Correlation between Dual-energy X-ray Absorptiometry (dxa) method and Computed Tomography (CT) measurement method for diagnosis of Sarcopenia in chronic liver disease

Background/Aims: Sarcopenia has recently been drawing attention as a factor related to the prognosis of life and quality of life of chronic liver disease. Diagnosis through muscle mass evaluation is typically performed using reference values for dual-energy X-ray absorptiometry (DXA) from the Asia Working Group for Sarcopenia (AWGS). On the other hand, consensus has not been obtained for the cut-off value of normal value in the computed tomography (CT) measurement method to be obtained from the area of the skeletal muscle or the psoas muscle. We investigated the correlation between CT method and DXA. Materials and Methods: Chronic liver disease patients (n=150) who underwent both DXA and CT for muscle mass measurement at our hospital between October 2015 and January 2016 were investigated. Participants comprised 90 males and 60 females, with a mean age of 66.6 years. Underlying liver diseases were: hepatitis B virus (n=30), hepatitis C virus (n=60), non-alcoholic fatty liver disease (NAFLD) (n=22), and others (n=38). Hepatocellular carcinoma was present in 41 patients. We examined the correlation between DXA and CT findings. Results: A most significant positive correlation was found between DXA and skeletal muscle index (SMI; skeletal muscle area by height squared (cm2/m2)) at the level of the third vertebra (L3) with CT attenuation (-29 to 150 HU) (r=0.90, p<0.01). Conclusion: In order to diagnose sarcopenia, image diagnosis with objectivity is also necessary. The most accurate measurement by CT method is available for extracting the region of skeletal muscle (-29 to 150 HU) and using SMI at L3. However, considering complementarity with DXA, consideration in a large number of cases is necessary in the future.