Medical imaging in cancer cachexia

Abstract

Cancer cachexia, often referred to as "wasting syndrome," is characterized by fatigue, weakness, and involuntary weight loss. This syndrome is concomitant with progressive skeletal muscle atrophy with or without adipose tissue loss and is frequently accompanied by systemic inflammation. Understanding the complexities of cancer cachexia is crucial for early detection and intervention, and it is also paramount for enhancing patient outcomes. Medical imaging, comprising diverse imaging modalities, plays a pivotal role in this context, facilitating the diagnosis and surveillance assessment of both the disease extent and the body composition changes that offer valuable information and insights into disease progression. This article provides a comprehensive discourse of the pathophysiological mechanisms and clinical manifestations of cancer cachexia as well as the role of medical imaging in this setting. Particular emphasis is placed on contemporary multidisciplinary and translational research efforts for the development of diagnostic and treatment tools, aiming to mitigate the devastating consequences of cancer cachexia.

Keywords: Atrophy, muscle; Computed tomography; Imaging biomarkers; Radiology; Wasting syndrome.

Fig. 1

Pipeline of noninvasive screening tool for cancer cachexia, incorporating opportunistic artificial intelligence-assisted imaging analysis of body composition. (Adapted from [17])

Fig. 2

Number of PubMed articles on body composition, cancer, and the most common medical imaging modalities from 2000 to 2023. CT computed tomography, MRI magnetic resonance imaging, US ultrasound, PET positron emission tomography, DEXA dual-energy X‑ray absorptiometry

Fig. 3

Body composition analysis at the L3/L4 lumbar level and tissue segmentation in two patients with pancreatic ductal adenocarcinoma. a–c Imaging of an 81-year-old male patient with cachexia showing low muscle attenuation and low muscle area as well as low subcutaneous and high visceral fat area. d–f Imaging of a 49-year-old female patient without cachexia showing high muscle attenuation and area as well as high subcutaneous and low intramuscular fat area. a, d CT source image. b, e CT image with body composition overlay (light blue: skeletal muscle, yellow: visceral fat, maroon: subcutaneous fat, orange: intermuscular fat). c, f CT image with skeletal muscle body compartment overlay (dark blue: lean muscle, light blue: intramuscular fat, olive: intermuscular fat)