Imaging body composition in cancer patients: visceral obesity, sarcopenia and sarcopenic obesity may impact on clinical outcome

Abstract

In recent years, there has been increasing interest in the influence of body composition on oncological patient outcomes. Visceral obesity, sarcopenia and sarcopenic obesity have been identified as adverse factors in cancer patients. Imaging quantification of body composition such as lean muscle mass and fat distribution is a potentially valuable tool. This review describes the following imaging techniques that may be used to assess body composition: dual-energy X-ray absorptiometry (DXA), computed tomography (CT) and magnetic resonance imaging (MRI). CT and MRI are acquired as part of oncological patient care, thus providing an opportunity to integrate body composition assessment into the standard clinical pathway and allowing supportive care to be commenced as appropriate to improve outcome.

Main messages: • Sarcopenia, sarcopenic obesity and visceral obesity are adverse prognostic factors in cancer patients. • CT and MRI are the current gold standard in body composition evaluation. • Body composition may affect chemotherapy tolerance and toxicities.

Fig. 1

Whole-body DXA image showing lean, fat and bone masses

Fig. 2

Subcutaneous fat, visceral fat and skeletal muscle as depicted on an axial CT image at the level of L3 vertebral body

Fig. 3

T1-weighted axial DIXON MRI images highlighting (a) fat and (b) water signals at the level of the L3 vertebral body

Fig. 4

Axial CT images at the level of L3 vertebra demonstrating progressive sarcopenia in a patient with oesophageal cancer before (a) and after (b) neoadjuvant chemotherapy. There is a loss of abdominal muscle mass with an increase in visceral fat