在腹部CT的机会性筛查中，肌间脂肪组织比肌肉内脂肪组织含量对肌肉密度的影响更大-动脉网

Intermuscular adipose tissue affected muscle density more than intramuscular adipose tissue content with opportunistic screening at abdominal CT

Nature 等信源发布 2025-03-10 12:20

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Abstract

摘要

This study aimed to determine whether intermuscular adipose tissue (IMAT) or intramuscular adipose tissue content (IMAC) has a greater effect on skeletal muscle density (SMD) and to explore the underlying mechanisms. We recruited 292 inpatients without musculoskeletal system disease, all of whom underwent abdominal CT.

本研究旨在确定肌间脂肪组织 (IMAT) 或肌肉内脂肪组织含量 (IMAC) 对骨骼肌密度 (SMD) 的影响是否更大，并探讨其潜在机制。我们招募了 292 名无肌肉骨骼系统疾病的住院患者，所有患者均接受了腹部 CT 检查。

Muscle parameters, including skeletal muscle area (SMA), skeletal muscle index (SMI), SMD, IMAC, and IMAT, as well as fat parameters—subcutaneous fat area (SFA) and subcutaneous fat density (SFD) in the abdominal wall—were measured by two musculoskeletal radiologists using ImageJ software at the third lumbar vertebra (L3) level.

肌肉参数，包括骨骼肌面积（SMA）、骨骼肌指数（SMI）、SMD、IMAC 和 IMAT，以及脂肪参数——腹壁的皮下脂肪面积（SFA）和皮下脂肪密度（SFD），由两位肌肉骨骼放射科医生使用 ImageJ 软件在第三腰椎（L3）水平进行测量。

One-way ANOVA with LSD (chi-square test for group comparisons where .

单因素方差分析与LSD（用于组间比较的卡方检验，其中）。

> 0.05) or Dunnett’s T3 test (

> 0.05）或Dunnett’s T3检验（

< 0.05) was employed to compare muscle parameters between genders and across age groups. The relationship between SMD and muscle measurements was analyzed using Spearman’s correlation coefficient. Multiple regression analysis identified and compared factors influencing SMD. SMD was highly correlated with IMAT and IMAC (.

<0.05）被用来比较性别之间的肌肉参数和不同年龄组之间的差异。使用Spearman相关系数分析了SMD与肌肉测量值之间的关系。多元回归分析确定并比较了影响SMD的因素。SMD与IMAT和IMAC高度相关（。

< 0.05), moderately correlated with gender, age, and SFA (

<0.05)，与性别、年龄和SFA中等相关（

< 0.05). Multiple linear regression analysis indicated that IMAC, IMAT, and age significantly affected SMD (

<0.05）。多元线性回归分析表明，IMAC、IMAT 和年龄对 SMD 有显著影响 (

< 0.05), with the order of influence being IMAT (β = -0.616), IMAC (β = -0.429), and age (β = -0.098). SFA and gender did not significantly affect SMD (

<0.05)，影响程度的顺序为IMAT（β = -0.616）、IMAC（β = -0.429）和年龄（β = -0.098）。SFA和性别对SMD没有显著影响（

> 0.05). The findings revealed that age, IMAT, and IMAC influence SMD, with IMAT exerting the most significant impact.

> 0.05）。研究结果表明，年龄、IMAT 和 IMAC 均对 SMD 有影响，其中 IMAT 的影响最为显著。

Introduction

简介

Sarcopenia, first introduced by Rosenberg in 1984

1984年，Rosenberg首次提出了肌肉减少症的概念

, refers to the age-related decline in skeletal muscle mass and quality. In 2016, sarcopenia was classified under the International Classification of Diseases (ICD-10-CM) with the code M62.84

，指的是骨骼肌质量和质量随年龄增长而下降的现象。2016年，肌肉减少症被归类到《国际疾病分类》（ICD-10-CM）中，编码为M62.84。

. Numerous studies have confirmed its association with aging

众多研究已经证实其与衰老的关联。

，

, atherosclerosis, diabetes, malignancies, and cognitive disorders

，动脉粥样硬化、糖尿病、恶性肿瘤和认知障碍

, often leading to increased morbidity, mortality, and healthcare costs.

，常常导致发病率、死亡率和医疗成本的增加。

Early research primarily focused on the link between muscle performance decline and muscle mass loss

早期研究主要集中在肌肉性能下降与肌肉质量损失之间的联系。

，

. However, substantial reductions in skeletal muscle function with age can occur with minimal muscle mass loss

然而，随着年龄的增长，骨骼肌功能可能会出现显著下降，而肌肉质量的损失却很小。

，

, leading to a growing interest in muscle quality. Skeletal muscle density (SMD) has been widely used in muscle quality assessment, providing a quantitative measure of the density within the muscle’s region of interest (ROI), which can be directly obtained from computed tomography (CT). Numerous studies have shown a strong correlation between low muscle density and adverse health outcomes, yet the factors contributing to muscle density loss remain unclear..

