Journal of Gerontology

1983, Vol. 38, No. 6, 678-681

Human Major Psoas Muscle and

Sacrospinalis Muscle in Relation to Age:
A Study by Computed Tomography1
Keiko Imamura, DSc, Hiroshi Ashida, MD,

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Tohru Ishikawa, MD, and Masamichi Fujii, MD2

The size and density of the major psoas and sacrospinalis muscles in humans were measured in vivo by
X-ray computed tomography to determine the relationship of age and sex of these two muscles. Measure-
ments of 44 men and 52 women clarified patterns of development and aging. Differences due to age were
significant in the density of both muscles. There existed also a difference between the sexes in the size of the
two muscles.
Key Words: Muscles, Growth, Aging, Lifespan development

P OSTNATAL development and aging of human

skeletal muscle is not clearly understood, as
very few good techniques are available for in vivo
examination of the muscular system. In dissected
material the thickness of muscle fiber has been
measured (Braun, 1967) to clarify the evolution of
human muscle from birth to 25 years of age, the
probable period of muscle growth.
X-ray computed tomography (CT) made it possi-
ble to identify most of the human muscles. Some of
the other studies utilizing CT technique which have
been reported deal with variation in muscle size and
density with age and sex (Bulcke et al., 1979;
Termote et al., 1980), effects of immobilization on
thigh muscle (Ingemann-Hansen & Halkjaer-
Kristensen, 1980), effects of physical training on
thigh muscle (Haggmark et al., 1978), and muscle
hypertrophy after denervation (Bernat & Ochoa,
1978). In this paper we present the results of a CT
study of the size and density of the human major
psoas muscle and the sacrospinalis muscle for nor-
mal individuals and some pathological cases.
METHOD
Participants. — The participants were selected
from among inpatients and outpatients of our hos-
pital, and each was examined by abdominal CT
'This paper was presented al the 40th Annual Meeting of the Japan Radiological
Society at Fukuoka, Japan, in April, 1981.
Department of Radiology, St. Marianna University School of Medicine, 2095
Sugao, Miyamae-ku, Kawasaki, 213 Japan.
scan. In order to select persons having "normal"
muscles, it was first confirmed from the patients'
medical records that they did not have any ailment
associated with muscle disorder. Two additional
requirements in the case of inpatients were that the
CT examinations be performed within 7 days after
admission to the hospital and that the patients be
able to perform their daily activities by themselves,
thus excluding the possibility that individuals with
asthenia or muscle atrophy from disuse would be
included in the study. Forty-four men and 52
women between the ages of 9 to 86 were studied
(Table 1). Their occupations were not considered.
Procedure. — CT examination was performed
using a Varian whole body scanner, V 360-3, with
an image matrix of 256 x 256. Slice thickness was
11 mm FWHM (full width at half maximum), and
the scanning time was 3.6 seconds. Scan was car-
ried out at the level of the third lumbar vertebra
(L3), and the CT number in Hounsfield units was
calibrated by water (0 H.U.) and by air (-1000
H.U.) Size and density measurements were per-
formed for the major psoas and the sacrospinalis
muscles using a joystick marker on a videoscreen.
The encircled ROI (region of interest) was analyzed
for (a) average of all CT numbers, (b) standard
deviation of the average, and (c) the ROI area. It is
known that density has approximately a parallel
relationship with the CT number in the region of
soft tissue and fat.

678
 MAJOR PSOAS AND SACROSPINALIS MUSCLE 679

Table 1. Cross-section and Density of the Major Psoas and Sacrospinalis Muscles of 44 men and 52 women

Vlen Women
Major psoas Sacrospinalis Major psoas Sacrospinalis

CT Cross- CT Cross- CT Cross- CT Cross-

Age number section number section number section number section
(years) N (H.U ) (cm2) (H.U.) (cm2) N (H.U ) (cm2) (H.U ) (cm2)

