Aim/Introduction: Sarcopenia and coronary calcification may have a relevant prognostic impact in oncological and nononcological patients. The use of freeware software is promising for quantitative evaluation of these parameters after whole-body positron emission tomography (PET)/computed tomography (CT) and might be useful for one-stop shop risk stratification without additional radiation ionizing burden and health care. In this study, we compared the assessment of CAC score and muscle mass in patients undergoing whole-body PET/CT by two semiautomatic freeware software, Horos and LIFEx for the evaluation of coronary artery calcium (CAC) score and muscle mass in patients undergoing whole-body PET/CT. Materials and Methods: The study population included 40 patients without known coronary artery disease randomly selected from those undergoing from January 2019 to December 2021 unenhanced free breathing CT scan as part of whole-body co-registered PET/CT with 2-deoxy-2-[fluorine-18] fluoro-D-glucose or [fluorine-18] fluoromethylcholine PET/CT scans for oncological or non-oncological indications. The total calcium burden in the coronary arteries was quantified based on the Agatston method. The cross-sectional area of all skeletal muscles, was calculated on a single axial image at the level of the third lumbar vertebra, using the open-source Horos and LIFEx software. Once muscles borders were manually traced, a range of attenuation was then set to include tissue between -29 and +150 HU. Statistical difference between data distributions obtained by Horos and LIFEx software was evaluated using the Wilcoxon matched-pairs signedrank test. To assess the agreement between the measurements obtained by the two software we used the Bland-Altman analysis. Results: The muscle areas obtained by the two software programs were comparable, showing high correlation by Lin's concordance coefficient (0.9997; 95% confidence intervals, CI: 0.9995-0.9999), and a very good agreement by the Bland-Altman analysis (mean difference = 0.41 cm2, lower limit = -1.06 cm2, upper limit = 1.89). For CAC score the Lin's concordance correlation coefficient was 0.9976 (95% CI: 0.9965-0.9984) and at Bland-Altman analysis there was a mean difference of 8 (lower limit = -32, upper limit = 48), with a slight overestimation of Horos CAC score as compared to LIFEx. Conclusion: Our results demonstrated that off-line analysis performed with freeware software may allow a comprehensive evaluation of patients undergoing PET/CT studies, allowing the evaluation of muscle mass and calcium score, that may be relevant for the staging and prognostic stratification, beside standard data obtained by PET/CT imaging. For this purpose, the Horos and LIFEx software seem to be interchangeable.
Qualification of Coronary Artery Atherosclerotic Burden and Muscle Mass: Comparison of Two Freely Available Software Programs
Megna R;
2022
Abstract
Aim/Introduction: Sarcopenia and coronary calcification may have a relevant prognostic impact in oncological and nononcological patients. The use of freeware software is promising for quantitative evaluation of these parameters after whole-body positron emission tomography (PET)/computed tomography (CT) and might be useful for one-stop shop risk stratification without additional radiation ionizing burden and health care. In this study, we compared the assessment of CAC score and muscle mass in patients undergoing whole-body PET/CT by two semiautomatic freeware software, Horos and LIFEx for the evaluation of coronary artery calcium (CAC) score and muscle mass in patients undergoing whole-body PET/CT. Materials and Methods: The study population included 40 patients without known coronary artery disease randomly selected from those undergoing from January 2019 to December 2021 unenhanced free breathing CT scan as part of whole-body co-registered PET/CT with 2-deoxy-2-[fluorine-18] fluoro-D-glucose or [fluorine-18] fluoromethylcholine PET/CT scans for oncological or non-oncological indications. The total calcium burden in the coronary arteries was quantified based on the Agatston method. The cross-sectional area of all skeletal muscles, was calculated on a single axial image at the level of the third lumbar vertebra, using the open-source Horos and LIFEx software. Once muscles borders were manually traced, a range of attenuation was then set to include tissue between -29 and +150 HU. Statistical difference between data distributions obtained by Horos and LIFEx software was evaluated using the Wilcoxon matched-pairs signedrank test. To assess the agreement between the measurements obtained by the two software we used the Bland-Altman analysis. Results: The muscle areas obtained by the two software programs were comparable, showing high correlation by Lin's concordance coefficient (0.9997; 95% confidence intervals, CI: 0.9995-0.9999), and a very good agreement by the Bland-Altman analysis (mean difference = 0.41 cm2, lower limit = -1.06 cm2, upper limit = 1.89). For CAC score the Lin's concordance correlation coefficient was 0.9976 (95% CI: 0.9965-0.9984) and at Bland-Altman analysis there was a mean difference of 8 (lower limit = -32, upper limit = 48), with a slight overestimation of Horos CAC score as compared to LIFEx. Conclusion: Our results demonstrated that off-line analysis performed with freeware software may allow a comprehensive evaluation of patients undergoing PET/CT studies, allowing the evaluation of muscle mass and calcium score, that may be relevant for the staging and prognostic stratification, beside standard data obtained by PET/CT imaging. For this purpose, the Horos and LIFEx software seem to be interchangeable.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