，导致对肌肉质量的兴趣日益增长。骨骼肌密度（SMD）已被广泛用于肌肉质量评估，提供了肌肉感兴趣区域（ROI）内密度的定量测量值，该值可直接从计算机断层扫描（CT）中获取。大量研究表明，低肌肉密度与不良健康结果之间存在很强的相关性，但导致肌肉密度下降的因素仍不明确。

Skeletal muscle fat infiltration, known as myosteatosis, defined as the accumulation of intramuscular and intermuscular fat within skeletal muscle, serves as an indicator of poor muscle quality

骨骼肌脂肪浸润，称为肌脂肪变性，定义为骨骼肌内和肌肉间脂肪的积累，是肌肉质量差的一个指标。

. A decrease in computed tomography (CT) attenuation by 1 Hounsfield unit (HU) corresponds to an increase in lipid concentration of 1 g/100 mL

计算机断层扫描 (CT) 衰减每减少 1 亨斯菲尔德单位 (HU)，相当于脂质浓度增加 1 克/100 毫升。

. The primary cause of altered muscle density is skeletal muscle fat infiltration, assessed by CT parameters such as intermuscular adipose tissue (IMAT) and intramuscular adipose tissue content (IMAC). IMAT, defined as adipose tissue accumulation between muscles and muscle fiber bundles, is directly associated with declines in muscle mass, flexibility, and quality.

肌肉密度改变的主要原因是骨骼肌脂肪浸润，这可以通过CT参数来评估，例如肌间脂肪组织（IMAT）和肌肉内脂肪组织含量（IMAC）。IMAT被定义为在肌肉与肌纤维束之间积累的脂肪组织，它与肌肉质量、灵活性和品质的下降直接相关。

This measure, quantified by CT attenuation ranging from − 190 HU to -30 HU.

该指标通过CT衰减进行量化，范围为-190 HU到-30 HU。

，

, has been widely used to assess muscle fat infiltration, with Amini et al.

，已被广泛用于评估肌肉脂肪浸润，Amini 等人。

noting that 191 of the 388 studies reviewed used IMAT as an evaluation metric.

注意到在审查的388项研究中，有191项使用IMAT作为评估指标。

IMAC, introduced by Kitajima in 2010

IMAC，由北岛在2010年提出

, represents extra-myocyte adipose tissue within muscle fiber bundles. Calculated as the ratio of CT attenuation in the multifidus muscle to CT attenuation in abdominal wall subcutaneous fat, IMAC serves as a standardized SMD indicator, eliminating variations from CT equipment, scan parameters, and individual differences among patients.

，代表肌纤维束内的肌外脂肪组织。IMAC通过将多裂肌的CT衰减与腹壁皮下脂肪的CT衰减进行比值计算，作为一个标准化的SMD指标，消除了CT设备、扫描参数和患者个体差异带来的影响。

Most studies on IMAC have focused on disease prognosis, with high IMAC scores often indicating poor outcomes.

大多数关于IMAC的研究集中在疾病预后上，高IMAC评分通常预示着不良结果。

. However, fat infiltration distribution within skeletal muscle at the third lumbar vertebra (L3) level is uneven. Some individuals exhibit abdominal wall muscle atrophy, while others show multifidus muscle atrophy. Kitajima’s study evaluated only the multifidus muscle, and the IMAC of a single muscle may not adequately reflect extra-myocyte fat within muscle fiber bundles or provide an accurate measure of overall muscle fat content..

然而，在第三腰椎（L3）水平，骨骼肌内的脂肪浸润分布并不均匀。一些人表现为腹壁肌肉萎缩，而另一些人则表现为多裂肌萎缩。Kitajima的研究仅评估了多裂肌，单块肌肉的IMAC可能无法充分反映肌纤维束内的细胞外脂肪，也无法准确衡量整体肌肉脂肪含量。

It is hypothesized that increases in IMAT and IMAC contribute to reduced SMD. However, it remains unclear which factor has a greater impact on SMD. Considering this background, our study aims to conduct a cross-sectional analysis to identify factors influencing SMD in the abdominal wall and paravertebral muscle groups (SM) at the L3 level in individuals over 50 years and in postmenopausal women, using opportunistic abdominal CT scans of inpatients..

假设IMAT和IMAC的增加会导致SMD降低。然而，目前尚不清楚哪个因素对SMD的影响更大。基于这一背景，本研究旨在通过利用50岁以上人群及绝经后女性的住院患者腹部CT扫描机会性数据，对L3水平的腹壁和椎旁肌群（SM）进行横断面分析，以确定影响SMD的因素。

Results

结果

Baseline characteristics

基线特征

A total of 499 inpatients were recruited for this study. Of these, 112 patients were excluded due to age mismatch, 84 were excluded due to poor health status or the presence of diseases significantly affecting muscle quality, and 11 were excluded because of poor image quality. Figure

本研究共招募了499名住院患者。其中，112名患者因年龄不符被排除，84名因健康状况不佳或存在显著影响肌肉质量的疾病被排除，11名因图像质量不佳被排除。图

illustrates the recruitment process. Ultimately, 292 inpatients were enrolled, consisting of 146 males (mean age 62.25 ± 9.99 years) and 146 females (mean age 69.16 ± 9.95 years), with an overall mean age of 65.71 ± 10.54 years.

