Computed tomography derived cervical fat-free muscle fraction as an imaging-based outcome marker in patients with acute ischemic stroke: a pilot study

• Published in: BMC neurology Vol. 23; no. 1; p. 86
• Main Authors: Mesropyan, Narine, Khorsandian, Louisa, Faron, Anton, Sprinkart, Alois M, Dorn, Franziska, Paech, Daniel, Isaak, Alexander, Kuetting, Daniel, Pieper, Claus C, Radbruch, Alexander, Attenberger, Ulrike I, Reimann, Jens, Bode, Felix J, Kornblum, Cornelia, Luetkens, Julian A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28.02.2023; BioMed Central; BMC
• Subjects: Acute ischemic stroke; Aged; Aged, 80 and over; Analysis; Angiography; Biomarkers; Cardiac arrhythmia; Cardiovascular system; Care and treatment; Computed tomography; CT imaging; Fat-free muscle fraction; Female; Humans; Ischemia; Ischemic Stroke; Medical examination; Medical imaging; Middle Aged; Muscle quality; Muscles; Musculoskeletal system; Patients; Pilot Projects; Retrospective Studies; Software; Statistical analysis; Stroke; Stroke - diagnostic imaging; Stroke patients; Tomography, X-Ray Computed; Veins & arteries; Germany; Computed tomography; Acute ischemic stroke; Fat-free muscle fraction; Muscle quality
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-023-03132-7

Outcome assessment in stroke patients is essential for evidence-based stroke care planning. Computed tomography (CT) is the mainstay of diagnosis in acute stroke. This study aimed to investigate whether CT-derived cervical fat-free muscle fraction (FFMF) as a biomarker of muscle quality is associated with outcome parameters after acute ischemic stroke. In this retrospective study, 66 patients (mean age: 76 ± 13 years, 30 female) with acute ischemic stroke in the anterior circulation who underwent CT, including CT-angiography, and endovascular mechanical thrombectomy of the middle cerebral artery between August 2016 and January 2020 were identified. Based on densitometric thresholds, cervical paraspinal muscles covered on CT-angiography were separated into areas of fatty and lean muscle and FFMF was calculated. The study cohort was binarized based on median FFMF (cutoff value: < 71.6%) to compare clinical variables and outcome data between two groups. Unpaired t test and Mann-Whitney U test were used for statistical analysis. National Institute of Health Stroke Scale (NIHSS) (12.2 ± 4.4 vs. 13.6 ± 4.5, P = 0.297) and modified Rankin scale (mRS) (4.3 ± 0.9 vs. 4.4 ± 0.9, P = 0.475) at admission, and pre-stroke mRS (1 ± 1.3 vs. 0.9 ± 1.4, P = 0.489) were similar between groups with high and low FFMF. NIHSS and mRS at discharge were significantly better in patients with high FFMF compared to patients with low FFMF (NIHSS: 4.5 ± 4.4 vs. 9.5 ± 6.7; P = 0.004 and mRS: 2.9 ± 2.1 vs.3.9 ± 1.8; P = 0.049). 90-day mRS was significantly better in patients with high FFMF compared to patients with low FFMF (3.3 ± 2.2 vs. 4.3 ± 1.9, P = 0.045). Cervical FFMF obtained from routine clinical CT might be a new imaging-based muscle quality biomarker for outcome prediction in stroke patients.