The use of the second thoracic vertebral landmark for skeletal muscle assessment and computed tomography-defined sarcopenia evaluation in patients with head and neck cancer

Belinda Vangelov, Judith Bauer, Daniel Moses, Robert Smee

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Background: The cross-sectional area (CSA) of skeletal muscle (SM) at the third lumbar vertebra (L3) is used to determine computed tomography (CT)-defined sarcopenia. We investigated the feasibility of SM assessment at the second thoracic vertebra (T2) in patients with head and neck cancer (HNC). Methods: Diagnostic PET-CT scans were used to develop a prediction model for L3-CSA using T2-CSA. Effectiveness of the model and cancer-specific survival (CSS) were investigated. Results: Scans of 111 patients (85% male) were evaluated. The predictive formula: L3-CSA (cm2) = 174.15 + [0.212 × T2-CSA (cm2)] – [40.032 × sex] – [0.928 × age (years)] + [0.285 × weight (kg)] had good correlation r = 0.796, ICC = 0.882 (p < 0.001). SM index (SMI) mean difference (bias) was −3.6% (SD 10.2, 95% CI −8.7% to 1.3%). Sensitivity (82.8%), specificity (78.2%), with moderate agreement (ƙ = 0.540, p < 0.001). Worse 5-year CSS with lower quartile T2-SMI (51%, p = 0.003). Conclusions: SM at T2 can be effectively used for CT-defined sarcopenia evaluation in HNC.

Original languageEnglish
Pages (from-to)1006-1016
Number of pages11
JournalHead and Neck
Issue number4
Publication statusPublished - Apr 2023


  • body composition
  • computed tomography
  • head and neck cancer
  • sarcopenia
  • skeletal muscle

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