Objective comparison of commonly used CT body composition analysis software

Background Sarcopenia is defined as an age related, involuntary loss of skeletal muscle mass and strength. This condition increasingly gets clinical attention, as it has proved to be a predictor of complications and unfavourable outcomes in several diseases. For analysis of body composition on Computed Tomography (CT) images, several different software packages are utilized. Currently, extensive research is conducted globally, to establish general cut-off values for different patient groups, by combining the results of different studies with meta-analysis. Therefore, it is of utmost importance that the measurements are independent of the used software. However, clinical software comparisons suggest differences between analysis packages are present, which would complicate establishment of cut-off values. Purpose For this study we compared the eight most used analysis software programs in an objective manner, using a phantom image, to assess whether their results can be readily compared. Methods Eight software packages (SliceOmatic, OsiriX, ImageJ/Fiji, Mimics, CoreSlicer, SarcoMeas, 3D Slicer and Aquarius iNtuition) were objectively evaluated, by performing measurements in a standardized synthetic image, containing fixed muscle and fat compartments with homogeneous radiodensities. For all programs, the measured areas and radiodensities of the regions of interest were assessed. Results For SliceOmatic, OsiriX, ImageJ/Fiji, Mimics, CoreSlicer, SarcoMeas and 3D Slicer identical results were found, all reporting correct values for muscle and fat areas, as well as correct radiodensity values, whereas values reported by Aquarius iNtuition deviated up to 5% for area measurements and also showed slight variation in radiodensity measurements. Conclusions Seven out of eight software packages (SliceOmatic, OsiriX, ImageJ/Fiji, Mimics, CoreSlicer, SarcoMeas and 3D Slicer) perform identically, so their results can be readily compared and combined when assessing body composition in CT images. Area measurements acquired with Aquarius iNtuition may slightly differ (up to 5%) from the other packages.