Body composition measurement using computed tomography: Does the phase of the scan matter?

- In this study, we clarified the effect of intravenous contrast on body composition analysis of computed tomography (CT) scans.
- Triphasic abdominal CT scans from 111 patients were analyzed.
- Skeletal muscle attenuation (myosteatosis) was dependent on the phase of the scan.
- No difference was seen in fat-free mass or skeletal muscle index.
- The definition of myosteatosis should include a standardized phase of CT for analysis.

ObjectivesThe aim of this study was to determine, from the methodologic standpoint, the effect of the presence or absence of intravenous contrast on body composition variables obtained by analysis of computed tomography (CT) images.MethodsTriphasic abdominal (noncontrast, arterial phase, and portovenous phase contrast) CT scans from 111 patients were analyzed by two independent assessors at the third lumbar vertebral level using SliceOmatic software (version 5.0, TomoVision, Montreal, Canada). Variables included skeletal muscle index (SMI), fat and fat-free mass (FM and FFM, respectively), and mean skeletal muscle Hounsfield units (SMHU).ResultsMean SMHU was lowest in the noncontrast phase (29.4, standard deviation [SD] 8.9 HU), followed by arterial (32.4, SD 9.3 HU) then portovenous phases (34.9, SD 9.4 HU). The mean skeletal muscle attenuation was significantly different depending on the phase of the scan in which the images were obtained. Calculated FM was significantly lower in both arterial (28.6, SD 8.8 kg, P < 0.0001) and portovenous phase scans (28.5, SD 8.9 kg, P < 0.0001) when compared with noncontrast (29.2, SD 8.9 kg). The mean FFM was not significantly different as measured on noncontrast, arterial, or portovenous phase CT scans (48, SD 11.2; 48.1, SD 9.8; and 48.6, SD 10.2 kg, respectively). No difference was seen in SMI. Interobserver reliability was high.ConclusionsThe definition of myosteatosis should include a standardized phase of CT for analysis and this should be incorporated within its definition. However, as the magnitudes of the differences were relatively small, the effect of the phase of the scan on predicting outcome needs to be determined.