CT scan based densitometric quantification has been described in detail elsewhere [18 (link)]. Briefly, area-based quantification of adipose tissue compartments was performed on the L3/4 spinal level (volumetric quantification of selected slice, divided by slice thickness) using a semiautomatic software tool (Syngo Volume tool, Siemens Healthcare, Munich, Berlin, Germany). Specific regions of interest (ROI) were manually determined: total fat area (TFA) (whole abdominal circumference, Figure 1 a) and VFA (by defining the fascial plane of the abdominal muscle wall, Figure 1 b). The limits of measurement for selecting the specific fat area were −190 HU (Hounsfield units) to −30 HU. SFA was calculated by subtracting VFA from TFA. On the same image slice, at the L3/4 spinal level, an ROI determining the SMM (sum of M. psoas major, M. erector spinae, M. quadratus lumborum, M. latissimus dorsi, M. transversus abdominis, M. obliquus internus abdominis and externus abdominis, and M. rectus abdominis;Figure 1 c) was measured by limiting the attenuation threshold between 40 HU and 100 HU (excluding muscle lipid content; thresholds were based on visual controls which were conducted as a plausibility test within our study cohort) and normalized for height squared (see Figure 1 ) [13 (link),18 (link)].
Syngo volume tool
Manufactured by Siemens
Sourced in Germany
The Syngo Volume tool is a software application developed by Siemens for medical imaging analysis. The core function of this tool is to allow users to visualize and measure the volume of anatomical structures or lesions from various medical imaging modalities, such as CT, MRI, and PET scans.
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Lab products found in correlation
4 protocols using syngo volume tool
1
CT-based Quantification of Body Composition
2
Quantifying Abdominal Adipose Tissue
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Area-based quantification of adipose tissue compartments was performed on one image slice between vertebral-body L2/3 with a semiautomatic volume tool (Syngo Volume tool, Siemens Healthcare, Munich, Berlin, Germany). By manually determining specific regions of interest (ROI), the Total-Fat-Area (TFA, whole circumference abdomen) and the Visceral-Fat-Area (VFA, along the fascial plane tracing the abdominal wall) were measured (volumetric quantification of selected slice, divided by slice thickness) [19 ]. Adipose tissue within these ROIs was selected by limiting the measurement thresholds to a lower attenuation limit of -190HU and an upper attenuation limit of -30HU as previously described [19 , 20 (link)]. Subcutaneous-fat-area (SFA) was calculated by subtracting VFA from TFA and the visceral to subcutaneous fat ratio was calculated as VFA/SFA [19 ].
3
Quantifying Muscle Characteristics from Imaging
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Trained analysts (one radiation oncologist, one radiologist) blinded to outcomes independently quantified total muscle CSA on an axial image at the level of the T8, T10, and T12 thoracic vertebral bodies under the supervision of board‐certified thoracic radiologists (F.J.F., C.P.H.). Analysts used semi‐automated threshold‐based segmentation (−29 to +150 Hounsfield units) as illustrated in Figure 2 and previously described.14 Analysts used OsiriX Lite software (version 11.0.3, Pixmeo SARL, Bernex, Switzerland) at MGH and the Syngo Volume tool (Siemens Healthineers) at HDB. Twenty‐five randomly selected subjects were assessed with both software packages to determine inter‐software agreement. Two additional sets of 25 randomly selected subjects (one set per institution) were compared with the same software to determine inter‐analyst agreement.
4
Quantifying Body Composition Changes via CT
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Data obtained from abdominal CT scans were entered into a semi‐automatic volume tool (Syngo Volume tool, Siemens Healthcare) to assess body composition. The patient's baseline abdominal CT (CT0) examination time was within 30 days before surgery (0–30 days, mean 7 days), and the follow‐up CT examinations were included as CT1 (short‐term): CT examination 3 months after surgery (83–96 days, mean 90.2 days), CT2 (long‐term): CT examination 1 year after operation (346–385 days, mean 360 days). Abdominal cross‐sectional area (CSA) (cm2) was measured at the level of the third lumbar vertebra, including all muscles bilaterally in this area (internal/external obliques, quadratus lumborum, transversus abdominis, paraspinous, psoas, and rectus abdominis). Muscle density was corrected by using Hounsfield Units (HU) range −29 to 150, visceral fat area (VFA) (cm2) was delineated and obtained on CT by using the adipose tissue threshold (−190 to −130HU) (Figure 1 ). CSA was adjusted to Skeletal Muscle Index (SMI) by dividing the muscle area by the square of the patient's height, SMI = CSA (cm2)/Height (m2). Sarcopenia was defined: <52.4 cm2/m2 in men and <38.4 cm2/m2 in women.15 All data were collected in a retrospective manner after receiving appropriate approval by the Institutional Review Board.
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