Thursday, September 19, 2024 | New York Academy of Medicine (NYAM)
1216 5th Ave, New York, NY 10029
Dr. Mingqian Huang, MD, discusses the increasing prevalence of osteoporosis and sarcopenia in aging populations and their significant impact on health and lifespan. Early detection through advanced imaging techniques, such as DXA and quantitative CT, is crucial for diagnosing and managing these conditions. Dr. Huang highlights recent studies that advocate the use of AI and deep learning to enhance screening and diagnosis, providing new opportunities for research and clinical practice.
Watch Dr. Mingqian Huang's Presentation Below:
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Transcript of Dr. Mingqian Huang's Presentation:
[Mingqian Huang] [416.79s] So right now, clinically, they usually begin with a patient filled out questionnaire, and they do some measurements in term of muscle condition.
[Mingqian Huang] [426.17s] So usually by measuring the circumference of either upper or lower extremity and some of the simple muscle function tests.
[Mingqian Huang] [434.74s] However, it's not.
[Mingqian Huang] [435.70s] And also the biomedical impedance, analysis.
[Mingqian Huang] [440.42s] However, it's not very well standardized, so there's a lot of non standardization in there.
[Mingqian Huang] [449.45s] So let's look at the encyclopedia on imaging.
[Mingqian Huang] [454.10s] And so we know that with decreased muscle, there's increasing fat.
[Mingqian Huang] [459.85s] Okay.
[Mingqian Huang] [460.17s] That's a very interesting phenomenon because it affects so many different areas.
[Mingqian Huang] [465.61s] We can see, for example, on the top, that's a MRT one image, and it shows the intra muscular fat very well.
[Mingqian Huang] [474.04s] Right?
[Mingqian Huang] [474.36s] You'd see the posteriorly in that side.
[Mingqian Huang] [476.60s] That part of the muscle looks much fattier.
[Mingqian Huang] [479.72s] Right?
[Mingqian Huang] [481.07s] And, also, it affects the muscle, in a way that along the muscle fibers, they are the perimuscular adipose tissues.
[Mingqian Huang] [491.91s] And also inside, there is extra myosin liver increased fat.
[Mingqian Huang] [497.99s] And even more, there's increased lipid level even in the myocyte.
[Mingqian Huang] [503.29s] So it's very interesting.
[Mingqian Huang] [507.13s] So here are the list of imaging, modalities we can use to study muscle.
[Mingqian Huang] [513.12s] So of them, CT and MR stands out because the ability to do cross sectional imaging, and we can see the mass the fat disperse and infiltrate into the muscle better this way using Hansel Unit and the different MR sequences.
[Mingqian Huang] [531.93s] Because of that, the European Working Group of Sarcopenia of older people in 2018 advocated CT MR use for opportunistic sarcopenia evaluation and they suggested L3 and the mid size as the levels.
[Mingqian Huang] [551.69s] So with CT and we have Hounsville unit, So we can do a threshold cutoff and do good segmentation of the muscles, and then we can do a histogram of the muscle composition based on the different, Hansel unit like here.
[Mingqian Huang] [569.65s] And the gluteal muscles and then the paraspinous muscles are usually the ones we study.
[Mingqian Huang] [576.85s] So a group of the studies showing here demonstrate the muscle density is very well correlates with the, muscle strains and the physical performance.
[Mingqian Huang] [589.34s] So because of that, earlier this year, the global leadership initiative of Encyclopedia Group, have the consensus and morphological characteristics of the muscles such as fatty infiltration and texture and density should be part of the definition of encyclopedia.
[Mingqian Huang] [608.98s] So this cemented the use of imaging for devout for diagnose of sarcopenia.
[Mingqian Huang] [616.89s] Here is an example of a CT histogram based on the density and Hansel unit measurements, and it well the different level of fats and, also correlates with the involvement.
[Mingqian Huang] [633.32s] So earlier, I know the speaker talked about a different part of the fat in our body.
[Mingqian Huang] [638.12s] It's very interesting.
[Mingqian Huang] [639.37s] So this is a study, very interesting, from a group in, in China.
[Mingqian Huang] [644.88s] They used CT and MR to study, various parts of fats in our body and, age and the BMI's effect on them.
[Mingqian Huang] [655.44s] So as you can see here, TAT is total abdominal fat.
[Mingqian Huang] [660.00s] VAT is vascular fat and then subcutaneous fat, and PASES are around the paraspinous muscle area, and the liver and the bone marrow.
[Mingqian Huang] [669.88s] And then men and women, they both are affected by the BMI and aging.
[Mingqian Huang] [675.96s] But different areas fat response or effects to it are quite different.
[Mingqian Huang] [681.49s] So it's very interesting.
[Mingqian Huang] [682.71s] And we know for opportunistic screening to work, all our physicians are facing with a big clinical burden.
[Mingqian Huang] [690.43s] So this mesh this way has to be not burden.
[Mingqian Huang] [692.87s] So this mesh this way has to be not very cumbersome and accurate.
[Mingqian Huang] [698.14s] So AI and deep learning is a very good tool we can use.
[Mingqian Huang] [702.87s] So here's an article that demonstrates deep learning based fully automated segmentation studying muscle volume composition is very possible.
[Mingqian Huang] [714.80s] And this group by Doctor.
[Mingqian Huang] [716.32s] Pehart in University of Wisconsin Wisconsin did a lot of work on sarcopenia.
[Mingqian Huang] [721.37s] This particular study showed they compared a study at a level l one and l three of the muscle, measurements and found them comparable, and they both can be used as opportunist prediction for fractures.
[Mingqian Huang] [740.98s] And, you know, we all know chest x-ray is one of the most performed procedures in the hospital.
[Mingqian Huang] [748.09s] And this Korean group even GOCAD using chest x rays and they build models to GOCAD if they can base chest array for opportunity encyclopedia screening and got decent results.
[Mingqian Huang] [759.29s] So it's very promising.
[Mingqian Huang] [762.91s] So with this come with challenges.
[Mingqian Huang] [765.87s] That's well said here.
[Mingqian Huang] [767.79s] And with challenges, it comes opportunities.
[Mingqian Huang] [771.07s] So there's a lot of things we can do with opportunistic osteoporosis screening and, sarcopenia evaluations, and they are now strongly aided by segmentation and artificial intelligence.
[Mingqian Huang] [784.97s] And I think it's an important parameter about patients' general health that we can obtain with, low dose CHEST CT imaging that grid gate promotes patients' health.
[Mingqian Huang] [795.94s] Thank you..
The presentations were hosted by I-ELCAP – The International Early Lung Cancer Action Program.
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