Table 1 Summary of the uses of imaging modalities in diagnosis, monitoring and prognosis and findings in cancer cachexia for different cancer types

Dual-energy

X-ray absorptiometry (DXA)

Muscle mass and body fat loss observed in advanced cancer patients

Progression of muscle mass loss was greater in men compared to women

[51, 52]

67% of palliative cancer patients had a low appendicular lean soft tissue index

[53]

Accelerated depletion of body fat was found compared to lean tissue, with lean tissue loss in the arms but a relative weight gain in the trunk

[54]

WAT loss increased with disease progression, preferentially in the trunk before appendicular regions, despite the maintenance or increase of caloric intake

Gastrointestinal cancer

[23]

Computed Tomography (CT)

Sarcopenia associated with higher mortality and morbidity rates in cancer patients

[63,64,65,66]

High muscle radiodensity was a prognostic factor for longer survival

Non-small cell lung cancer

[69]

Low muscle attenuation of cross-sectional paraspinal muscles predictive of unsatisfactory therapy response

Renal cell cancer

[73]

Low skeletal muscle indices strongly associated with prevalence of dose limiting chemotherapy related toxicity

[74,75,76,77,78]

Skeletal muscle loss during neoadjuvant chemotherapy predictive of increased postoperative mortality

Esophageal cancer

[81]

Myosteatosis related to shorter survival and systemic inflammation

Higher myosteatosis levels related to longer hospitalization times

Colorectal cancer, Pancreatic cancer, Distal cholangiocarcinoma

[85,86,87]

Higher VAT CT attenuation than SAT may indicate inflammation and fibrotic response

High VAT HU and low VAT volume lead to worse clinical outcomes and survival

Head and neck squamous cell carcinoma

[104]

Higher VAT and SAT CT attenuation lead to poor survival

Esophageal adenocarcinoma and

squamous cell carcinoma

[105, 106]

High VAT/SAT ratio prognostic of poor overall survival

Pancreatic cancer, Lung cancer

[79, 107]

Decrease in fat mass and fat-free mass post neoadjuvant chemotherapy but relative increase in sarcopenic obesity prevalence

Respiratory and gastrointestinal tract cancer

[65, 137]

Exponential increase in liver volume, hepatic metastases and increase in spleen volume was observed concurrent to muscle and fat loss

Advanced colorectal cancer

[128]

Magnetic resonance Imaging

(MRI)

T₂* contrast and fat fraction imaging a possible method to evaluate BAT activation status and brown fat volume change

Murine pancreatic ductal adenocarcinoma

[125]

Loss of skeletal muscle volume und muscle quality observed in cachectic cancer patients

[89,90,91]

Reduction in cross-sectional area after surgery

Malignant glioma

[92]

Greater decline in lower limb muscle mass, quality and function in men than women

Gastrointestinal cancer

[91]

Increased fatty infiltration of quadriceps muscle

Lower homogeneity in muscle composition

Upper gastrointestinal cancer

[90]

Low fat-free muscle area associated with shorter overall survival

Colorectal cancer,

Hepatocellular carcinoma

[94, 95]

Temporal muscle thickness predictor of survival in patients with brain metastasis

Non-small cell lung cancer,

Breast cancer

[96]

Amelioration of aspects of cancer cachexia through lipase deficiency with protective effects on WAT loss

Lewis lung carcinoma, B16 melanoma

[112]

Increase in cholines and decrease in glutamine and formate in ¹H MRS analyses of brains of cachectic mice

Pancreatic cancer

[129]

¹⁸FDG-PET

Increased ¹⁸FDG uptake in cachexia-inducing tumors compared to non-cachectic tumors in mice

[39]

Metabolic tumor volume positively correlated with the degree of weight loss

Gastric cancer

[41]

PET/CT based radiomics analysis of primary tumor and skeletal muscle could predict probability of cachexia onset before therapy

Advanced non-small-cell lung carcinoma

[42]

Elevated tumor activity associated with greater risk of malnutrition however no correlation with CT-measured body composition

Lung cancer

[43]

Tumor mass and percentage of anaerobic metabolism contribute to greater energy burden, with consequent increase in muscle wasting and negative energy balance

[44]

Elevated ¹⁸FDG uptake in VAT related to worse outcomes

Head and neck squamous cell carcinoma, Pancreatic adenocarcinoma

[104, 106]

High SUV of VAT and SAT lead to worse survival

SAT ¹⁸FDG uptake was reduced and relatively decreased compared to VAT and correlated negatively correlated with primary tumor metabolism

Pancreatic cancer

[109]

SAT volume negatively correlated with ¹⁸FDG uptake of tumor

High SAT volume associated with better progression-free survival

Non-small cell lung cancer

[110]

No relation of BAT activation with cancer progression

[123]

Reduced liver ¹⁸FDG uptake increased the risk of cachexia and worse overall survival

[127]