Various
imaging techniques, including dual-energy X-ray absorptiometry, CT and MRI, can
be employed to assess muscle mass, aiding in the diagnosis of sarcopenia3.
Unlike X-ray absorptiometry and CT, MRI enables the quantification of muscle
mass without the use of ionizing radiation, making it a suitable technique for
follow-up measurements. The goal of this study was to assess the prognostic
value of an MR imaging-based quantification of muscle mass in patients with PSC
with regards to the clinical course of the disease.Methods
231 patients (152m/79f; mean age 41y) with
confirmed diagnosis of PSC were included in this retrospective single-center
study. All study participants underwent MRI at either 1.5T or 3T. Muscle mass was quantified on an axial
non-contrast breath-hold T1 weighted 3D spoiled gradient echo sequence (slice
thickness 5mm). Measurements were performed at the level of the cranial
endplate of the third lumbar vertebra (L3) by a radiologist with >15y of
years of experience, in the following two ways: maximal transverse diameter of the
right psoas (PMT) and total area of psoas muscle on both sides (PMA).
Sarcopenia was defined according to previously published cut-off-values (for
PMT:<8mm/m (f), <12mm/m (m)4; for PMA: <1464mm2
(f), <1561mm2 (m)5). Muscle mass and prevalence of
sarcopenia were correlated with patient sex, concomitant inflammatory bowel
disease (IBD) or autoimmune hepatitis (AIH)-overlap syndrome (Mann-Whitney-U Test,
Fisher-exact Test), duration of disease, established clinical scores (model for
end-stage liver disease (MELD), Mayo Risk, Amsterdam-Oxford; Spearman
correlation) and solid clinical endpoints (liver related death,
transplantation, cholangiocarcinoma; ROC-analysis, binary logistic regression).
For all analyses a p-value <0.05 was deemed significant.Results
At a mean follow-up of 7 years, 95 endpoints
were observed in 80 patients (transplantation n=57; cholangiocarcinoma n=19;
death n=19). 160 out of 231 included patients had concomitant IBD. Sarcopenia
was prevalent in 27.7% and 51.5%, respectively (according to the definition of
PMT and PMA). Sarcopenia was significantly more prevalent in female patients
and in patients without IBD (p<0.05). Individual muscle parameters
correlated all very well with each other (r=0.859-1; p<0.0001). However, a weak
but significant negative correlation of muscle mass was observed only with the
MELD-Score (r=-0.184 to -0.275; p<0.05). There was no significant
correlation of muscle mass or sarcopenia, respectively, with solid clinical
endpoints (all p>0.05).Conclusion
Sarcopenia
is highly prevalent in a large PSC cohort from a tertiary care center. Male sex
and concomitant IBD are rather protective factors. As a prognostic biomarker
with regards to the development of clinical endpoints, imaging-based
quantification of muscle mass seems to be of limited value, however.Acknowledgements
No acknowledgement found.References
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