Trunk Skeletal Muscle Changes on CT with Long-Duration Spaceflight

Astronauts exposed to microgravity for extended time are susceptible to trunk muscle atrophy, which may compromise strength and function on mission and after return. This study investigates changes in trunk skeletal muscle size and composition using computed tomography (CT) and dual-energy X-ray absorptiometry (DXA) among 16 crewmembers (1 female, 15 male) on 4-6 month missions. Muscle cross-sectional area and muscle attenuation were measured using abdominal CT scans at pre-flight, post-flight return, 1 year post-flight, and 2–4 years post-flight. Longitudinal muscle changes were analyzed using mixed models. In six crewmembers, CT and DXA data were used to calculate subject height-normalized skeletal muscle indices. Changes in these indices were analyzed using paired t-tests and compared by imaging modality using Pearson correlations. Trunk muscle area decreased at post-flight return (− 4.7 ± 1.1%, p < 0.001) and recovered to pre-flight values at 1–4 years post-flight. Muscle attenuation changes were not significant. Skeletal muscle index from CT decreased (− 5.2 ± 1.0%, p = 0.004) while appendicular skeletal muscle index from DXA did not change significantly. In summary, trunk muscle atrophies with long-duration microgravity exposure but recovers to pre-flight values within 1–4 years. The CT measures highlight size decreases not detected with DXA, emphasizing the importance of advanced imaging modalities in assessing muscle health with spaceflight.