Sarcopenia in Neurological Patients: Standard Values for Temporal Muscle Thickness and Muscle Strength Evaluation

Ariane Steindl, Johannes Leitner, Matthias Schwarz, Karl-Heinz Nenning, Ulrika Asenbaum, Sophie Mayer, Ramona Woitek, Michael Weber, Veronika Schöpf, Anna S Berghoff, Thomas Berger, Georg Widhalm, Daniela Prayer, Matthias Preusser, Julia Furtner, Ariane Steindl, Johannes Leitner, Matthias Schwarz, Karl-Heinz Nenning, Ulrika Asenbaum, Sophie Mayer, Ramona Woitek, Michael Weber, Veronika Schöpf, Anna S Berghoff, Thomas Berger, Georg Widhalm, Daniela Prayer, Matthias Preusser, Julia Furtner

Abstract

Temporal muscle thickness (TMT) was investigated as a novel surrogate marker on MRI examinations of the brain, to detect patients who may be at risk for sarcopenia. TMT was analyzed in a retrospective, normal collective cohort (n = 624), to establish standard reference values. These reference values were correlated with grip strength measurements and body mass index (BMI) in 422 healthy volunteers and validated in a prospective cohort (n = 130) of patients with various neurological disorders. Pearson correlation revealed a strong association between TMT and grip strength (retrospective cohort, ρ = 0.746; p < 0.001; prospective cohort, ρ = 0.649; p < 0.001). A low or no association was found between TMT and age (retrospective cohort, R2 correlation coefficient 0.20; p < 0.001; prospective cohort, ρ = -0.199; p = 0.023), or BMI (retrospective cohort, ρ = 0.116; p = 0.042; prospective cohort, ρ = 0.227; p = 0.009), respectively. Male patients with temporal wasting and unintended weight loss, respectively, showed significantly lower TMT values (p = 0.04 and p = 0.015, unpaired t-test). TMT showed a high correlation with muscle strength in healthy individuals and in patients with various neurological disorders. Therefore, TMT should be integrated into the diagnostic workup of neurological patients, to prevent, delay, or treat sarcopenia.

Keywords: cranial MRI; muscle strength; reference values; sarcopenia; temporal muscle thickness.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overview of the type of clinical and functional data collected. The study was approved by the ethics committee of the Medical University of Vienna (1406/2017).
Figure 2
Figure 2
Anatomical landmarks represented with white lines (a–c) and an example of a TMT measurement in a healthy volunteer on T1-weighted, non-contrast-enhanced cranial MR images depicted in red (c).
Figure 3
Figure 3
Correlation between mean TMT values and grip strength of male (blue) and female (pink) healthy volunteers.
Figure 4
Figure 4
Correlation between age and mean TMT values in male (blue) and female (pink) healthy volunteers.
Figure 5
Figure 5
Correlation between mean TMT values and grip strength in the overall patient population (a) and subdivided into the different disease entities of neuro-oncological patients (b), patients with cerebrovascular disease (c), patients with demyelinating disease of the central nervous system (d), patients with psychiatric disorders (e), and patients with “other disease entities” (f).
Figure 6
Figure 6
Adapted algorithm for sarcopenia case identification, diagnosis, and quantification of severity in patients with neurological disorders (modified after Cruz-Jentoft et al., 2019) [2]. Abbrevations: BIA: bioelectrical impedance analysis; CT: computer tomography; DXA: dual energy x-ray; MRI: magnet resonance imaging; SARC-F: sarcopenia questionnaire; SPPB: short physical performance battery; TMT: temporal muscle thickness; TUG: time up and go.

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