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Sarcopenia in liver cirrhosis: the role of computed tomography scan for the assessment of muscle mass compared with dual-energy X-ray absorptiometry and anthropometry

Giusto, Michelaa; Lattanzi, Barbaraa; Albanese, Carlinac; Galtieri, Alessiaa; Farcomeni, Alessiob; Giannelli, Valerioa; Lucidi, Cristinaa; Di Martino, Michelec; Catalano, Carloc; Merli, Manuelaa

European Journal of Gastroenterology & Hepatology: March 2015 - Volume 27 - Issue 3 - p 328–334
doi: 10.1097/MEG.0000000000000274
Original Articles: Liver Fibrosis and Cirrhosis

Background Sarcopenia evaluated by computed tomography (CT) scan at the lumbar site has been identified as a risk factor for morbidity and mortality in cirrhosis.

Aim The aim of this study was to compare the measurement of muscle mass through CT scan, considered the gold standard, with other reliable techniques to evaluate the rate of agreement between different available methods for the assessment of muscle mass in cirrhosis. The correlation between measurements of muscle mass and of muscle strength was also investigated.

Patients and methods Adult patients eligible for liver transplantation were studied. Lumbar skeletal muscle cross-sectional area was measured by CT and muscle depletion was defined using previously published cut-offs. Mid-arm muscle circumference was calculated following anthropometric measures. The Fat-Free Mass Index and the Appendicular Skeletal Muscle Index were calculated using dual-energy X-ray absorptiometry. Muscle strength was evaluated using the Hand Grip test.

Results Fifty-nine patients with cirrhosis were included. Sarcopenia was diagnosed in 76% of the patients according to CT evaluation. A significant reduction in Fat-Free Mass Index and Appendicular Skeletal Muscle Index was observed in 42–52% of the patients, whereas 52% showed a mid-arm muscle circumference less than 10th percentile. Skeletal muscle mass evaluation through CT was only weakly correlated with dual-energy X-ray absorptiometry and anthropometry evaluation. No correlation was observed between CT measurement of muscle mass and Hand Grip test.

Conclusion CT scan can identify the highest percentage of sarcopenia in cirrhosis and no other techniques are actually available as a replacement. Future efforts should focus on approaches for assessing both skeletal muscle mass and function to provide a better evaluation of sarcopenia in cirrhotic patients.

aDepartment of Clinical Medicine

bDepartment of Public Health and Infectious Diseases

cDepartment of Radiological Sciences, Sapienza Università di Roma, Rome, Italy

Correspondence to Manuela Merli, MD, II Gastroenterologia, Dipartimento di Medicina Clinica, Viale dell’Università 37, 00185 Rome, Italy Tel/fax: +39 06 4997 2001; e-mail:

Received August 28, 2014

Accepted December 5, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.