Imaging Software-Based Sarcopenia Assessment in Gastroenterology: Evolution and Clinical Meaning

Abstract

Sarcopenia is gaining attention as a negative prognostic factor in different fields of medicine, including chronic liver failure. However, the assessment of sarcopenia in patients with liver diseases is often neglected due to unawareness of reliable tools and methods and thus is limited to research studies. Cross-sectional imaging is a diffuse diagnostic tool and is commonly performed in patients with chronic liver failure. The last advancements in radiology image analysis using dedicated software allow an easy and standardized method to assess skeletal muscle volume. Several measures can be obtained from cross-sectional imaging analysis to evaluate sarcopenia in patients affected by chronic liver disease. We aimed to review the recent advances in imaging-based sarcopenia assessment, in particular in patients with chronic liver diseases. As a result, we found that the skeletal muscle index (SMI) seems to be a reliable method to assess sarcopenia in cirrhotic patients. Even if further studies are needed to validate proper cut-offs for each clinical endpoint, physicians are invited to consider the assessment of sarcopenia in the work-up of patients with chronic liver disease.

Figure 1

Sarcopenia impact on physical performance.

Figure 2

Computed tomography images of two different patients, one without cirrhosis (a) and one with cirrhosis (b). The patient without cirrhosis does not demonstrate imaging sign of sarcopenia using the public domain software (ImageJ) (c). The patient with cirrhosis demonstrates imaging sign of sarcopenia using the public domain software (ImageJ) (d).

Figure 3

Computed tomography images of two different patients, one affected by HCC (a) and one affected by pancreatic cancer (b). Both patients demonstrate imaging sign of sarcopenia using the public domain software (ImageJ) (B B').