Diagnosis of Sarcopenia in Head and Neck Computed Tomography: Cervical Muscle Mass as a Strong Indicator of Sarcopenia

OBJECTIVES: Patients with head and neck cancer (HNC) have a high risk of sarcopenia, which is associated with poor prognosis. Skeletal-muscle area and index at the third lumbar (L3) vertebra level (L3MA and L3MI) are recommended for the detection of sarcopenia. However, L3 level is not included in many imaging protocols and there are no data for optimal levels and cutoffs for the diagnosis of sarcopenia in head and neck computed tomography (HNCT) scans. Our aim was to assess the relationship between cervical paravertebral muscle values and L3MI and to investigate optimal level to diagnose sarcopenia on HNCTs. METHODS: Patients with HNC (n=159) who underwent positron emission tomography-CT for tumor staging were retrospectively analyzed. On CT images, paravertebral and sternocleidomastoid muscle areas at second (C2), third (C3), and fourth (C4) cervical vertebrae levels (C2MA, C3MA, C4MA, SCMA) and L3MA were measured. Cross-sectional areas were normalized for stature (muscle area/height square) and muscle index (C2MI, C3MI, C4MI, SCMI, L3MI) values were obtained. Spearman correlation and linear regression analyses were used for assessing correlations. To calculate the diagnostic performance of SCMI, C2MI, C3MI, and C4MI for the diagnosis of sarcopenia with respect to the cutoffs of L3MI, receiver operating characteristic (ROC) analysis was used. RESULTS: Males had significantly higher muscle areas than females. Although C2MI, C3MI, C4MI, and SCMI values all showed very strong and significant correlation with L3MI (P<0.001). According to the ROC analysis, the best discriminative for sarcopenia was C3MI in males (area under curve [AUC], 0.967) and SCMI in females (AUC, 0.898). CONCLUSION: C2MI, C3MI, C4MI, and SCMI values can be used as alternatives for the diagnosis of sarcopenia in routine HNCT examinations.

Tracheobronchial Angle Measurements in Children: An Anthropometric Retrospective Study With Multislice Computed Tomography

OBJECTIVES: The purpose of this study is to investigate if any change exists in the values of tracheal bifurcation angles (subcarinal angle [SCA] and interbronchial angle [IBA]), right and left bronchial angles (RBA and LBA) in different pediatric age groups. METHODS: Chest computed tomography (CT) images of children aged 18 years and younger were reviewed retrospectively by two radiologists who were blinded to each other's measurements. One hundred and eighteen children were involved. RBA, LBA, SCA, and IBA were measured on coronal reformatted images. Subjects were classified into three groups according to their age. Measurement of IBA was done by measuring the angle between the lines drawn along the central axis of right and left main bronchi over their length. RBA and LBA were measured at the intersection points of the lines drawn along the inferior borders of the right and left main bronchi and the line passing through the longitudinal axis of trachea. Sums of RBA and LBA gave SCA. Interobserver agreement was also analyzed. RESULTS: SCA, IBA, and RBA values were statistically significant between children of ages less than 10 years and over 10 years P<0.01). Interobserver agreement was excellent with an intraclass correlation coefficient score of 0.87 (95% confidence interval) for RBA, SCA, and IBA measurements. CONCLUSION: We concluded that tracheal bifurcation angles are wider in children of age 10 years and younger. As age increases values of SCA, IBA, and RBA decrease.

Leptin receptor gene polymorphism may affect subclinical atherosclerosis in patients with acromegaly

Background: Acromegaly is associated with increased morbidity and mortality relatedto cardiovascular diseases. Leptin [LEP] and Leptin Receptor [LEPR] gene polymorphismscan increase cardiovascular risks. The aim of this study was to investigateassociation between the frequencies of LEP and LEPR gene polymorphisms and subclinicalatherosclerosis in acromegalic patients

Methods: Forty-four acromegalic patients and 30 controls were admitted to study.The polymorphisms were identified by using polymerase chain reaction from peripheralblood samples. The levels of systolic and diastolic blood pressure, BMI, fastingplasma glucose, fasting insulin, IGF-I, GH, IGFBP3, leptin, triglyceride, carotid IntimaMedia Thickness [cIMT] and HDL and LDL cholesterol concentrations were evaluated

Results: There was statistically significant difference between the LEPR genotypes ofacromegalic patients [GG 11.4%, GA 52.3%, and AA 36.4%] and controls [GG 33.3%,GA 50%, and AA 16.7%] although their LEP genotype distribution was similar. In addition,the prevalence of the LEPR gene G and A alleles was significantly different betweenpatients and controls. No significant difference was found among the G[-2548]A leptin genotypes of groups in terms of the clinical parameters. cIMT significantly increasedhomozygote LEPR GG genotype group compared to AA subjects in patients.But the other parameters were not different between LEPR genotypes groups of patientsand controls

Conclusion: It can be said that the LEPR gene polymorphism may affect cIMT in patients.The reason is that LEPR GG genotype carriers may have more risk than othergenotypes in the development of subclinical atherosclerosis in acromegaly