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. 2020 Dec 28;10:22391. doi: 10.1038/s41598-020-79495-5

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© The Author(s) 2020

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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The concept of FMF. (A) Skeletal muscle fat infiltration is considered an indicator of muscle quality. Based on densitometric thresholds and accepted cut-off values of lean and fatty skeletal muscle, muscle compartments may be separated into areas of fatty and lean muscle. The FMF is calculated as the area of fatty muscle tissue related to the total skeletal muscle area, resulting in a relative and comparable measure of muscle quality. This biomarker can be opportunistically obtained from clinical CT scans. (B) Skeletal muscle area was obtained as the bilateral compartment area of paraspinal skeletal muscles at the level of the superior mesenteric artery. Within the skeletal muscle area, muscle tissue is identified by an attenuation threshold range of 100 to − 29 HU. Mean Radiodensity was highlighted to visualize overall muscle fat infiltration (myosteatosis). Based on thresholds ranges of − 29 to 29 HU for fatty muscle and 30 to 100 HU for lean muscle, FMF was calculated. CT Computed tomography, FMF Fatty muscle fraction, HU Hounsfield units.