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Background: We aimed to evaluate the feasibility of the upper thigh level as a landmark to measure muscle area for sarcopenia assessment on computed tomography (CT)., Methods: In the 116 healthy subjects who performed CT scans covering from mid-abdomen to feet, the skeletal muscle area in the upper thigh level at the inferior tip of ischial tuberosity (SMA UT ), the mid-thigh level (SMA MT ), and L3 inferior endplate level (SMA L3 ) were measured by two independent readers. Pearson correlation coefficients between SMA UT , SMA MT , and SMA L3 were calculated. Inter-reader agreement between the two readers were evaluated using intraclass correlation coefficient (ICC) and Bland-Altman plots with 95% limit of agreement (LOA)., Results: In readers 1 and 2, very high positive correlations were observed between SMA UT and SMA MT (r = 0.91 and 0.92, respectively) and between SMA UT and SMA L3 (r = 0.90 and 0.91, respectively), while high positive correlation were observed between SMA MT and SMA L3 (r = 0.87 and 0.87, respectively). Based on ICC values, the inter-reader agreement was the best in the SMA UT (0.999), followed by the SMA L3 (0.990) and SMA MT (0.956). The 95% LOAs in the Bland-Altman plots indicated that the inter-reader agreement of the SMA UT (- 0.462 to 1.513) was the best, followed by the SMA L3 (- 9.949 to 7.636) and SMA MT (- 12.105 to 14.605)., Conclusion: Muscle area measurement at the upper thigh level correlates well with those with the mid-thigh and L3 inferior endpoint level and shows the highest inter-reader agreement. Thus, the upper thigh level might be an excellent landmark enabling SMA UT as a reliable and robust biomarker for muscle area measurement for sarcopenia assessment., (© 2022. The Author(s).)

Objective: To evaluate predictive values of sarcopenia and visceral obesity measured from preoperative CT/MRIs for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy in patients with periampullary malignancies., Methods: From the prospectively constructed surgical registry, we included adult patients treated with pancreaticoduodenectomy. Based on CT/MRIs, body morphometric analysis was performed to evaluate the visceral obesity and sarcopenia, based on the areas of visceral fat and skeletal muscle measured at the L3 vertebrae level. We retrieved various perioperative factors from registry. As outcomes of postoperative complications, we evaluated POPF and major complications based on the Clavien-Dindo classification. Multivariate logistic regression analyses were performed., Results: From a total of 284 patients (163 males, 121 females) who met the inclusion/exclusion criteria, POPF, major complications, and 60-day mortality occurred in 52 (18.3%), 34 (12.0%), and 6 (2.1%), respectively. Sarcopenia and visceral obesity were noted in 123 (75.5%) and 66 (40.5%) of men and 68 (56.2%) and 53 (43.8%) of women, respectively. Combination of sarcopenia and obesity (sarcopenic obesity) was noted in 31.9% (52/163) of men and in 26.4% (32/121) of women. In multivariate logistic regression analyses, sarcopenic obesity was the only independent predictor for POPF (OR 2.65, 95% CI 1.43-4.93), and the vascular resection during pancreaticoduodenectomy was the only independent predictor for severe complications (OR 3.75, 95% CI 1.61-8.70)., Conclusion: Sarcopenic obesity might be highly predictive for POPF. Body morphometric analysis in preoperative CT/MRI combined with assessment of perioperative clinical features may help to identify high-risk patients and determine perioperative management strategies., Key Points: • Sarcopenic obesity might be predictive for postoperative pancreatic fistula after pancreaticoduodenectomy. • The vascular resection during pancreaticoduodenectomy might be predictive of major complications. • Body morphometric analysis might be helpful for identifying high-risk patients.

Background: Quantification of abdominal muscle mass by cross-sectional imaging has been increasingly used to diagnose sarcopenia; however, the technical method for quantification has not been standardized yet. We aimed to determine an optimal method to measure the abdominal muscle area. Methods: Among 50 consecutive subjects who underwent abdominal CT and MRI for possible liver donation, total abdominal muscle area (TAMA) and total psoas muscle area (TPA) at the L3 inferior endplate level were measured by two blinded readers. Inter-scan agreement between CT and MRI and inter-reader agreement between the two readers were evaluated using intraclass correlation coefficient (ICC) and within-subject coefficient of variation (WSCV). To evaluate the effect of measurement level, one reader measured TAMA and TPA at six levels from the L2 to L4 vertebral bodies. Results: TAMA was a more reliable biomarker than TPA in terms of inter-scan agreement (ICC: 0.928 vs. 0.788 for reader 1 and 0.853 vs. 0.821 for reader 2, respectively; WSCV: 8.3% vs. 23.4% for reader 1 and 10.4% vs. 22.3% for reader 2, respectively) and inter-reader agreement (ICC: 0.986 vs. 0.886 for CT and 0.865 vs. 0.669 for MRI, respectively; WSCV: 8.2% vs. 16.0% for CT and 11.6% vs. 29.7% for MRI, respectively). In terms of the measurement level, TAMA did not differ from the L2inf to L4inf levels, whereas TPA increased with a decrease in measurement level. Conclusions: TAMA is a better biomarker than TPA in terms of inter-scan and inter-reader agreement and robustness to the measurement level. CT was a more reliable imaging modality than MRI. Our results support the use of TAMA measured by CT as a standard biomarker for abdominal muscle area measurement. [ABSTRACT FROM AUTHOR]