Radiologic Features of T10 Paravertebral Muscle Sarcopenia: Prognostic Factors in COVID-19

Georgios Schinas; Vasiliki Dimakopoulou; Konstantinos Dionysopoulos; Georgia Fezoulidi; Marianna Vlychou; Katerina Vassiou; Nikolaos K Gatselis; Anna Samakidou; Georgios Giannoulis; Argyrios Tzouvelekis; Markos Marangos; Charalambos Gogos; George N Dalekos; Christina Kalogeropoulou; Karolina Akinosoglou

doi:10.14740/jocmr4963

Radiologic Features of T10 Paravertebral Muscle Sarcopenia: Prognostic Factors in COVID-19

J Clin Med Res. 2023 Jul;15(7):368-376. doi: 10.14740/jocmr4963. Epub 2023 Jul 31.

Authors

Georgios Schinas^{1

2}, Vasiliki Dimakopoulou^{3

2}, Konstantinos Dionysopoulos⁴, Georgia Fezoulidi⁵, Marianna Vlychou⁶, Katerina Vassiou⁷, Nikolaos K Gatselis⁸, Anna Samakidou⁸, Georgios Giannoulis⁸, Argyrios Tzouvelekis⁹, Markos Marangos¹⁰, Charalambos Gogos¹⁰, George N Dalekos⁸, Christina Kalogeropoulou⁴, Karolina Akinosoglou¹⁰

Affiliations

¹ School of Medicine, University of Patras, Patras, Greece.
² These authors contributed equally to this article.
³ Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
⁴ Department of Radiology, University Hospital of Patras, Patras, Greece.
⁵ Faculty of Medicine, University of Thrace, Alexandroupolis, Greece.
⁶ Department of Radiology, General University Hospital of Larissa, Larissa, Greece.
⁷ Department of Anatomy, Medical School, University of Thessaly, Larisa, Greece.
⁸ Department of Medicine and Research Laboratory of Internal Medicine, Expertise Center of Greece in Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece.
⁹ Division of Respiratory Medicine, Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
¹⁰ Division of Infectious Diseases, Department of Internal Medicine, University Hospital of Patras, Patras, Greece.

Abstract

Background: Sarcopenia, defined as a small cross-sectional area (CSA) in computed tomography (CT) measurements of skeletal muscles, serves as a disease severity marker in various clinical scenarios, including pulmonary conditions and critical illness. Another parameter of sarcopenia, the level of myosteatosis, reflected by the tissue's radiodensity, in the thoracic skeletal muscles group, has been linked to disease progression in coronavirus disease 2019 (COVID-19) patients. We hypothesize that CT-derived measurements of the skeletal muscle density (SMD) and the CSA of thoracic skeletal muscles can predict outcomes in COVID-19 pneumonia.

Methods: We retrospectively reviewed the CT scans of 84 patients with COVID-19 pneumonia admitted to two of Greece's largest academic teaching hospitals between April 2020 and February 2021. CSA and SMD at the level of the T10 vertebra were measured using computational imaging methods. The patient population was stratified according to survival status and CT severity score (CT-SS). Correlations were drawn between the radiologic features of sarcopenia, CT severity subgroups, serum inflammatory markers, and adverse events, e.g., death and intubation.

Results: Thoracic muscles' CSA measurements correlate with CT-SS and prominent inflammatory markers, such as white blood cell (WBC), C-reactive protein (CRP), fibrinogen, and D-dimers. Moreover, according to linear regression analysis, CSA seems to predict CT-SS variation significantly (β = -0.266, P = 0.018). CSA proved to differ significantly across survivors (P = 0.027) but not between CT severity categories and intubation subgroups. The AUC (area under the curve) of the receiver operating characteristic (ROC) curve for the predictive value of thoracic muscles' CSA in mortality is 0.774 (95% confidence interval (CI): 0.66 - 0.83, P < 0.000). The optimal cut-off value (Youden index = 0.57) for mortality prognosis, with a sensitivity of 66.7% and a specificity of 88.9%, is 15.55. Thoracic muscles' SMD analyses did not reveal any significant correlations.

Conclusions: Easy to obtain and accurately calculated, radiologic features can provide a reliable alternative to laboratory methods for predicting survival in COVID-19. Thoracic muscles' CSA measurement in the level of the T10 vertebra, an acclaimed prognostic imaging assessment that relates directly to CT-SS and inflammatory markers in COVID-19 pneumonia, is a fairly specific tool for survival prognosis.

Keywords: COVID-19; Chest computed tomography; Cross-sectional anatomy; Muscle mass; Prognostic factors; SAR-CoV-2.