Assessment of Myosteatosis on Computed Tomography by Automatic Generation of a Muscle Quality Map Using a Web-Based Toolkit: Feasibility Study

Background Muscle quality is associated with fatty degeneration or infiltration of the muscle, which may be associated with decreased muscle function and increased disability. Objective The aim of this study is to evaluate the feasibility of automated quantitative measurements of the skeletal muscle on computed tomography (CT) images to assess normal-attenuation muscle and myosteatosis. Methods We developed a web-based toolkit to generate a muscle quality map by categorizing muscle components. First, automatic segmentation of the total abdominal muscle area (TAMA), visceral fat area, and subcutaneous fat area was performed using a predeveloped deep learning model on a single axial CT image at the L3 vertebral level. Second, the Hounsfield unit of each pixel in the TAMA was measured and categorized into 3 components: normal-attenuation muscle area (NAMA), low-attenuation muscle area (LAMA), and inter/intramuscular adipose tissue (IMAT) area. The myosteatosis area was derived by adding the LAMA and IMAT area. We tested the feasibility of the toolkit using randomly selected healthy participants, comprising 6 different age groups (20 to 79 years). With stratification by sex, these indices were compared between age groups using 1-way analysis of variance (ANOVA). Correlations between the myosteatosis area or muscle densities and fat areas were analyzed using Pearson correlation coefficient r. Results A total of 240 healthy participants (135 men and 105 women) with 40 participants per age group were included in the study. In the 1-way ANOVA, the NAMA, LAMA, and IMAT were significantly different between the age groups in both male and female participants (P≤.004), whereas the TAMA showed a significant difference only in male participants (male, P Conclusions The automated web-based toolkit is feasible and enables quantitative CT assessment of myosteatosis, which can be a potential quantitative biomarker for evaluating structural and functional changes brought on by aging in the skeletal muscle.