The Feasibility and Validity of Sarcopenia Assessment Using Standard of Care Stroke Imaging

Katrina Knight; Niall Finnegan; Aisling Rafter; Daniel Forbes; Douglas Black; Terry Quinn

doi:10.1159/000541649

The Feasibility and Validity of Sarcopenia Assessment Using Standard of Care Stroke Imaging

Cerebrovasc Dis. 2024 Sep 30:1-7. doi: 10.1159/000541649. Online ahead of print.

Authors

Katrina Knight¹, Niall Finnegan¹, Aisling Rafter^{1

2}, Daniel Forbes^{3

4}, Douglas Black^{3

4}, Terry Quinn²

Affiliations

¹ Academic Unit of Surgery, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
² Academic Geriatric Medicine, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
³ School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
⁴ Department of Radiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK.

PMID: 39348805
DOI: 10.1159/000541649

Abstract

Introduction: Sarcopenia, an age-related syndrome defined by low muscularity, loss of muscle strength, and performance, is increasingly recognized as a potential contributor to disability following acute stroke. It is challenging to assess functionally in the acute post-stroke setting. Radiological assessment of skeletal musculature using standard of care CT neck imaging has recently been described. We sought to determine its feasibility and explore associations between CT-defined sarcopenia, validated frailty and functional indices and outcome at 18 months.

Methods: Imaging and clinical data from a prospective cohort study were used. Frailty and functional indices were collected, including the NIH Stroke Scale, Barthel Index for Activities of Daily Living, Fried frailty phenotype, Lawton Instrumental Activities of Daily Living (IADL) Scale, the Frail Non-Disabled (FiND) Questionnaire and pre-stroke modified Rankin Scale. Single transverse slices of neck CT angiograms obtained at the time of acute stroke diagnosis were assessed for skeletal muscle area using ImageJ software; a skeletal muscle index (SMI) was calculated. The relationship between sarcopenia, frailty and functional indices and death or disability at 18 months was assessed using binary logistic regression.

Results: Of 86 potentially eligible patients, 73 were included. It was possible to perform skeletal muscle analysis on the CT scans of all included patients. SMI and functional or frailty indices were not closely correlated. SMI alone was independently related to death or disability at 18 months. The addition of SMI to the abbreviated FiND score appeared to strengthen its associations and prognostic value.

Conclusion: This study demonstrates initial feasibility of CT-based skeletal muscle assessment in patients with acute stroke. The relationships with functional and frailty measures as well as short term outcomes including the ability to execute activities of daily living are required to be explored and validated in a larger, external cohort.

Keywords: Body composition; Frailty; Functional status; Sarcopenia; Stroke.

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