展示了招募过程。最终，共有292名住院患者被纳入研究，其中男性146名（平均年龄62.25±9.99岁），女性146名（平均年龄69.16±9.95岁），总体平均年龄为65.71±10.54岁。

Fig. 1

图1

Flow chart of participant selection for the study, with a total of 292 subjects enrolled.

研究参与者选择的流程图，总共纳入了292名受试者。

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No significant differences in age or body mass index (BMI) were observed between genders within each group (Tables

在各组内，性别之间的年龄或身体质量指数（BMI）没有观察到显著差异（表

and

和

). Muscle parameters for males and females are shown in Table

). 男性和女性的肌肉参数如表所示

. The inter-observer reliability, measured by the intraclass correlation coefficient (ICC), exceeded 0.75, indicating excellent repeatability (Table

。通过组内相关系数（ICC）测量的观察者间可靠性超过了0.75，表明具有极好的可重复性（表

）。

Table 1 Age comparison of male and female in each age group (

表1 各年龄组男女性别年龄比较 (

\(\:\stackrel{-}{x}\)

\(\:\overline{x}\)

±s). Significant statistical difference* (

±s)。显著的统计学差异* (

< 0.05).

< 0.05)。

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Table 2 BMI comparison of male and female in each age group (

表 2 各年龄组男女 BMI 比较 (

\(\:\stackrel{-}{x}\)

\(\:\overline{x}\)

±s). BMI, body mass index. Significant statistical difference* (

±s)。BMI，身体质量指数。显著性统计差异* (

< 0.05).

< 0.05)。

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Table 3 Muscle parameters of male and female in each age group (

表3 各年龄组男性和女性的肌肉参数 (

\(\:\stackrel{-}{x}\)

\(\:\overline{x}\)

±s). SMA, skeletal muscle area; SMI, skeletal muscle index; SMD, skeletal muscle density; IMAT, intermuscular adipose tissue; IMAC, intramuscular adipose tissue content; SFA, subcutaneous fat area in abdominal wall; SFD, subcutaneous fat density in abdominal wall.

±s）。SMA，骨骼肌面积；SMI，骨骼肌指数；SMD，骨骼肌密度；IMAT，肌间脂肪组织；IMAC，肌肉内脂肪组织含量；SFA，腹壁皮下脂肪面积；SFD，腹壁皮下脂肪密度。

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Table 4 The ICC of muscle parameters between the two observers (

表4 两位观察者之间肌肉参数的ICC（

\(\:\stackrel{-}{x}\)

\(\:\overline{x}\)

±s). SMA, skeletal muscle area; SMD, skeletal muscle density; IMAT, intermuscular adipose tissue; SFA, subcutaneous fat area in abdominal wall; SFD, subcutaneous fat density in abdominal wall.

±s）。SMA，骨骼肌面积；SMD，骨骼肌密度；IMAT，肌间脂肪组织；SFA，腹壁皮下脂肪面积；SFD，腹壁皮下脂肪密度。

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Correlation analysis and influencing factors of SMD

SMD的相关性分析及影响因素

Table

表格

presents the correlation analysis results between SMD and various variables, including age, gender, BMI, and other muscle parameters at the L3 level. The analysis showed a strong correlation between SMD and both IMAT and IMAC (

展示了SMD与各种变量（包括年龄、性别、BMI和其他L3水平的肌肉参数）之间的相关性分析结果。分析显示SMD与IMAT和IMAC均存在强相关性（

< 0.05), a moderate correlation with gender, age, SMA, skeletal muscle index (SMI), and subcutaneous fat area (SFA) (

<0.05)，与性别、年龄、SMA、骨骼肌指数（SMI）和皮下脂肪面积（SFA）有中等相关性（

< 0.05), and insignificant correlation with BMI (

<0.05），与BMI的相关性不显著（

> 0.05).

> 0.05)。

Table 5 Correlation between SMD and age, gender, BMI and other muscle parameters. Significant statistical difference* (

表5 SMD与年龄、性别、BMI及其他肌肉参数的相关性。显著性统计学差异* (

< 0.05),

<0.05),

value was obtained from Spearman’s correlation coefficient.

该值是通过斯皮尔曼相关系数获得的。

, correlation coefficient;

，相关系数；

, p-value.

`, p值。`

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Table

表格

details the impact of SMI, IMAC, IMAT, SFA, gender, and age on SMD. Multiple linear regression analysis identified IMAC, IMAT, and age as significant factors influencing SMD (

详细说明了SMI、IMAC、IMAT、SFA、性别和年龄对SMD的影响。多元线性回归分析确定IMAC、IMAT和年龄是影响SMD的显著因素（

< 0.05). The order of influence was IMAT (β = -0.616), IMAC (β = -0.429), and age (β = -0.098). Specifically, as IMAT increased by 1 unit, SMD decreased by 0.968 HU; as IMAC increased by 1 unit, SMD decreased by 17.524 HU; and as age increased by 1 year, SMD decreased by 0.097 HU. SMI, SFA and gender did not significantly influence SMD (.

