Quantitative AI Volumetry Profiling Regional Muscle Hypotrophy in Chronic Limb-Threatening Ischemia.
Authors
Affiliations (3)
Affiliations (3)
- Department of Vascular Surgery and Angiology, Pomeranian Medical University in Szczecin, Al. Powsta艅c贸w Wielkopolskich 72, 70-111 Szczecin, Poland.
- Department of General, Dental and Interventional Radiology, Pomeranian Medical University in Szczecin, Powsta艅c贸w Wielkopolskich 72, 70-111 Szczecin, Poland.
- Department of Vascular Surgery and Angiology, Pomeranian Medical University in Szczecin, Al. Powsta艅c贸w Wielkopolskich 72, 70-111 Szczecin, Poland. Electronic address: [email protected].
Abstract
Chronic Limb-Threatening Ischemia (CLTI) leads to severe functional impairment and degeneration of lower-limb musculature. Although muscle wasting in CLTI has been assessed using single-slice or density-based approaches, three-dimensional volumetric analysis using artificial intelligence (AI) remains limited. This study aimed to quantify and compare muscle volumes in both limbs of patients with unilateral CLTI using AI-based computed tomography angiography (CTA) segmentation to identify muscle groups most susceptible to ischemic hypotrophy. The cohort of 100 consecutive patients undergoing lower-limb CTA for CLTI evaluation was screened. After exclusion of bilateral disease, prior amputation, poor image quality, and non-occlusive pathology, 30 patients with unilateral CLTI (Fontaine III-IV) and 10 controls without significant stenosis were included. Three-dimensional muscle volumes were obtained using a deep-learning model (TotalSegmentator 2.11.0). The Hypotrophy Rate (HR) was defined as the ischemic-to-contralateral limb volume ratio. Significant hypotrophy was determined using a control-derived threshold of two standard deviations. Sarcopenia was evaluated using psoas muscle area. Significant muscle hypotrophy was present in 11 of 30 CLTI patients (37%). The greatest volume loss involved the gluteus minimus, quadriceps femoris, medial thigh compartment, and sartorius (p<0.05). No significant hypotrophy was observed in the gluteus maximus, gluteus medius, or lower-leg muscles. Proximal muscle volume loss correlated strongly with total limb hypotrophy, particularly in the quadriceps (蟻=0.90) and gluteal region (r=0.97). Sarcopenia increased the odds of significant hypotrophy more than tenfold (OR 10.29; p=0.047). AI-based volumetry enables precise, operator-independent quantification of regional muscle wasting in CLTI.