10-14 4 60± 7 3.6 dt 1.0 63 ± 8 11 dt 2 4 62 ± 4 4.1 ± .8 66 ± 6 13 ± 2

15-19 3 67 ± 2 8.8 dt 1.9 73 ± 2 19 dt 2
20-29 6 60± 5 11.1 dt 3.2 64 ± 8 23 dt 4 5 61 ± 7 4.9 :t .9 61 ± 9 14 dt 2
30-39 7 59 ± 9 7.2 dt 2.8 63 ± 7 19 dt 3 9 64± 9 4.1 dt .9 63 ± 9 15 dt 3

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40-49 6 50 ± 8 6.3 dt 2.3 55 ± 6 18 dt 3 6 46 ± 13 4.0 dt 1.3 48 ± 8 14 dt 1
50-59 8 52 ± 10 5.1 dt 1.7 57 ± 9 19 d- A 8 46± 6 3.4 dt .6 47 ± 11 14 dt 3
60-69 3 43 ± 16 6.3 dt 2.3 47 ± 6 17 dt 3 5 46 ± 11 4.4 :t 2.1 33 ± 11 16 :t 3
70-79 6 54 ± 11 5.9 dt 1.0 43 ± 17 18 dt 4 7 46 ± 10 3.5 :t .7 27 ± 16 17 dt 3
80-89 1 49 3.0 19 12 8 47 ± 7 5.2 :t 1.5 26 ± 23 13 ± 3
Total 44 55 ± 9 6.7 ± 2.2 57 ± 9 18 ± 3 52 52 ± 9 4.2 ± 1.2 45 ± 13 14 ± 3

Note. Entries are means plus or minus standard deviations.

RESULTS
The normal CT appearance of the muscular sys-
tem at the level of L3 is presented in Figure 1. In
older patients the major psoas muscle, as well as the
sacrospinalis, were each well separated from the
quadratus lumborum by interstitial fat, whereas
those of younger patients were closely packed.
The results of measurements are presented in
Table 1 and Figure 2. In men in the age range from 9
to 29, an increase with age was observed in the size
of both the major psoas and the sacrospinalis musc-
les; beyond the age of 30 a gradual decrease oc-
curred. In women, differences in the size of the
muscle with age were relatively small. Density of
the major psoas muscle decreased with increasing
age in both men and women, and in the case of the
sacrospinalis it decreased markedly in the 40 to 49
year age bracket in women, whereas it changed
only moderately in men.
Two-way (sex by age) analyses of variance were
performed for the density and for the size of both
muscles. As members in the cells were unequal and
disproportionate, the method of weighted means
was used. Sex had a substantial effect on the size of
both the major psoas and the sacrospinalis muscles;
for the former, F (1, 80) = 56.8, p < .01, a>2 =
.27, a n d F ( l , 80) = 30.8,/? < .01, for the latter.
Age also had an effect on the size of both muscles; F
(7, 80) = 5.67, p < .01, a)2 = .16, for the major
psoas muscle andF(7,80) = 3.80,/? < .01,forthe
sacrospinalis muscle. The interaction was signifi- Figure 1. CT apppearance of muscles at the level of L3 of a
cant for the size of the major psoas muscle, F (7,80) 29-year-old man (upper) and a 74-year-old woman (lower).
= 3.06, p< .01. Arrow 1 points to the major psoas muscle, arrow 2 the quadratus
lumborum, and arrow 3 the sacrospinalis. Comparison of these
With respect to the density of muscles, it was two images shows a reduction in the cross-section of the major
observed that age factor was significant: F (7, 80) psoas muscle and in the density of the sacrospinalis in the older
= 7.39,/? < .01, for the major psoas muscle, and F woman.
680 IMAMURA, ASHIDA, ISHIKAWA, AND FUJII

15 30 one-way analysis of variance. Our results are con-

Major psoas Sacrospinalis
muscle muscle
sistent with the findings in both of these reports.
In six of our inpatients who had been confined to
20 bed for longer than 3 weeks, a marked reduction of
about 50% of normal for the same age group was
observed in the size of the sacrospinalis muscle
(Figure 3). The size of the major psoas also de-
10 creased, but not to such a large degree. These
findings are supported by a study of the effect of
immobilization in plastic on the thigh muscle (Inge-
mann-Hansen & Halkjaer-Kristensen, 1980), in

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20 40 60 80 20 40 60 80 which a reduction to 44% of the lean area after 5
AGE (y.o.) AGE (y.o.) weeks of immobilization was also observed in the
quadriceps femoris.
80 80 In view of our findings, we believe the CT tech-
nique can make an important contribution to the
noninvasive quantification of individual muscles
60 60
and be of great help in the understanding of normal
development and pathological changes in human
muscles.

