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Download references. We thank Ronald Driessen from the Department of Intensive Care Medicine for his contribution in the collection of data. A research grant provided by Baxter Healthcare was used for acquisition of CT scan analysis software and for a part of CT scan analysis.

The funding source was not involved in any aspect of the design of the study, nor in collection, analysis, and interpretation of data, nor in manuscript preparation. The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

WGPML, HMO-vS and PJMW designed research; WGPML and IMD collected data; ARJG and SNS provided essential resources; WGPML, PJMW, HMO-vS, and JWRT analysed the data; WGPML, HMO-vS, and PJMW wrote the paper; WGPML had primary responsibility for final content. All authors read and approved the final manuscript.

All images in this manuscript are entirely unidentifiable and do not include any personal details, therefore no consent for publication was obtained. The need for informed consent was waived because of the retrospective nature of the study using only data obtained from standard care.

Department of Intensive Care Medicine, VU University Medical Center Amsterdam, De Boelelaan , Amsterdam, The Netherlands. Wilhelmus G. Looijaard, Sandra N. Stapel, Armand R. Girbes, Heleen M. Institute for Cardiovascular Research, VU University Medical Center Amsterdam, De Boelelaan , Amsterdam, The Netherlands.

Oudemans-van Straaten. Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center Amsterdam, De Boelelaan , HV, Amsterdam, The Netherlands.

Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, van der Boechorststraat 7, Amsterdam, The Netherlands. Department of Nutrition and Dietetics, Amsterdam University of Applied Sciences, Dr. Meurerlaan 8, Amsterdam, The Netherlands.

VU University Medical Center Amsterdam, Room ZH 7D, P. Box , MB, Amsterdam, The Netherlands. You can also search for this author in PubMed Google Scholar. Correspondence to Wilhelmus G. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.

Reprints and permissions. Looijaard, W. et al. Skeletal muscle quality as assessed by CT-derived skeletal muscle density is associated with 6-month mortality in mechanically ventilated critically ill patients.

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Am J Physiol-Endocrinol Metab. Heymsfield SB, Arteaga C, McManus C, et al. Measurement of muscle mass in humans: validity of the hour urinary creatinine method. This measure of mass in a given area can currently only be done using magnetic resonance imaging MRI or computed tomography CT. Basically, a Hounsfield Unit is a relative quantitative measurement of radio density used by radiologists in the interpretation of CT images.

These units make it difficult for coaches and athletes to interpret the data. In addition, both MRI and CT image only single slices of a muscle at a time. To image an entire muscle a series of slices covering the whole muscle must be done and then mathematically stacked together.

This can be time-consuming and costly making the use of MRI and CT for the determination of muscle density only practical in research settings.

Finally, as mentioned above, because both the MRI or CT images need to be converted into a measure of physical density a calibration step is required, which requires scanning a calibration object with a standardized muscle density value. Furthermore, even if it were feasible to measure muscle density with CT or MRI, it still would not represent muscle quality.

To determine a measure of muscle quality you would need a measure of force or power for the muscle that you imaged. TAKE-HOME MESSAGE So what is the take-home message?

The main point is muscle density and muscle quality are not the same thing. Currently, limitations in technology make it difficult, if not impossible, to measure muscle density or muscle quality for a single muscle. That does not mean we should not try.