{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:48:20Z","timestamp":1791427700772,"version":"4.3.3"},"reference-count":32,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science and Technology Council, Taiwan","award":["NSTC 112-2314-B-A49-063-MY3"],"award-info":[{"award-number":["NSTC 112-2314-B-A49-063-MY3"]}]},{"name":"National Science and Technology Council, Taiwan","award":["MOST 111-2314-B-A49-040"],"award-info":[{"award-number":["MOST 111-2314-B-A49-040"]}]},{"name":"Ministry of Science and Technology, Taiwan","award":["NSTC 112-2314-B-A49-063-MY3"],"award-info":[{"award-number":["NSTC 112-2314-B-A49-063-MY3"]}]},{"name":"Ministry of Science and Technology, Taiwan","award":["MOST 111-2314-B-A49-040"],"award-info":[{"award-number":["MOST 111-2314-B-A49-040"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objectives: Peripheral arterial disease (PAD) is a common vascular condition with amputation as a major complication. While muscle volume and vascular severity is often considered in risk prediction, the prognostic value of muscle density remains underexplored. Methods: In this exploratory study, we retrospectively analyzed 134 patients undergoing lower-limb computed tomography angiography between January 2018 and December 2023. Muscle density (MD), muscle volume, intermuscular adipose tissue (IMAT), and vascular severity scores were quantified using deep learning software. Patients were stratified into non-PAD, mild PAD, and critical limb ischemia (CLI) groups. Multivariate Cox regression assessed associations with amputation risk. Results: PAD patients, especially those with CLI, had lower muscle volumes (e.g., total leg: 7945.3 \u00b1 2012.5 cm3 in CLI vs. 11,161.6 \u00b1 4670.4 cm3 in non-PAD), lower muscle densities (e.g., lower leg: 34.0 \u00b1 10.5 HU in CLI vs. 44.1 \u00b1 6.9 HU in non-PAD), higher intermuscular adipose tissue volume percentage (e.g., total leg: 15.6 \u00b1 5.4% in CLI vs. 10.5 \u00b1 3.6% in non-PAD), and higher vascular severity scores (e.g., total leg: 12.6 \u00b1 5.0 in CLI vs. 0.1 \u00b1 0.3 in non-PAD), compared to non-PAD individuals. Only muscle density (MD) including that of abdominal muscle, thigh muscle, and lower leg muscle remained significant predictors of amputation risk after adjusting for confounders. Multivariate Cox regression models, adjusted for demographics and comorbidities, revealed that lower MD of abdomen (&lt;18.7 HU; HR, 6.50, 95% CI, 1.95\u201321.77), thigh (&lt;27.8 HU; HR, 5.00, 95% CI, 1.60\u201315.66), and lower leg (&lt;32.4 HU; HR, 6.89, 95% CI, 2.17\u201321.93) muscles were independently associated with increased amputation risk. Conclusions: Muscle density, reflecting muscle quality rather than quantity, was an independent predictor of amputation risk in PAD. These findings highlight the prognostic value of muscle quality and support the integration of advanced imaging techniques, such as automated CTA-based body composition analysis, for risk stratification in PAD patients.<\/jats:p>","DOI":"10.3390\/diagnostics15111439","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T08:34:32Z","timestamp":1749112472000},"page":"1439","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Role of Muscle Density in Predicting the Amputation Risk in Peripheral Arterial Disease: A Tissue Composition Study Using Lower Extremity CT Angiography"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7939-2348","authenticated-orcid":false,"given":"Yueh-Hung","family":"Lin","sequence":"first","affiliation":[{"name":"Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan"},{"name":"Department of Medicine, Mackay Medical College, New Taipei City 252005, Taiwan"},{"name":"Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Shan","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mackay Medical College, New Taipei City 252005, Taiwan"},{"name":"Department of Radiology, MacKay Memorial Hospital, Taipei 104217, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2858-3493","authenticated-orcid":false,"given":"Chung-Lieh","family":"Hung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan"},{"name":"Department of Medicine, Mackay Medical College, New Taipei City 252005, Taiwan"},{"name":"Mackay Junior College of Medicine, Nursing and Management, Taipei City 11260, Taiwan"},{"name":"Institute of Biomedical Sciences, Mackay Medical College, New Taipei City 252005, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirza Faisal","family":"Beg","sequence":"additional","affiliation":[{"name":"School of Engineering Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3206-0908","authenticated-orcid":false,"given":"Hung-I","family":"Yeh","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan"},{"name":"Department of Medicine, Mackay Medical College, New Taipei City 252005, Taiwan"},{"name":"Institute of Biomedical Sciences, Mackay Medical College, New Taipei City 252005, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2463-1726","authenticated-orcid":false,"given":"Chun-Ho","family":"Yun","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mackay Medical College, New Taipei City 252005, Taiwan"},{"name":"Department of Radiology, MacKay Memorial Hospital, Taipei 104217, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2850-1400","authenticated-orcid":false,"given":"Ming-Ting","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan"},{"name":"Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.ahj.2012.12.002","article-title":"High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease","volume":"165","author":"Jones","year":"2013","journal-title":"Am. 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