Abstract：
BACKGROUND: Measuring the swallowing muscle mass with volume measurements is complex and time intensive; therefore, it is not used in clinical practice. However, it can be clinically relevant, for instance, in the case of sarcopenic dysphagia. The aim of the study was to develop a feasible and clinically applicable method to measure swallowing muscle mass.
METHODS: Data from 10 head and neck cancer patients were collected from the Oncological Life Study data-biobank of the University Medical Center Groningen. The pharyngeal constrictor, genioglossus, mylohyoid and geniohyoid complex muscles, as well as the tongue complex muscles, were delineated manually on routinely performed head and neck computed tomography scans. Axial and sagittal planes were used for volume and area measurements, respectively. Muscle density measurements were performed with and without Hounsfield unit thresholding. Correlations were assessed by Pearson correlation coefficients, and interobserver reliability was measured using intra-class correlation coefficients (ICCs).
RESULTS: Significant differences were observed between sagittal area measurements with and without Hounsfield unit thresholds for pharyngeal constrictor, tongue complex and the sum of the swallowing muscles (t > 6; P-value < 0.001). Stronger correlations emerged without Hounsfield unit thresholding. Strong positive and significant correlations were found between the total swallowing muscle mass volume and the sagittal area of the tongue complex muscles (r = 0.87, P-value < 0.05) and the sum of the sagittal areas of the pharyngeal constrictor and tongue complex muscles (r = 0.85, P-value < 0.05). The use of the Hounsfield unit threshold weakened correlations. Interobserver reliability was assessed and found to be fair to good for the pharyngeal constrictor muscle (ICC = 0.68, P-value < 0.05), excellent for the tongue complex muscles (ICC = 0.98, P-value < 0.05) and excellent for the total swallowing muscle area (ICC = 0.96, P-value < 0.05).
CONCLUSIONS: Single-slice delineation of the sagittal area of tongue complex muscle and pharyngeal constrictor muscle is a promising, fast, simple and clinically applicable method for measuring the total volume of the swallowing muscle mass in head and neck cancer patients without Hounsfield unit thresholding. These advancements and findings would help in the early and accurate diagnosis of definitive sarcopenic dysphagia.
METHODS: Data from 10 head and neck cancer patients were collected from the Oncological Life Study data-biobank of the University Medical Center Groningen. The pharyngeal constrictor, genioglossus, mylohyoid and geniohyoid complex muscles, as well as the tongue complex muscles, were delineated manually on routinely performed head and neck computed tomography scans. Axial and sagittal planes were used for volume and area measurements, respectively. Muscle density measurements were performed with and without Hounsfield unit thresholding. Correlations were assessed by Pearson correlation coefficients, and interobserver reliability was measured using intra-class correlation coefficients (ICCs).
RESULTS: Significant differences were observed between sagittal area measurements with and without Hounsfield unit thresholds for pharyngeal constrictor, tongue complex and the sum of the swallowing muscles (t > 6; P-value < 0.001). Stronger correlations emerged without Hounsfield unit thresholding. Strong positive and significant correlations were found between the total swallowing muscle mass volume and the sagittal area of the tongue complex muscles (r = 0.87, P-value < 0.05) and the sum of the sagittal areas of the pharyngeal constrictor and tongue complex muscles (r = 0.85, P-value < 0.05). The use of the Hounsfield unit threshold weakened correlations. Interobserver reliability was assessed and found to be fair to good for the pharyngeal constrictor muscle (ICC = 0.68, P-value < 0.05), excellent for the tongue complex muscles (ICC = 0.98, P-value < 0.05) and excellent for the total swallowing muscle area (ICC = 0.96, P-value < 0.05).
CONCLUSIONS: Single-slice delineation of the sagittal area of tongue complex muscle and pharyngeal constrictor muscle is a promising, fast, simple and clinically applicable method for measuring the total volume of the swallowing muscle mass in head and neck cancer patients without Hounsfield unit thresholding. These advancements and findings would help in the early and accurate diagnosis of definitive sarcopenic dysphagia.
摘要：
背景：通过体积测量来测量吞咽肌肉质量是复杂且时间密集的；因此，它不用于临床实践。然而,它可能是临床相关的，例如,在肌肉减少性吞咽困难的情况下。该研究的目的是开发一种可行且临床适用的方法来测量吞咽肌肉质量。
方法：从格罗宁根大学医学中心的肿瘤生命研究数据-生物库收集来自10名头颈部癌症患者的数据。咽部收缩器,遗传舌,舌骨和舌骨复合体肌肉，以及舌头的复杂肌肉，在常规进行的头颈部计算机断层扫描中手动描绘。轴向和矢状平面用于体积和面积测量，分别。在有和没有Hounsfield单位阈值的情况下进行肌肉密度测量。用皮尔逊相关系数评估相关性，观察者间可靠性使用类内相关系数(ICC)进行测量。
结果：在有和没有Hounsfield单位阈值的情况下，咽部收缩器的矢状面积测量之间观察到显着差异，舌复合体和吞咽肌肉的总和（t>6；P值<0.001）。在没有Hounsfield单位阈值的情况下，出现了更强的相关性。总吞咽肌质量体积与舌复肌矢状面积(r=0.87,P值<0.05)、咽缩肌和舌复肌矢状面积之和(r=0.85,P值<0.05)之间存在较强的正相关。使用Hounsfield单位阈值削弱了相关性。评估了观察者间的可靠性，发现咽缩肌的可靠性是公平或良好的（ICC=0.68，P值<0.05），舌复合肌优异（ICC=0.98，P值<0.05），总吞咽肌面积优异（ICC=0.96，P值<0.05）。
结论：舌复合体肌和咽缩肌的矢状区域的单层勾画是有前途的，快,在没有Hounsfield单位阈值的情况下，测量头颈部癌症患者吞咽肌肉质量总体积的简单且临床适用的方法。这些进步和发现将有助于早期和准确地诊断明确的肌肉减少性吞咽困难。
方法：从格罗宁根大学医学中心的肿瘤生命研究数据-生物库收集来自10名头颈部癌症患者的数据。咽部收缩器,遗传舌,舌骨和舌骨复合体肌肉，以及舌头的复杂肌肉，在常规进行的头颈部计算机断层扫描中手动描绘。轴向和矢状平面用于体积和面积测量，分别。在有和没有Hounsfield单位阈值的情况下进行肌肉密度测量。用皮尔逊相关系数评估相关性，观察者间可靠性使用类内相关系数(ICC)进行测量。
结果：在有和没有Hounsfield单位阈值的情况下，咽部收缩器的矢状面积测量之间观察到显着差异，舌复合体和吞咽肌肉的总和（t>6；P值<0.001）。在没有Hounsfield单位阈值的情况下，出现了更强的相关性。总吞咽肌质量体积与舌复肌矢状面积(r=0.87,P值<0.05)、咽缩肌和舌复肌矢状面积之和(r=0.85,P值<0.05)之间存在较强的正相关。使用Hounsfield单位阈值削弱了相关性。评估了观察者间的可靠性，发现咽缩肌的可靠性是公平或良好的（ICC=0.68，P值<0.05），舌复合肌优异（ICC=0.98，P值<0.05），总吞咽肌面积优异（ICC=0.96，P值<0.05）。
结论：舌复合体肌和咽缩肌的矢状区域的单层勾画是有前途的，快,在没有Hounsfield单位阈值的情况下，测量头颈部癌症患者吞咽肌肉质量总体积的简单且临床适用的方法。这些进步和发现将有助于早期和准确地诊断明确的肌肉减少性吞咽困难。