<0.05）。影响程度的顺序为IMAT（β = -0.616）、IMAC（β = -0.429）和年龄（β = -0.098）。具体而言，IMAT每增加1个单位，SMD减少0.968 HU；IMAC每增加1个单位，SMD减少17.524 HU；年龄每增加1岁，SMD减少0.097 HU。SMI、SFA和性别对SMD没有显著影响（。

> 0.05).

> 0.05)。

Table 6 Multiple linear regression analysis about influencing factors of SMD of abdominal wall and paravertebral muscle group at L3 level. Significant statistical difference (

表6 L3水平腹壁和椎旁肌群SMD影响因素的多元线性回归分析。显著统计学差异 (

< 0.05) *. B, partial regression coefficient; SE, standard error; β, standardized partial regression coefficient; t, t-statistic;

< 0.05) *。B，偏回归系数；SE，标准误；β，标准化偏回归系数；t，t统计量；

, p-value.

，p值。

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Discussion

讨论

Our analysis of 292 inpatients using abdominal opportunistic CT demonstrated that IMAT had a greater effect on SMD than IMAC and age. Previous studies may not have fully investigated the relative impacts of IMAT and IMAC on SMD.

我们对292名住院患者进行腹部机会性CT分析后发现，IMAT对SMD的影响比IMAC和年龄更大。以往的研究可能尚未充分探讨IMAT和IMAC对SMD的相对影响。

Most research has focused on evaluating healthy individuals

大多数研究集中在评估健康个体上。

，

. However, a significant proportion of participants in our study were elderly with underlying medical conditions. Jong Hyuk Lee et al. assessed 2,720 patients undergoing annual physical examinations, finding that 12% had a history of cancer, 27% had hypertension, 14% diabetes, 11% cardiovascular disease, and 5.4% chronic liver or kidney disease.

然而，我们研究中相当比例的参与者是患有基础疾病的老年人。Jong Hyuk Lee 等人评估了 2720 名接受年度体检的患者，发现 12% 有癌症病史，27% 患有高血压，14% 患有糖尿病，11% 患有心血管疾病，5.4% 患有慢性肝病或肾病。

. Relying solely on direct assessments of muscle quality in such populations can lead to inaccuracies. We selected inpatients for their clear and comprehensive medical histories, facilitating the exclusion of conditions affecting muscles, reducing experimental error, and enhancing reliability.

仅依靠对这类人群肌肉质量的直接评估可能导致不准确。我们选择住院患者，因其病史明确且全面，有助于排除影响肌肉的疾病，减少实验误差，提高可靠性。

Measurement of muscle quality is also influenced by CT equipment, tube voltage, slice thickness, and iodine contrast use. Lamba et al. recruited 48 patients over 18 years who underwent unenhanced CT scans on both GE and Siemens 64-MDCT scanners within 12 months, observing that Hounsfield unit measurements for unenhanced abdominal soft tissues varied between the two manufacturers.

肌肉质量的测量也会受到CT设备、管电压、层厚和碘对比剂使用的影响。Lamba等人招募了48名18岁以上的患者，这些患者在12个月内分别使用GE和西门子64排MDCT扫描仪进行了未增强的CT扫描，观察到两种设备对未增强腹部软组织的亨斯菲尔德单位测量值存在差异。

. Lortie et al. retrospectively analyzed the effects of iodine contrast and tube voltage on muscle mass and quality evaluation, finding that iodine contrast significantly increased muscle density and area, while lower tube voltage resulted in higher muscle density and lower muscle area, with the impact on muscle density being greater than on muscle area.

Lortie 等人回顾性分析了碘对比剂和管电压对肌肉质量和质量评估的影响，发现碘对比剂显著增加了肌肉密度和面积，而较低的管电压导致更高的肌肉密度和更低的肌肉面积，对肌肉密度的影响大于对肌肉面积的影响。

. Fuchs et al. noted an 11.64% decrease in muscle density (

Fuchs 等人注意到肌肉密度下降了 11.64% (

< 0.0001) and a 1.11% increase in muscle area (

<0.0001）和肌肉面积增加1.11%（

< 0.0001) when measured on 5 mm slice thickness images compared to 2 mm slices

当在5毫米层厚图像上测量时，与2毫米层厚相比，差异显著（P < 0.0001）。

. Therefore, controlling these conditions is essential to ensure measurement stability and reproducibility, minimizing errors. In this study, we used the same CT scanner with standardized parameters: tube voltage at 120 kV, scan slice thickness at 10 mm, reconstructed slice thickness at 0.625 mm, reconstruction window width of 350 HU, and reconstruction window level at 40 HU..

