Rationale and Objectives
The prognostic role of computed tomography (CT)-defined skeletal muscle features in COVID-19 is still under investigation. The aim of the present study was to evaluate the prognostic role of CT-defined skeletal muscle area and density in patients with COVID-19 in a multicenter setting.
Materials and Methods
This retrospective study is a part of the German multicenter project RACOON (Radiological Cooperative Network of the COVID-19 pandemic). The acquired sample included 1379 patients, 389 (28.2%) women and 990 (71.8%) men. In each case, chest CT was analyzed and pectoralis muscle area and density were calculated. Data were analyzed by means of descriptive statistics. Group differences were calculated using the Mann–Whitney-U test and Fisher’s exact test. Univariable and multivariable logistic regression analyses were performed.
Results
The 30-day mortality was 17.9%. Using median values as thresholds, low pectoralis muscle density (LPMD) was a strong and independent predictor of 30-day mortality, HR = 2.97, 95%-CI: 1.52–5.80, p = 0.001. Also in male patients, LPMD predicted independently 30-day mortality, HR = 2.96, 95%-CI: 1.42–6.18, p = 0.004. In female patients, the analyzed pectoralis muscle parameters did not predict 30-day mortality.
For patients under 60 years of age, LPMD was strongly associated with 30-day mortality, HR = 2.72, 95%-CI: 1.17;6.30, p = 0.019. For patients over 60 years of age, pectoralis muscle parameters could not predict 30-day mortality.
Conclusion
In male patients with COVID-19, low pectoralis muscle density is strongly associated with 30-day mortality and can be used for risk stratification. In female patients with COVID-19, pectoralis muscle parameters cannot predict 30-day mortality.
In recent decades, percutaneous ablation procedures have evolved into a recognized treatment option for renal cell carcinoma (RCC). Thermal ablation techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) are now incorporated in most treatment guidelines as a viable alternative, and in some cases, deemed equivalent to nephron-sparing surgery (NSS) or other surgical methods, especially for small renal masses (SRM) up to 4 cm. This review offers an overview of the most prevalent ablation techniques used to treat localized RCC. Additionally, it compares the oncological and clinical outcomes of these techniques with those of surgical options. Finally, it provides an assessment of the role that ablation treatment occupies in current guidelines. In conclusion, the use and incorporation of image-guided minimally invasive treatment options for RCC is on the rise. Existing data suggest that thermal ablation procedures (RFA, MWA, and CA) and partial nephrectomy yield comparable oncologic and clinical outcomes. Despite the data available, the recommendations for thermal ablations vary significantly across national and international guidelines.
