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Imaging of sarcopenia: old evidence and new insights

  • Musculoskeletal
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Abstract

To date, sarcopenia is considered a patient-specific imaging biomarker able to predict clinical outcomes. Several imaging modalities, including dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance (MR), and ultrasound (US), can be used to assess muscle mass and quality and to achieve the diagnosis of sarcopenia. With different extent, all these modalities can provide quantitative data, being thus reproducible and comparable over time. DXA is the one most commonly used in clinical practice, with the advantages of being accurate and widely available, and also being the only radiological tool with accepted cutoff values to diagnose sarcopenia. CT and MR are considered the reference standards, allowing the evaluation of muscle quality and fatty infiltration, but their application is so far mostly limited to research. US has been always regarded as a minor tool in sarcopenia and has never gained enough space. To date, CT is probably the easiest and most promising modality, although limited by the long time needed for muscle segmentation. Also, the absence of validated thresholds for CT measurements of myosteatosis requires that future studies should focus on this point. Radiologists have the great potential of becoming pivotal in the context of sarcopenia. We highly master imaging modalities and know perfectly how to apply them to different organs and clinical scenarios. Similarly, radiologists should master the culture of sarcopenia, and its clinical aspects and relevant implications for patient care. The medical and scientific radiological community should promote specific educational course to spread awareness among professionals.

Key Points

• DXA is an accurate, reproducible, and widely available imaging modality to evaluate body composition, being the most commonly used radiological tool to diagnose sarcopenia in clinical practice

• CT and MR are the gold standard imaging modalities to assess muscle mass and quality, but no clear cutoff values have been reported to identify sarcopenia, limiting the application of these modalities to research purposes

• US has shown to be accurate in the evaluation of muscle trophism, especially in the thigh, but its current application in sarcopenia is limited

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Abbreviations

ALM:

Appendicular lean mass

ALMI:

Appendicular lean mass index

BC:

Body composition

BMC:

Bone mineral content

CSA:

Cross-sectional area

CT:

Computed tomography

DTI:

Diffusion tensor imaging

DXA:

Dual-energy X-ray absorptiometry

EWGSOP:

European Working Group on Sarcopenia in Older People

FA:

Fractional anisotropy

FM:

Fat mass

HU:

Hounsfield

LM:

Lean mass

MR:

Magnetic resonance

ROIs:

Regions of interest

SMI:

Skeletal muscle index

US:

Ultrasound

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Author notes

  1. Domenico Albano and Carmelo Messina share the first author position as they equally contributed to this work

Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy

    Domenico Albano, Carmelo Messina, Jacopo Vitale & Luca Maria Sconfienza

  2. Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127, Palermo, Italy

    Domenico Albano

  3. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122, Milan, Italy

    Carmelo Messina & Luca Maria Sconfienza

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Albano, D., Messina, C., Vitale, J. et al. Imaging of sarcopenia: old evidence and new insights. Eur Radiol 30, 2199–2208 (2020). https://doi.org/10.1007/s00330-019-06573-2

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