. 因此，控制这些条件对于确保测量的稳定性和可重复性、尽量减少误差至关重要。在本研究中，我们使用了同一台CT扫描仪，并采用了标准化参数：管电压120 kV，扫描层厚10 mm，重建层厚0.625 mm，重建窗宽350 HU，重建窗位40 HU。

For CT-based muscle quality assessment, inter-observer, intra-observer, and inter-software variability also play roles. Barbalho et al.

基于CT的肌肉质量评估中，观察者间、观察者内以及软件间的差异性也起到作用。Barbalho等。

showed that muscle parameters measured by Slice-O-Matic and OsiriX software exhibited excellent consistency (ICC ≥ 0.954,

表明通过Slice-O-Matic和OsiriX软件测量的肌肉参数表现出极好的一致性（ICC ≥ 0.954，

< 0.001). Our findings demonstrated excellent inter-observer consistency (ICC > 0.75), consistent with other studies

<0.001）。我们的研究结果展示了极好的观察者间一致性（ICC>0.75），与其他研究一致。

。

Our study demonstrated a strong negative correlation between IMAC and IMAT with SMD, identifying both as influential factors for SMD. Multiple linear regression analysis revealed standardized regression coefficients of -0.616 for IMAT and − 0.429 for IMAC, indicating that a one-unit increase in IMAT led to a 0.968 HU decrease in SMD, while a one-unit increase in IMAC resulted in a 17.524 HU decrease in SMD.

我们的研究显示IMAC和IMAT与SMD之间存在强烈的负相关，确定两者均为SMD的影响因素。多元线性回归分析显示，IMAT的标准化回归系数为-0.616，IMAC为-0.429，表明IMAT每增加一个单位，SMD减少0.968 HU，而IMAC每增加一个单位，SMD减少17.524 HU。

These findings underscore the significantly greater impact of IMAT on SMD compared to IMAC. Brennan et al. demonstrated a significant association (.

这些研究结果强调了IMAT对SMD的影响显著大于IMAC。Brennan等人展示了显著的关联性（。

< 0.01) between lower muscle density in the elderly and higher intracellular lipid concentrations; however, SMD showed a weaker correlation with intracellular lipid concentrations, being more influenced by extra-myocyte lipids and independent of age, gender, race, and obesity

老年人较低的肌肉密度与较高的细胞内脂质浓度之间存在显著相关性（P < 0.01）；然而，骨骼肌密度（SMD）与细胞内脂质浓度的相关性较弱，更多受到肌细胞外脂质的影响，并且独立于年龄、性别、种族和肥胖因素。

. IMAT represents lipid storage in adipose cells beneath the deep muscle fascia, encompassing visible lipids stored within intermuscular fibers and adipocytes

IMAT代表深部肌肉筋膜下脂肪细胞中的脂质储存，包括储存在肌内纤维和脂肪细胞内的可见脂质。

. Therefore, we infer that muscle density is predominantly influenced by the visible fat component located between muscles and fascicles, with minimal impact from intrafascicular and intramuscular cell fat. This aligns with Brennan’s findings

因此，我们推断肌肉密度主要受肌肉和肌束之间可见脂肪成分的影响，而肌束内和肌肉细胞内脂肪的影响较小。这与布伦南的发现一致。

. Further research is needed to determine whether muscle function and metabolism relate to the location of fat infiltration within muscle.

需要进一步研究来确定肌肉功能和代谢是否与肌肉内脂肪浸润的位置有关。

Additionally, our study demonstrated a moderate association between age and SMD, with no significant influence from gender. Aging significantly contributed to muscle quality decline in both males and females. Multiple linear regression analysis revealed a standardized regression coefficient of -0.098 for age, indicating that SMD decreased by 0.097 HU annually.

此外，我们的研究显示年龄与SMD之间存在中度关联，性别无显著影响。衰老显著导致了男性和女性的肌肉质量下降。多元线性回归分析显示，年龄的标准化回归系数为-0.098，表明SMD每年降低0.097 HU。

Previous studies consistently reported that IMAT increases with age. Our results also align with Tetsuro Hida.

以往的研究一致报道IMAT随年龄增长而增加，我们的结果也与Tetsuro Hida一致。

, who observed that aging is associated with reduced muscle area and increased fat deposition in muscle, even after controlling for gender and ethnicity. This suggests that the effect of age on muscle quality is universal, irrespective of spinal disease presence, muscle type, gender, or ethnicity.

，他观察到衰老与肌肉面积减少和肌肉内脂肪沉积增加有关，即使在控制性别和种族后也是如此。这表明年龄对肌肉质量的影响是普遍的，不论是否存在脊柱疾病、肌肉类型、性别或种族。

Our study excluded patients with conditions that could severely affect muscle quality, such as subcutaneous oedema and hemorrhage, the evaluation of the effect of IMAT and IMAC on muscle density was limited in this pathological state. As in many previous large studies, we used a fixed threshold approach to define IMAT.

