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. 2019 Aug;92(1100):20190327.
doi: 10.1259/bjr.20190327. Epub 2019 Jun 24.

Deep learning-based muscle segmentation and quantification at abdominal CT: application to a longitudinal adult screening cohort for sarcopenia assessment

Peter M Graffy  1 , Jiamin Liu  2 , Perry J Pickhardt  1 , Joseph E Burns  3 , Jianhua Yao  2 , Ronald M Summers  2
Affiliations

Deep learning-based muscle segmentation and quantification at abdominal CT: application to a longitudinal adult screening cohort for sarcopenia assessment

Peter M Graffy et al. Br J Radiol. 2019 Aug.

Abstract

Objective: To investigate a fully automated abdominal CT-based muscle tool in a large adult screening population.

Methods: A fully automated validated muscle segmentation algorithm was applied to 9310 non-contrast CT scans, including a primary screening cohort of 8037 consecutive asymptomatic adults (mean age, 57.1±7.8 years; 3555M/4482F). Sequential follow-up scans were available in a subset of 1171 individuals (mean interval, 5.1 years). Muscle tissue cross-sectional area and attenuation (Hounsfield unit, HU) at the L3 level were assessed, including change over time.

Results: Mean values were significantly higher in males for both muscle area (190.6±33.6 vs 133.3±24.1 cm2, p<0.001) and density (34.3±11.1 HU vs 27.3±11.7 HU, p<0.001). Age-related losses were observed, with mean muscle area reduction of -1.5 cm2/year and attenuation reduction of -1.5 HU/year. Overall age-related muscle density (attenuation) loss was steeper than for muscle area for both sexes up to the age of 70 years. Between ages 50 and 70, relative muscle attenuation decreased significantly more in females (-30.6% vs -18.0%, p<0.001), whereas relative rates of muscle area loss were similar (-8%). Between ages 70 and 90, males lost more density (-22.4% vs -7.5%) and area (-13.4% vs -6.9%, p<0.001). Of the 1171 patients with longitudinal follow-up, 1013 (86.5%) showed a decrease in muscle attenuation, 739 (63.1%) showed a decrease in area, and 1119 (95.6%) showed a decrease in at least one of these measures.

Conclusion: This fully automated CT muscle tool allows for both individualized and population-based assessment. Such data could be automatically derived at abdominal CT regardless of study indication, allowing for opportunistic sarcopenia detection.

Advances in knowledge: This fully automated tool can be applied to routine abdominal CT scans for prospective or retrospective opportunistic sarcopenia assessment, regardless of the original clinical indication. Mean values were significantly higher in males for both muscle area and muscle density. Overall age-related muscle density (attenuation) loss was steeper than for muscle area for both sexes, and therefore may be a more valuable predictor of adverse outcomes.

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Figures

Figure 1.
Figure 1.
Muscle segmentation for quantification using our automated algorithm. (a, b) Unenhanced transverse (axial) CT images at the L3 level in a 50-year-old male (a) and a 87-year-old female (b) undergoing colonography screening, both without (left) and with (right) the automated muscle segmentation depicted. In (b) note how the areas of fatty involution in the paraspinal musculature (left >right) in (b) remain segmented as muscle, which would decrease the mean attenuation value but not the area.
Figure 2.
Figure 2.
Density plots of muscle cross-sectional area (top row) and attenuation (bottom row) at the L3 level of the entire study cohort (n = 8037) combined (left images) and according to gender (right). Note the bimodal normal distribution of L3-level muscle area for males and females, with greater values in the former. For muscle attenuation, both gender distributions skew to lower values but otherwise appear normally distributed, with less gender separation.
Figure 3.
Figure 3.
Muscle area and attenuation differences according to subject age. (a) Graph shows mean CT-based muscle cross-sectional area (blue line) and attenuation (red line) at the L3 level according to age. Note that muscle density (measured by HU attenuation values) decreases at a greater rate than muscle area. (b) Graph shows mean CT-based muscle cross-sectional area (dotted lines) and attenuation (solid lines) according to both age and gender (males in blue, females in yellow). Despite male–female offset in mean values, the overall trends appear similar for ages 40–70 years. After age 70, female attenuation and area values plateau more than males.
Figure 4.
Figure 4.
Case of muscle tool failure due to segmentation error. (a, b) CT images in (a) soft tissue and (b) bone windows at the L3 level in a 79-year-old female show marked streak artfifact related to metaliic spinal fusion hardware. (c) CT scout image shows lumbar fusion and bilateral total hip arthroplasties
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