A pilot feasibility study of an ultrasound-based tool to assess muscle mass in children with liver disease
Sarcopenia is associated with adverse outcomes following liver transplantation, and at-risk children must be identified and prehabilitated. The gold standard for assessing sarcopenia in end-stage liver disease (ESLD) is CT assessment of the total Psoas Muscle Area (tPMA). However, radiation exposure...
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Published in | Hepatology communications Vol. 7; no. 8 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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Lippincott Williams & Wilkins
01.08.2023
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Abstract | Sarcopenia is associated with adverse outcomes following liver transplantation, and at-risk children must be identified and prehabilitated. The gold standard for assessing sarcopenia in end-stage liver disease (ESLD) is CT assessment of the total Psoas Muscle Area (tPMA). However, radiation exposure and sedation requirements make this approach impractical for children. The bilateral anterior thigh thickness (BATT) is the cumulative measurement of the rectus femoris and vastus intermedius muscles by ultrasound and has been used to identify sarcopenia in adults. There are no studies assessing muscle mass in children using ultrasound. We hypothesized that measuring BATT with ultrasound in children with ESLD is feasible and is associated with sarcopenia.
A prospective pilot feasibility study of patients with ESLD on the liver transplantation waitlist and age-matched healthy controls. BATT was measured by a single operator using ultrasound. tPMA indices were determined by CT imaging, along with clinical and anthropometric data.
Thirty children were studied between September 2021 and December 2022, 15 listed patients aged 4-30 months, and 15 controls aged 4-32 months. No major technical challenges or complications were encountered while performing the ultrasounds. Median BATTs of 30.8 mm (interquartile range: 27.9-32.8 mm) versus 32.7 mm (interquartile range: 31.8-36.9 mm) were demonstrated in the ESLD and control groups, respectively, and p = 0.01. A positive correlation (R = 0.603) was demonstrated between BATT and tPMA at the L4-5 level among patients with ESLD. No correlation was observed between BATT and anthropometrics.
This study yields novel data on the feasibility of ultrasound to measure mid-thigh thickness in children with ESLD and suggests a correlation between BATT and tPMA, the gold standard for diagnosing sarcopenia. It sets the stage for ultrasound as a simple, noninvasive, and easily repeatable tool for assessing sarcopenia in children. |
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AbstractList | BACKGROUNDSarcopenia is associated with adverse outcomes following liver transplantation, and at-risk children must be identified and prehabilitated. The gold standard for assessing sarcopenia in end-stage liver disease (ESLD) is CT assessment of the total Psoas Muscle Area (tPMA). However, radiation exposure and sedation requirements make this approach impractical for children. The bilateral anterior thigh thickness (BATT) is the cumulative measurement of the rectus femoris and vastus intermedius muscles by ultrasound and has been used to identify sarcopenia in adults. There are no studies assessing muscle mass in children using ultrasound. We hypothesized that measuring BATT with ultrasound in children with ESLD is feasible and is associated with sarcopenia.METHODSA prospective pilot feasibility study of patients with ESLD on the liver transplantation waitlist and age-matched healthy controls. BATT was measured by a single operator using ultrasound. tPMA indices were determined by CT imaging, along with clinical and anthropometric data.RESULTSThirty children were studied between September 2021 and December 2022, 15 listed patients aged 4-30 months, and 15 controls aged 4-32 months. No major technical challenges or complications were encountered while performing the ultrasounds. Median BATTs of 30.8 mm (interquartile range: 27.9-32.8 mm) versus 32.7 mm (interquartile range: 31.8-36.9 mm) were demonstrated in the ESLD and control groups, respectively, and p = 0.01. A positive correlation (R = 0.603) was demonstrated between BATT and tPMA at the L4-5 level among patients with ESLD. No correlation was observed between BATT and anthropometrics.CONCLUSIONSThis study yields novel data on the feasibility of ultrasound to measure mid-thigh thickness in children with ESLD and suggests a correlation between BATT and tPMA, the gold standard for diagnosing sarcopenia. It sets the stage for ultrasound as a simple, noninvasive, and easily repeatable tool for assessing sarcopenia in children. Sarcopenia is associated with adverse outcomes following liver transplantation, and at-risk children must be identified and prehabilitated. The gold standard for assessing sarcopenia in end-stage liver disease (ESLD) is CT assessment of the total Psoas Muscle Area (tPMA). However, radiation exposure and sedation requirements make this approach impractical for children. The bilateral anterior thigh thickness (BATT) is the cumulative measurement of the rectus femoris and vastus intermedius muscles by ultrasound and has been