我们的研究排除了那些可能严重影响肌肉质量的患者，例如患有皮下水肿和出血等情况的患者，在这种病理状态下，对IMAT和IMAC影响肌肉密度的评估受到了限制。正如许多之前的大规模研究一样，我们使用固定阈值方法来定义IMAT。

But in a clinical setting, variations in scanning modes and acquisition schemes could potentially affect muscle measurements and limit the power of our analysis.

但在临床环境中，扫描模式和采集方案的变化可能会潜在影响肌肉测量，并限制我们分析的能力。

. Further research in this area, conducted through animal testing studies, is recommended to provide more conclusive evidence. Recently, a novel approach to muscle segmentation is beginning to emerge. The method suggested by Mühlberg et al.

建议通过动物实验研究在这一领域进行进一步研究，以提供更确凿的证据。最近，一种新颖的肌肉分割方法开始出现。Mühlberg 等人提出的方法。

was used to estimate an individualized threshold for the IMAT by using the attenuation of the subcutaneous adipose tissue. This method is currently used for the segmentation of the pectoral and upper femoral thigh muscles

通过使用皮下脂肪组织的衰减来估计IMAT的个体化阈值。该方法目前用于胸部和股骨上部大腿肌肉的分割。

，

, and extending this approach to large-scale multi-center research applications may enable more accurate assessment.

，并将这种方法扩展到大规模多中心研究应用可能会实现更准确的评估。

This study has several limitations. First, we evaluated the entire abdominal wall and paraspinal muscles, which show a good linear correlation with total body muscle

本研究有几个局限性。首先，我们评估了整个腹壁和椎旁肌肉，这些肌肉与全身肌肉显示出良好的线性相关性。

. However, delineating the entire muscle group was time-consuming. Future studies should separately analyze the abdominal wall and individual paraspinal muscles to identify the best indicators of changes in muscle mass and quality. Second, due to the difficulty in distinguishing between adipose tissue within muscle bundles and intramuscular lipids, CT attenuation only reflects the overall composition within the muscle.

然而，描绘整个肌肉群非常耗时。未来的研究应分别分析腹壁和各个椎旁肌肉，以确定肌肉质量和质量变化的最佳指标。其次，由于难以区分肌肉束内的脂肪组织和肌内脂质，CT衰减仅反映肌肉内的整体组成。

With advances in magnetic resonance spectroscopy (MRS), intramyocellular lipids (IMCL) warrant further investigation in future studies. Finally, our study was a single-center study, and the sample size of this study was relatively small and lack of younger cohort, necessitating further validation of these conclusions through larger-scale studies..

随着磁共振波谱(MRS)的进步，肌细胞内脂质(IMCL)在今后的研究中值得进一步探讨。最后，我们的研究为单中心研究，本研究的样本量相对较小，缺乏较年轻的队列，需要通过更大规模的研究进一步验证这些结论。

Conclusions

结论

Our findings indicate that IMAT has a greater effect on SMD than IMAC and age, suggesting a distinct causal mechanism for SMD reduction. This insight may encourage a stronger emphasis on preventing IMAT increase.

我们的研究结果表明，IMAT对SMD的影响比IMAC和年龄更大，这表明SMD减少可能存在独特的因果机制。这一见解可能会促使更加重视预防IMAT的增加。

Materials and methods

材料与方法

Study Design and participants

研究设计与参与者

This retrospective study recruited 499 inpatients from Tianjin Hospital between July 2019 and July 2022. Clinical information and abdominal CT scans were routinely collected for each participant. Inclusion criteria were: (1) males aged ≥ 50 years and females in a postmenopausal state, and (2) abdominal CT images with optimal clarity, showing no density impact on SM, subcutaneous fat tissue in abdominal wall (SAT), or intra-abdominal fat at the L3 level, regardless of underlying causes such as edema, hemorrhage, or artifacts.

这项回顾性研究招募了2019年7月至2022年7月期间天津医院的499名住院患者。每位参与者均常规收集了临床信息和腹部CT扫描数据。纳入标准为：(1) 年龄≥50岁的男性和处于绝经后状态的女性，以及 (2) 腹部CT图像清晰度最佳，在L3水平显示骨骼肌（SM）、腹壁皮下脂肪组织（SAT）或腹腔内脂肪无密度影响，无论其原因为何，如水肿、出血或伪影。

，

. Exclusion criteria included conditions severely affecting muscle quality, such as musculoskeletal, neuromuscular, malignant, and chronic wasting diseases (e.g., severe diabetes, chronic obstructive pulmonary disease, chronic liver disease). The study followed the Helsinki Declaration and was approved by the Ethics Committee of Tianjin Hospital (2024YLS061).

排除标准包括严重影肌肉质量的状况，如骨骼肌肉、神经肌肉、恶性及慢性消耗性疾病（例如，严重糖尿病、慢性阻塞性肺病、慢性肝病）。本研究遵循赫尔辛基宣言，并获得天津医院伦理委员会批准（2024YLS061）。

Due to its retrospective nature, Tianjin Hospital waived the requirement for informed consent..

