AI-based fully automatic image analysis: Optimal abdominal and thoracic segmentation volumes for estimating total muscle volume on computed tomography scans

Objectives: Evaluation of sarcopenia from computed tomography (CT) is often based on measuring skeletal muscle area on a single transverse slice. Automatic segmentation of muscle volume has a lower variance and may be a better proxy for the total muscle volume than single-slice areas. The aim of the study was to determine which abdominal and thoracic anatomical volumes were best at predicting the total muscle volume. Methods: A cloud-based artificial intelligence tool (recomia.org) was used to segment all skeletal muscle of the torso of 994 patients who had performed whole-torso CT 2008-2020 for various clinical indications. Linear regression models for several anatomical volumes and single-slice areas were compared with regard to predicting the total torso muscle volume. Results: The muscle volume from the tip of the coccyx and 25 cm cranially was the best of the abdominal volumes and was significantly better than the L3 slice muscle area (R-2 0.935 vs 0.830, P < 0.0001). For thoracic volumes, the muscle volume between the top of the sternum to the lower bound of the Th12 vertebra showed the best correlation with the total volume, significantly better than the Th12 slice muscle area (R-2 0.892 vs 0.775, P < 0.0001). Adjusting for body height improved the correlation slightly for all measurements but did not significantly change the ordering. Conclusions: We identified muscle volumes that can be reliably segmented by automated image analysis which is superior to single slice areas in predicting total muscle volume.