Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of the article is prohibited. Sarcopenia in liver cirrhosis: the role of computed tomography scan for the assessment of muscle mass compared with dual-energy X-ray absorptiometry and anthropometry Michela Giusto a , Barbara Lattanzi a , Carlina Albanese c , Alessia Galtieri a , Alessio Farcomeni b , Valerio Giannelli a , Cristina Lucidi a , Michele Di Martino c , Carlo Catalano c and Manuela Merli a Background Sarcopenia evaluated by computed tomography (CT) scan at the lumbar site has been identified as a risk factor for morbidity and mortality in cirrhosis. Aim The aim of this study was to compare the measurement of muscle mass through CT scan, considered the gold standard, with other reliable techniques to evaluate the rate of agreement between different available methods for the assessment of muscle mass in cirrhosis. The correlation between measurements of muscle mass and of muscle strength was also investigated. Patients and methods Adult patients eligible for liver transplantation were studied. Lumbar skeletal muscle cross-sectional area was measured by CT and muscle depletion was defined using previously published cut-offs. Mid-arm muscle circumference was calculated following anthropometric measures. The Fat-Free Mass Index and the Appendicular Skeletal Muscle Index were calculated using dual-energy X-ray absorptiometry. Muscle strength was evaluated using the Hand Grip test. Results Fifty-nine patients with cirrhosis were included. Sarcopenia was diagnosed in 76% of the patients according to CT evaluation. A significant reduction in Fat-Free Mass Index and Appendicular Skeletal Muscle Index was observed in 42–52% of the patients, whereas 52% showed a mid-arm muscle circumference less than 10th percentile. Skeletal muscle mass evaluation through CT was only weakly correlated with dual-energy X-ray absorptiometry and anthropometry evaluation. No correlation was observed between CT measurement of muscle mass and Hand Grip test. Conclusion CT scan can identify the highest percentage of sarcopenia in cirrhosis and no other techniques are actually available as a replacement. Future efforts should focus on approaches for assessing both skeletal muscle mass and function to provide a better evaluation of sarcopenia in cirrhotic patients. Eur J Gastroenterol Hepatol 00:000–000 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. European Journal of Gastroenterology & Hepatology 2015, 00:000–000 Keywords: cirrhosis, computed tomography scan, sarcopenia, skeletal muscle a Department of Clinical Medicine, b Department of Public Health and Infectious Diseases and c Department of Radiological Sciences, Sapienza Università di Roma, Rome, Italy Correspondence to Manuela Merli, MD, II Gastroenterologia, Dipartimento di Medicina Clinica, Viale dell’Università 37, 00185 Rome, Italy Tel/fax: + 39 06 4997 2001; e-mail: manuela.merli@uniroma1.it Received 28 August 2014 Accepted 5 December 2014 Introduction Skeletal muscle wasting is a common feature of malnutrition in patients with liver cirrhosis [1] and is widely recognized as an independent predictor of poor outcome and mortality in this setting [2–5]. In the last few years, the term ‘sarcopenia’ has been introduced to describe a condition of progressive and generalized loss of muscle mass and strength [6] and a recent European Consensus Statement has identified com- puted tomography (CT) as the gold standard for the detection of muscle wasting in clinical trials [7]. Dual-energy X-ray absorptiometry (DEXA) and anthropometry, despite some limitations, have been utilized frequently to evaluate muscle mass in cirrhotic patients [8–10]. The definition of sarcopenia should also include an assessment of muscle function. There are few well- validated techniques to measure muscle strength; among these, the Hand Grip (HG) test has been shown to be frequently compromised in cirrhotic patients even at early stages [11–13]. Recent reports have investigated the pre- sence of sarcopenia in patients with end-stage liver disease [14–23]. In these studies, the prevalence of muscle wasting, determined using CT, and its accuracy as a prognostic factor were investigated [14–18,21–23], although an assessment of muscle function, through HG or physical performance tests, was lacking. Muscle depletion was found to be associated with higher mortality in patients awaiting liver transplanta- tion (LT) [15–17], whereas controversial results were obtained for mortality after LT [8,18,22,23]. Nevertheless, caution has been suggested in the use of CT for the detection of sarcopenia in cirrhosis [24,25]. Indeed, meth- ods and threshold values for the diagnosis of muscle wasting in patients with cirrhosis have not been examined exten- sively. Furthermore, the possible correlation with other Original article 1 0954-691X Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. DOI: 101097/MEG.0000000000000274