Tutorial for using SliceOmatic to calculate thigh area and composition from computed tomography images from older adults

Objective Area of muscle, fat, and bone is often measured in thigh CT scans when tissue composition is a key outcome. SliceOmatic software is commonly referenced for such analysis but published methods may be insufficient for new users. Thus, a quick start guide to calculating thigh composition using SliceOmatic has been developed. Methods CT images of the thigh were collected from older (69 +/- 4 yrs, N = 24) adults before and after 12-weeks of resistance training. SliceOmatic was used to segment images into seven density regions encompassing fat, muscle, and bone from -190 to +2000 Hounsfield Units [HU]. The relative contributions to thigh area and the effects of tissue density overlap for skin and marrow with muscle and fat were determined. Results The largest contributors to the thigh were normal fat (-190 to -30 HU, 29.1 +/- 7.4%) and muscle (35 to 100 HU, 48.9 +/- 8.2%) while the smallest were high density (101 to 150 HU, 0.79 +/- 0.50%) and very high density muscle (151 to 200 HU, 0.07 +/- 0.02%). Training significantly (P<0.05) increased area for muscle in the very low (-29 to -1 HU, 5.5 +/- 7.9%), low (0 to 34 HU, 9.6 +/- 16.8%), normal (35 to 100 HU, 4.2 +/- 7.9%), and high (100 to 150 HU, 70.9 +/- 80.6%) density ranges for muscle. Normal fat, very high density muscle and bone did not change (P>0.05). Contributions to area were altered by similar to 1% or less and the results of training were not affected by accounting for skin and marrow. Conclusions When using SliceOmatic to calculate thigh composition, accounting for skin and marrow may not be necessary. We recommend defining muscle as -29 to +200 HU but that smaller ranges (e.g. low density muscle, 0 to 34 HU) can easily be examined for relationships with the health condition and intervention of interest.