Reduced CT-derived erector spinae muscle area: a poor prognostic factor for short- and long-term outcomes in idiopathic pulmonary fibrosis patients.

AIM: To assess the relationship between idiopathic pulmonary fibrosis (IPF) prognosis, baseline skeletal muscle mass, and attenuation on computed tomography (CT) and clinical parameters. MATERIAL AND METHODS: This retrospective cohort study enrolled 195 patients. The mean follow-up duration was 42.52 months. Erector spinae muscle area (ESMA), pectoralis muscle area (PMA), and the attenuation of the erector spinae muscle at the level of T12 vertebrae were measured. Muscle indexes were obtained by adjusting the measured muscle areas to the patients' heights. The relationship between baseline CT-derived muscle metrics and clinical parameters including short- and long-term mortality were evaluated. RESULTS: There was a moderate correlation between ESMA and PMA and pectoralis muscle index (PMI; r=0.536, p<0001 and r=0.403, p<0.001 respectively). ESMA correlated significantly with forced expiratory volume in 1 second (FEV1; hazard ratio [HR] = 0.488 p<0.001) and forced vital capacity (FVC; HR=0.501, p<0.001). Compared with PMA, ESMA was more strongly associated with 1- and 2-year mortality in patients with IPF (HR=0.957, p=0.022). The survival rate in male patients with sarcopenia was significantly worse (p=0.040). CONCLUSION: ESMA measurements obtained from CT correlated with clinical parameters in IPF patients and were also predictors of short- and long-term survival.

The effect of skeletal muscle area and attenuation in patients with sternum fracture due to blunt chest trauma.

OBJECTIVE: This study aims to retrospectively investigate the imaging features of patients with sternum fracture (SF) and concomitant organ injuries. We also aimed to evaluate the potential prognostic effect of skeletal muscle area (TMA) and muscle attenuation (MuA) values. PATIENTS AND METHODS: Computed tomography (CT) images of patients with SF were re-evaluated by two observers (Observer-1 and 2). Observer-3 has measured TMA and MuA values. Observer-1 has repeated the measurements blindly to the first measurement results to evaluate the inter-observer agreement. The length of hospital stay, death, hemiplegia, or quadriplegia were investigated from the archives. Mann-Whitney U-test or Student's t-test was used to investigate the relationship between linear variables. The intraclass correlation coefficient (ICC) score was used to evaluate the interobserver agreement. Logistic regression analysis was used to estimate the relative effect of variables by calculating unadjusted odds ratios (ORs) for categorical outcomes. RESULTS: Sixty-five patients had SF and 53 patients had SF and concomitant organ injuries. The most common injuries accompanying SF were rib fracture (73.58%) and lung contusion (60.38%). Manubrium fracture was the most common fracture location (52.3%), and 18 patients (27.7%) had displaced SF. Eight patients (15.1%) were discharged with plegia and five (9.4%) died. Hemothorax, displaced SF and decreased MuA were predictors of prolonged hospital stay, and the presence of cardiac contusion, displaced SF, hemothorax, and vertebra body fracture were independent factors for death. CONCLUSIONS: The presence of a displaced SF and decreased MuA value are important prognostic factors in patients with SF.