used to identify sarcopenia in adults. There are no studies assessing muscle mass in children using ultrasound. We hypothesized that measuring BATT with ultrasound in children with ESLD is feasible and is associated with sarcopenia. Sarcopenia is associated with adverse outcomes following liver transplantation, and at-risk children must be identified and prehabilitated. The gold standard for assessing sarcopenia in end-stage liver disease (ESLD) is CT assessment of the total Psoas Muscle Area (tPMA). However, radiation exposure and sedation requirements make this approach impractical for children. The bilateral anterior thigh thickness (BATT) is the cumulative measurement of the rectus femoris and vastus intermedius muscles by ultrasound and has been used to identify sarcopenia in adults. There are no studies assessing muscle mass in children using ultrasound. We hypothesized that measuring BATT with ultrasound in children with ESLD is feasible and is associated with sarcopenia. A prospective pilot feasibility study of patients with ESLD on the liver transplantation waitlist and age-matched healthy controls. BATT was measured by a single operator using ultrasound. tPMA indices were determined by CT imaging, along with clinical and anthropometric data. Thirty children were studied between September 2021 and December 2022, 15 listed patients aged 4-30 months, and 15 controls aged 4-32 months. No major technical challenges or complications were encountered while performing the ultrasounds. Median BATTs of 30.8 mm (interquartile range: 27.9-32.8 mm) versus 32.7 mm (interquartile range: 31.8-36.9 mm) were demonstrated in the ESLD and control groups, respectively, and p = 0.01. A positive correlation (R = 0.603) was demonstrated between BATT and tPMA at the L4-5 level among patients with ESLD. No correlation was observed between BATT and anthropometrics. This study yields novel data on the feasibility of ultrasound to measure mid-thigh thickness in children with ESLD and suggests a correlation between BATT and tPMA, the gold standard for diagnosing sarcopenia. It sets the stage for ultrasound as a simple, noninvasive, and easily repeatable tool for assessing sarcopenia in children. |
Author | Ng, Vicky L Kamath, Binita M Shpoliansky, Michael Chavhan, Govind B Zhou, Alex |
AuthorAffiliation | 2 Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada 3 Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada 1 Division of Gastroenterology, Department of Pediatrics, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada |
AuthorAffiliation_xml | – name: 1 Division of Gastroenterology, Department of Pediatrics, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada – name: 2 Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada – name: 3 Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada |
Author_xml | – sequence: 1 givenname: Michael orcidid: 0000-0002-3628-4565 surname: Shpoliansky fullname: Shpoliansky, Michael organization: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada – sequence: 2 givenname: Govind B surname: Chavhan fullname: Chavhan, Govind B organization: Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada – sequence: 3 givenname: Alex surname: Zhou fullname: Zhou, Alex organization: Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada – sequence: 4 givenname: Vicky L surname: Ng fullname: Ng, Vicky L organization: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada – sequence: 5 givenname: Binita M orcidid: 0000-0002-9982-5023 surname: Kamath fullname: Kamath, Binita M organization: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada |
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Cites_doi | 10.1016/j.archger.2019.03.014 10.1111/jgh.13166 10.1111/ajt.15392 10.1016/j.dld.2019.08.017 10.3748/wjg.v21.i25.7637 10.1007/s00247-019-04562-7 10.1111/ajt.13732 10.1016/j.jhep.2014.02.026 10.1002/jcsm.12514 10.1111/petr.13537 10.1097/MPG.0000000000001792 10.1016/j.cgh.2016.10.028 10.1038/ctg.2015.31 10.1002/jpen.1414 10.1016/j.jamcollsurg.2010.03.039 10.1002/jcsm.12039 10.1159/000521241 10.1002/hep.30828 10.1016/j.jhep.2021.01.025 10.1016/j.pmrj.2015.09.014 10.1016/j.jhep.2018.06.024 10.1002/lt.25985 10.1093/ageing/afz046 10.1177/0884533612474043 10.1002/lt.23724 10.1016/j.jamda.2019.04.005 10.1016/j.cgh.2016.04.040 10.1111/hepr.12873 |
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Copyright | Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases. Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases. 2023 |
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Snippet | Sarcopenia is associated with adverse outcomes following liver transplantation, and at-risk children must be identified and prehabilitated. The gold standard... BACKGROUNDSarcopenia is associated with adverse outcomes following liver transplantation, and at-risk children must be identified and prehabilitated. The gold... |
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SubjectTerms | Adult Child End Stage Liver Disease Feasibility Studies Humans Muscles Original Prospective Studies Sarcopenia - complications Sarcopenia - diagnostic imaging |
Title | A pilot feasibility study of an ultrasound-based tool to assess muscle mass in children with liver disease |
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