Height and weight were measured with a stadiometer and balance-beam scale, respectively, with participants wearing light clothing and no shoes. BMI was quantified by weight in kilograms divided by height in meters-squared. Waist circumference was measured at a level midway between the lowest rib and the top of the iliac crest, as previously described (Alberga et al., 2012 (link)). Body composition was assessed by MRI with a 1.5-T system (EchoSpeed, signal 11 version; GE Medical Systems). Participants lay prone for whole-body cross sectional images using protocols by Ross et al. (1992) (link). The MRIs were analyzed using Slice-OMaticTM software, version 4.3; (Tomovision, Magog, QC, Canada). Fat-free mass (FFM) is defined as total lean tissue mass, including all fat-free skeletal muscle, organs, intestines, and bones, without adipose tissue, while fat mass (FM) represents the amount of visceral and subcutaneous adipose tissue. Percent body fat was calculated by dividing the amount of FM by total body mass (i.e., FM + FFM) × 100.
Slice o matic software version 4
Manufactured by Tomovision
Sourced in Canada
Slice-O-matic software, version 4.3 is a digital imaging application designed for the analysis and processing of digital images. The software provides tools for segmentation, measurement, and visualization of image data.
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Lab products found in correlation
9 protocols using slice o matic software version 4
1
Comprehensive Body Composition Assessment
2
Body Composition Assessment by MRI
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Height and weight were recorded with a manual stadiometer and scale, respectively, with participants wearing light clothing and no shoes. Waist circumference was measured at a level midway between the lowest rib and the top of the iliac crest, as previously described (Alberga et al. 2012) . Body composition was assessed by MRI with a 1.5-T system (EchoSpeed, signal 11 version; GE Medical Systems). Participants lay D r a f t prone for whole-body cross sectional images using protocols by Ross and colleagues (Ross et al. 1992 ). The MRIs were analyzed using a Slice-OMatic TM software, version 4.3; Tomovision, Magog, Canada. FFM is defined as total lean tissue mass, which includes all fat-free skeletal muscle, organs, intestines, and bones, without adipose tissue.
Total skeletal muscle mass is defined by fat-free skeletal muscle due to the absence of intramuscular fat included in the calculation. Visceral adipose tissue is the fat surrounding the internal organs, whereas, subcutaneous adipose tissue lies immediately below the dermis of the skin.
Total skeletal muscle mass is defined by fat-free skeletal muscle due to the absence of intramuscular fat included in the calculation. Visceral adipose tissue is the fat surrounding the internal organs, whereas, subcutaneous adipose tissue lies immediately below the dermis of the skin.
3
CT-Based Body Composition Analysis
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CT images taken routinely for clinical purposes are used for body composition analysis, i.e. quantification of fat (visceral, subcutaneous and intermuscular adipose tissue) and skeletal muscle. The images are analysed using the Slice-o-matic software, version 4.3 (Tomovision, Montreal, Canada). The third lumbar vertebra (L3) is chosen as standard landmark since skeletal muscle, lean tissue mass and adipose tissue at this level are significantly correlated to whole-body tissue in healthy adults [72 (link)].
4
Assessing Muscle Mass and Myosteatosis
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On the day of TE analysis, muscle mass was assessed by bio-impedance devices (BIA 101, Akern, Italy; Biocorpus, Medi Cal, Germany; Tanita BC-418 MA, Tanita, UK), and an abdominal CT scan at the third lumbar level (L3) was performed to measure muscle mass and density indexes. Of note, we used a dedicated low-dose protocol centred at the L3 and evaluated the induced volume CT dose index (CTDIvol) and the dose–length product (DLP). We used Hounsfield unit (HU) values at the commonly accepted threshold of −29 to +150 HU23 (link) to semi-automatically delineate psoas, dorsal, and abdominal muscles. Muscle area and density were quantified by the Slice-O-Matic software, version 4.3 (TomoVision, Montreal, Canada). Total muscle area was normalised for stature and was referred to as the skeletal muscle index (SMI) (cm2/m2). Sarcopenia was defined as a SMI <41 cm2/m2 in female and <53 cm2/m2 in male.24 (link) We measured the mean skeletal muscle density (SMD), and the absolute amount of fat in the muscle was computed as the ratio of the muscle area in cm2 by muscle density in HU. This ratio, multiplied by 100, is referred to as the skeletal muscle fat index (SMFI). For simplification, the term “myosteatosis” will be used to denote a high(er) SMFI or absolute muscle fat content. All CT images were analysed by a single operator (MN), unaware of metabolic and TE data.
5
Skeletal Muscle Quantification from CT Images
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The CT images that were stored electronically were utilized for the purpose of quantifying the skeletal muscle at the L3 vertebra. As previously described, skeletal muscle area (SMA) was identified and measured by applying Hounsfield unit (HU) thresholds of -29 to +150, and cross-sectional areas (cm 2 ) were automatically computed by summing tissue pixels and multiplying by pixel surface area. Images were analyzed by two trained observers using Slice-Omatic software, version 4.3 (Tomovision, Montreal, QC, Canada). Subsequently, the SMA was standardized to the individual's height in order to determine skeletal muscle index (SMI, cm 2 /m 2 ) [13] . According to the Japan Society of Hepatology guidelines for sarcopenia in liver disease, sarcopenia was defined as L3 SMI <42 cm 2 /m 2 for men and <38 cm 2 /m 2 for women [14] .
