Volume and fat infiltration of spino-pelvic musculature in adults with spinal deformity.
OBJECTIVE
To investigate fat infiltration and volume of spino-pelvic muscles in adults spinal deformity (ASD) with magnetic resonance imaging (MRI) and 3D reconstructions.


METHODS
Nineteen female ASD patients (mean age 60 ± 13) were included prospectively and consecutively and had T1-weighted Turbo Spin Echo sequence MRIs with Dixon method from the proximal tibia up to T12 vertebra. The Dixon method permitted to evaluate the proportion of fat inside each muscle (fat-water ratio). In order to investigate the accuracy of the Dixon method for estimating fat vs water, the same MRI acquisition was performed on phantoms of four vials composed of different proportion of fat vs water. With Muscl'X software, 3D reconstructions of 17 muscles or group of muscles were obtained identifying the muscle's contour on a limited number of axial images [Deformation of parametric specific objects (DPSO) Method]. Musclar volume (Vmuscle), infiltrated fat volume (Vfat) and percentage of fat infiltration [Pfat, calculated as follow: Pfat = 100 × (Vfat/Vmuscle)] were characterized by extensor or flexor function respectively for the spine, hip and knee and theirs relationship with demographic data were investigated.


RESULTS
Phantom acquisition demonstrated a non linear relation between Dixon fat-water ratio and the real fat-water ratio. In order to correct the Dixon fat-water ratio, the non linear relation was approximated with a polynomial function of degree three using the phantom acquisition. On average, Pfat was 13.3% ± 5.3%. Muscles from the spinal extensor group had a Pfat significantly greater than the other muscles groups, and the largest variability (Pfat = 31.9% ± 13.8%, P < 0.001). Muscles from the hip extensor group ranked 2(nd) in terms of Pfat (14% ± 8%), and were significantly greater than those of the knee extensor (P = 0.030). Muscles from the knee extensor group demonstrated the least Pfat (12% ± 8%). They were also the only group with a significant correlation between Vmuscle and Pfat (r = -0.741, P < 0.001), however this correlation was lacking in the other groups. No correlation was found between the Vmuscle total and age or body mass index. Except for the spine flexors, Pfat was correlated with age. Vmuscle and Vfat distributions demonstrated that muscular degeneration impacted the spinal extensors most.


CONCLUSIONS
Mechanisms of fat infiltration are not similar among the muscle groups. Degeneration impacted the spinal and hip extensors most, key muscles of the sagittal alignment.
Bertrand Moal, Frank Schwab, Virginie Lafage, Spine Division, Hospital for Joint Diseases, New-York University University Langone Medical Center, New York, NY 10003, United States.
Bertrand
B
Moal
Bertrand Moal, Frank Schwab, Virginie Lafage, Spine Division, Hospital for Joint Diseases, New-York University University Langone Medical Center, New York, NY 10003, United States.
Nicolas
N
Bronsard
Bertrand Moal, Frank Schwab, Virginie Lafage, Spine Division, Hospital for Joint Diseases, New-York University University Langone Medical Center, New York, NY 10003, United States.
José G
JG
Raya
Bertrand Moal, Frank Schwab, Virginie Lafage, Spine Division, Hospital for Joint Diseases, New-York University University Langone Medical Center, New York, NY 10003, United States.
Jean Marc
JM
Vital
Bertrand Moal, Frank Schwab, Virginie Lafage, Spine Division, Hospital for Joint Diseases, New-York University University Langone Medical Center, New York, NY 10003, United States.
Frank
F
Schwab
Bertrand Moal, Frank Schwab, Virginie Lafage, Spine Division, Hospital for Joint Diseases, New-York University University Langone Medical Center, New York, NY 10003, United States.
Wafa
W
Skalli
Bertrand Moal, Frank Schwab, Virginie Lafage, Spine Division, Hospital for Joint Diseases, New-York University University Langone Medical Center, New York, NY 10003, United States.
Virginie
V
Lafage
Adults with spinal deformity; Dixon method; Fat infiltration; Muscular degeneration; Muscular volume; Spino-pelvic musculature