由于其回顾性性质，天津医院免除了知情同意的要求。

Computed tomography acquisition

计算机断层扫描采集

Full abdominal spiral CT imaging was performed on all participants using a 128-slice GE Revolution ES CT scanner (GE Medical Systems, LLC*). Scans covered the region from the upper edge of the T12 vertebra to the lower edge of the L5 vertebra. Scan parameters were set as follows: tube voltage, 120 kV.

所有参与者均使用128层GE Revolution ES CT扫描仪（GE医疗系统有限公司*）进行了全腹部螺旋CT成像。扫描范围覆盖从第12胸椎上缘到第5腰椎下缘的区域。扫描参数设置如下：管电压，120 kV。

，

; tube current, 230 mA; table height, 85 cm; pitch, 0.948:1; and slice thickness, 10 mm.

；管电流，230毫安；床高，85厘米；螺距，0.948:1；层厚，10毫米。

Cross-sectional abdominal images were reconstructed at the L3 level on a GE AW4.7 workstation, aligned parallel to the upper endplate of the L3 vertebra, showing the longest transverse process slice (Fig.

在GE AW4.7工作站上，于L3水平重建腹部横断面图像，与L3椎体上终板平行对齐，显示最长的横突切片（图。

). Reconstruction parameters were: standard reconstruction algorithm, 0.625 mm reconstruction thickness, window width of 350 HU, window level of 40 HU, and a display field of view (DFOV) of 45 cm.

）。重建参数为：标准重建算法，0.625毫米重建层厚，窗宽350 HU，窗位40 HU，显示视野（DFOV）为45厘米。

Fig. 2

图2

Selection of the measurement level. With regard to the abdominal coronal and sagittal CT images, transverse images at the L3 level were obtained, which were parallel to the upper endplate of the L3 vertebrae and demonstrated the longest slice of the transverse process.

选择测量水平。对于腹部冠状面和矢状面CT图像，获取L3水平的横断面图像，这些图像平行于L3椎体的上终板，并显示横突的最长切片。

Full size image

全尺寸图像

Muscle quality assessments

肌肉质量评估

Image J 1.53e (Wayne Rasband and contributors, National Institutes of Health, USA) was used for analysis. Muscle segmentation was manually performed using the “Polygon Selections” tool to outline muscle contours at the L3 level. The segmented SM included the psoas, paraspinal (erector spinae and quadratus lumborum), and abdominal wall (external and internal abdominal obliques, transversus abdominis, and rectus abdominis) muscles.

Image J 1.53e（Wayne Rasband及贡献者，美国国立卫生研究院）用于分析。使用“多边形选择”工具在L3水平手动描绘肌肉轮廓以进行肌肉分割。分割后的骨骼肌包括腰大肌、椎旁肌（竖脊肌和腰方肌）以及腹壁肌群（腹外斜肌、腹内斜肌、腹横肌和腹直肌）。

SMA (cm.

SMA（厘米）

) and SMD (HU) values within the regions of interest were measured using the “Analyze-Measure” function, and muscle area was normalized for height in meters squared (m²) to obtain lumbar SMI (cm²/m²). Within these regions, a threshold of -190 HU to -30 HU was applied to distinguish muscle tissue from fat, allowing IMAT (%) measurement.

）使用“分析-测量”功能测量感兴趣区域内的SMD（HU）值，并将肌肉面积标准化为平方米（m²）以获得腰椎SMI（cm²/m²）。在这些区域内，应用-190 HU到-30 HU的阈值来区分肌肉组织和脂肪，从而允许测量IMAT（%）。

The same method was used to outline SAT to obtain the cross-sectional area (SFA) and density (SFD) (Fig. .

使用相同的方法来勾勒SAT的轮廓，以获得横截面积（SFA）和密度（SFD）（图。

）。

Fig. 3

图3

Muscle segmentation and measurement. Female, 53 years old, BMI 27.34, SMA 101.81cm

肌肉分割与测量。女性，53岁，BMI 27.34，SMA 101.81cm

, SMD 30.42HU, IMAT 4.89%, SFA 166.99cm

，SMD 30.42HU，IMAT 4.89%，SFA 166.99cm

, SFD − 99.88HU, IMAC − 0.30. Measurement of SMA (

，SFD − 99.88HU，IMAC − 0.30。SMA的测量（

), SMD (

），表面贴装器件（

), IMAT (

），IMAT（

) of the SM at L3 level. SFA (

) 在L3水平的SM。SFA (

) and SFD (

`) 和 SFD (`

) was displayed at L3 level by Image J.

) 在L3水平通过Image J显示。

Full size image

全尺寸图像

IMAC was calculated using the following formula:

IMAC 使用以下公式计算：

IMAC = SMD / SFD.

IMAC = SMD / SFD。

All measurements were independently performed by two musculoskeletal radiologists with 10 and 20 years of experience, and mean values were recorded. Figure

所有测量均由两名具有10年和20年经验的肌肉骨骼放射科医生独立进行，并记录平均值。图

shows a visual representation of the measurement process.