6
Surgical Difficulty Criteria in Pelvic Imaging
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Pelvimetry parameters were measured on lateral and axial computed tomography (CT) images as described previously (18 (link)). Pelvic inlet was defined as distance between promontory and the superior edge of symphysis pubis. Pelvic depth was the distance between promontory and coccyx. Pelvic outlet was the distance between coccyx and the inferior edge of the symphysis pubis. Interspinous distance corresponded to the transverse distance between the tips of ischial spines. Intertuberous distance corresponded to the transverse distance between the lowest points of ischial tuberositie. Additionally, the mesorectal fat area (MFA) was measured at the level of the tip of the sciatic spine using Slice-O-matic software, version 4.3 (Tomovision, Montreal, QC, Canada) (19 (link)) (Figure 2
The surgical difficulty criteria were referred to the definition previously given by Escal et al. (18 (link)) with modifications: operation time > 180 min (3 points), conversion to open surgery (3 points), transanal approach (2 points), postoperative hospital stay > 7 days (2 points), estimated blood loss ≥ 100 ml (1 points), Clavien–Dindo classifications grade II and III postoperative morbidities (1 point). Based on the surgical difficulty score, patients were classified into two subgroups, difficulty (≥ 6 points) and non-difficulty (0–5 points) groups (Table 1
The surgical difficulty criteria were referred to the definition previously given by Escal et al. (18 (link)) with modifications: operation time > 180 min (3 points), conversion to open surgery (3 points), transanal approach (2 points), postoperative hospital stay > 7 days (2 points), estimated blood loss ≥ 100 ml (1 points), Clavien–Dindo classifications grade II and III postoperative morbidities (1 point). Based on the surgical difficulty score, patients were classified into two subgroups, difficulty (≥ 6 points) and non-difficulty (0–5 points) groups (
7
Measuring Skeletal Muscle Mass via CT Scans
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The skeletal muscle mass was determined in the patients using stored images of computed tomography (CT) scans, which were obtained before any treatment. The skeletal muscle area was assessed from a single axial slice at the third lumber (L3) level. Hounsfield unit-based analyses of the images were performed using the dedicated SliceOmatic software version 4.3 (TomoVision, Montreal, QC, Canada) [16 (link)]. The skeletal muscle mass included the psoas muscle, quadratus lumborum, transversus abdominis, external and internal oblique muscles, rectus abdominis, and erector spinae, and the value was normalized for stature to determine the L3 skeletal muscle index (SMI).
8
Quantifying Spinal Muscle Degeneration
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Patients underwent plain CT using a 64-row multidetector CT (GE Healthcare, Milwaukee, WI, USA) with 1-mm slice thickness in the supine position at admission or within 7days after admission. The electronically stored CT images were collected from Picture Archiving and Communication Systems (PACS, IMPAX6.3.1.4095, AGFA HealthCare NV, Belgium). T12SMA was defined as any muscle within the region posterior to the T12 spine and ribs and no more lateral than the lateral-most edges of the erector spinal muscles (Fig 1). The skeletal muscle boundaries were segmented manually. The cross-sectional muscle area and radiodensity were semi-automated thresholding using Slice-O-matic software, version 4.3 (Tomovision, Montreal, QC, Canada). Skeletal muscle was identified and quantified by use of Hounsfield unit (HU) thresholds (À29 to +150) (14) . All imaging analyses were conducted in the cross-sectional area at the level of T12 vertebral. T12SMA was recorded as the sum of bilateral dorsal SMA, while T12SMD was recorded as the mean of bilateral dorsal muscle group radiodensity (Fig 1). Muscle segmentations were performed by an experienced operator, with an audit of all images and segmentations by a musculoskeletal radiologist.
9
Volumetric Analysis of Cerebellar Domains
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Volumetric analysis was conducted using 3D MR images of the cerebellum. The left and right cerebellar sides were divided at the midline, which was defined by the position of the cerebral longitudinal fissure. Cerebellar transverse domains were segmented semi-automatically into four zones: Anterior zone (AZ; lobules I-V of the vermis), central zone anterior (CZa; lobules VI and the lobules simplex), central zone posterior (CZp; lobules VII of the vermis and ansiform lobules), and posterior zone (PZ; lobules VIII-IXa of the vermis and paramedian lobule) [5] (link). Segmented areas of each domain were measured using the SliceOmatic software version 4.3 (TomoVision, Montreal, Canada), and the volume of each domain was calculated by multiplying the combined areas by the slice thickness (156.25 µm). The asymmetry quotient (AQ) was calculated using the formula ((R -L)/{(R + L) × 0.5}) and was used to assess the volume laterality of each domain. The direction of asymmetry was indicated by the AQ values: Positive value = rightward bias and negative value = leftward bias [12] (link).
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