Objective comparison of commonly used computed tomography body composition analysis software

Objectives: Sarcopenia is defined as an age-related, involuntary loss of skeletal muscle mass and strength. This condition is increasingly gaining clinical attention, as it has proved a predictor of complications and unfavorable outcomes in several diseases. For analysis of body composition on computed tomography images, several different software packages are used. Extensive research is being conducted globally to establish general cutoff values for different patient groups by combining the results of different studies with meta-analysis. Therefore, it is important that the measurements are independent of the software used. However, clinical software comparisons suggest there are differences between analysis packages, which would complicate establishment of cutoff values. For this study, we compared the eight most used analysis software programs in an objective manner, using a phantom image, to assess if 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 ≤ 5% for area measurements and had slight variation in radiodensity measurements. 

Conclusions: Seven 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 computed tomography images. Area measurements acquired with Aquarius iNtuition may differ slightly (≤ 5%) from the other packages.