Diagnosis of Sarcopenia Using the L3 Skeletal Muscle Index Estimated From the L1 Skeletal Muscle Index on MR Images in Patients With Cirrhosis

Abstract

BackgroundCirrhotic patients with sarcopenia have poor prognoses and higher mortality. The third lumbar vertebra (L3) skeletal muscle index (SMI) is widely used to assess sarcopenia. However, L3 is generally outside the scanning volume on standard liver MRI.PurposeTo investigate SMIs change between slices in cirrhotic patients and the relationships between SMI at the 12th thoracic vertebra (T12), the first lumbar vertebra (L1) and the second lumbar vertebra (L2) levels and L3‐SMI and assess the accuracy of the estimated L3‐SMIs in diagnosing sarcopenia.Study TypeProspective.SubjectsA total of 155 cirrhotic patients (109 with sarcopenia, 67 male; 46 without sarcopenia, 18 male).Field Strength/SequenceA 3.0 T, 3D dual‐echo T1‐weighted gradient echo sequence (T1WI).AssessmentTwo observers analyzed T12 to L3 skeletal muscle area (SMA) in each patient based on T1W water images and calculated the SMI (SMA/height2). Reference standard was L3‐SMI.Statistical TestsIntraclass correlation coefficient (ICC), Pearson correlation coefficients (r), and Bland–Altman plots. Models relating L3‐SMI to the SMI at T12, L1, and L2 levels were constructed using 10‐fold cross‐validation. Accuracy, sensitivity, and specificity were calculated for the estimated L3‐SMIs for diagnosing sarcopenia. P < 0.05 was considered statistically significant.ResultsIntraobserver and interobserver ICCs were 0.998–0.999. The L3‐SMA/L3‐SMI were correlated with the T12 to L2 SMA/SMI (r = 0.852–0.977). T12‐L2 models had mean‐adjusted R2 values of 0.75–0.95. The estimated L3‐SMI from T12 to L2 levels to diagnose sarcopenia had good accuracy (81.4%–95.3%), sensitivity (88.1%–97.0%), and specificity (71.4%–92.9%). The recommended L1‐SMI threshold of 43.24 cm2/m2 in males and 33.73 cm2/m2 in females.Data ConclusionThe estimated L3‐SMI from T12, L1 and L2 levels had good diagnostic accuracy in assessing sarcopenia in cirrhotic patients. Although L2 was best associated with L3‐SMI, L2 is generally not included in standard liver MRI. L3‐SMI estimate from L1 may therefore be most clinically applicable.Evidence Level1.Technical EfficacyStage 2