显示了测量过程的可视化表示。

Fig. 4

图4

Abdominal wall and the whole paraspinal muscles at the level of L3 with different extent of fat infiltration in postmenopausal females and males over 50 years old.

绝经后女性和50岁以上男性在L3水平的腹壁及整个椎旁肌肉出现不同程度的脂肪浸润。

Full size image

全尺寸图像

All the abbreviations of muscle indicators measured at the L3 level are displayed as following:

L3水平测量的所有肌肉指标的缩写如下所示：

SM: Abdominal wall and paravertebral muscle groups

SM：腹壁和椎旁肌群

SMD: Skeletal muscle density

SMD：骨骼肌密度

SMA: Skeletal muscle area

SMA：骨骼肌面积

SAT: Subcutaneous fat tissue of abdominal wall

SAT：腹壁皮下脂肪组织

SFA: Subcutaneous fat area of abdominal wall

SFA：腹壁皮下脂肪面积

SFD: Subcutaneous fat density of abdominal wall

SFD：腹壁皮下脂肪密度

IMAC: Intramuscular adipose tissue content

IMAC：肌内脂肪组织含量

IMAT: Intermuscular adipose tissue

IMAT：肌间脂肪组织

Statistical analysis

统计分析

All statistical analyses were conducted using IBM SPSS Statistics Version 21 (USA). Continuous variables are expressed as mean ± standard deviation (

所有统计分析均使用 IBM SPSS Statistics 21 版（美国）进行。连续变量表示为平均值 ± 标准差 (

\(\:\stackrel{-}{x}\)

\(\:\overline{x}\)

±s), with all continuous variables following a normal distribution. The significance level was set at α = 0.05.

±s），所有连续变量均服从正态分布。显著性水平设定为 α = 0.05。

The intraclass correlation coefficient (ICC) was used to assess interobserver reliability, with ICC > 0.75 indicating good agreement. An independent samples t-test compared age and BMI between men and women within the same age group. One-way ANOVA with LSD (chi-square test for group comparisons,

组内相关系数 (ICC) 用于评估观察者间可靠性，ICC > 0.75 表示一致性良好。独立样本 t 检验比较同一年龄组内男女之间的年龄和 BMI 差异。单因素方差分析与 LSD（组间比较采用卡方检验）。

> 0.05) or Dunnett’s T3 (

> 0.05）或Dunnett’s T3（

< 0.05) was used to compare muscle parameters by gender and age group. The relationship between SMD and muscle measurements was analyzed using Spearman’s correlation coefficient. Multiple linear regression analysis identified and compared factors influencing SMD.

<0.05）被用来按性别和年龄组比较肌肉参数。使用Spearman相关系数分析了SMD与肌肉测量值之间的关系。多元线性回归分析确定并比较了影响SMD的因素。

Data availability

数据可用性

The datasets used during the current study available from the corresponding author on reasonable request.

当前研究中使用的数据集可在合理要求下由通讯作者提供。

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Author notes

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Xinyi Guo and Nana Cao contributed equally to this work.

郭欣怡和曹娜娜对这项工作贡献相同。

Authors and Affiliations

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Department of Radiology, Tianjin Hospital of Tianjin University, Tianjin, 300210, China

天津大学天津医院放射科，天津，300210，中国

Xinyi Guo, Nana Cao, Xin Deng, Nan Wang, Rui Li, Fei Fu & Zhen He

郭欣怡、曹娜娜、邓欣、王楠、李睿、傅飞、何振

Department of Radiology, Tianjin Medical University Cancer Hospital, Tianjin, 300000, China

中国天津医科大学肿瘤医院放射科，天津，300000

Song Ren

宋人

Department of Magnetic Resonance, Cang Zhou Central Hospital, Hebei, 061000, China

河北省沧州市中心医院磁共振科，061000，中国

Liqing Kang

康立清

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Xinyi Guo

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Contributions

贡献

Conceptualization, X.G. and N.C.; methodology, X.G. and N.C.; software, X.D., N.W., R.L. and F.F.; formal analysis, X.G., N.C. and Z.H.; investigation, X.G.; resources, X.G.; data curation, X.G.; writing—original draft preparation, X.G. and N.C.; writing—review and editing, X.G., N.C., S.R., L.G., L.K., Z.H.; visualization, X.G.; supervision, Z.H.; funding acquisition, Z.H.

概念化，X.G. 和 N.C.；方法论，X.G. 和 N.C.；软件，X.D.、N.W.、R.L. 和 F.F.；形式分析，X.G.、N.C. 和 Z.H.；调查，X.G.；资源，X.G.；数据管理，X.G.；撰写—原始草稿准备，X.G. 和 N.C.；撰写—审核与编辑，X.G.、N.C.、S.R.、L.G.、L.K.、Z.H.；可视化，X.G.；监督，Z.H.；资金获取，Z.H.

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Zhen He

郑和

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Guo, X., Cao, N., Deng, X.

郭，X.，曹，N.，邓，X.