20

Major psoas Sacrospinalis

muscle muscle

20 40 60 80 20 40 60 80
AGE (y.o.) AGE (y.o.)

Figure 2. Muscle cross-section and density in relation to age.

Solid circles indicate men, and open circles women. Ordinates of
the upper two figures indicate cross-section in cm2, and those of
the lower two figures CT number in Hounsfield units.

(7 ,80) = 15.7, p < .01, for the sacrospinalis

muscle. There were no significant interactions.

DISCUSSION
CT gives an excellent view of in vivo muscle
anatomy. It makes possible reliable measurements
of the cross-sectional size and density of human
muscles. In this study, patterns of development and
aging were observed for the size of the major psoas
and sacrospinalis muscles, although a complete pat-
tern of muscle development could not be obtained Major Sacrospinalis
inasmuch as clinical CT examinations are rarely psoas muscle
performed on young patients.
CT measurements on several muscles in indi-
muscle
viduals aged 10 to 59 (Bulcke et al., 1979) showed a Figure 3. Muscle size of six pathological cases shown relative
progressive increase in muscle density up to age 39, to normals of the same generation. Case 1 is a 77-year-old
followed by a decrease thereafter. In another report woman who was confined to bed 3 weeks. Case 2 is a 53-year-old
man confined 10 weeks. Case 3 is a 79-year-old man confined 5
summarizing the data on normal muscles (Termote months. Case 4 is a 76-year-old man with disturbance of gait.
et al., 1980), differences among the averaged den- Case 5 is a 52-year-old man with severe asthenia. Case 6 is a
sities of the different age groups were confirmed by 83-year-old man with muscle atrophy from disuse.
 MAJOR PSOAS AND SACROSPINALIS MUSCLE 681

REFERENCES thigh muscle in man measured by computed tomography.

Bernat, J. L., & Ochoa, J. L. Muscle hypertrophy after partial
denervation: A human case. Journal of Neurology, Neuro-
surgery and Psychiatry, 1978,4/, 719-725.
Braun, P. Contribution to the study of post-natal changes in the
skeletal muscle in man. Folia Morphologica, 1967, 1, 11-
17.
Bulcke, J. A., Termote, J.-L., Palmers, Y., & Crolla, D. Com-
puted tomography of the human skeletal muscular system.
Neuroradiology, 1979, 17, 127-136.
Haggmark, T., Jansson, E., & Svane, B. Cross-sectional area of
Scandinavian Journal of Clinical and Laboratory Investiga-
tion, 1978, 38, 355-360.
Ingemann-Hansen, T., & Halkjaer-Kristensen, J. Computerized
tomographic determination of human thigh components: the
effects of immobilization in plaster and subsequent training.
Scandinavian Journal ofRehabilitation Medicine, 1980,12,
27-31.
Termote, J. L., Baert, A., Crolla, D., Palmers, T., & Bulcke, J.
A. Computed tomography of the normal and pathologic
muscular system. Radiology, 1980, 137, 439-444.

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INTERNATIONAL ASSOCIATION OF GERONTOLOGY
announces the second
SANDOZ PRIZE FOR GERONTOLOGICAL RESEARCH

The prize will be worth 20.000 Swiss Francs and will be sponsored by SANDOZ LTD, Basel/
Switzerland with the purpose of encouraging research in all areas of gerontology and geriatric
medicine including biological, medical, psychological, social, and other relevant aspects with
special emphasis on multidisciplinary research programs.

The jury consists of the Executive Committee of the IAG. The prize will be awarded on the occasion
of the Xlllth International Congress of Gerontology, New York, 12-17 July 1985.

Applications in English should comprise a summary of the research work of 3-5 pages, curriculum
vitae, bibliography and reprints of not more than three pivotal publications in English or with
extended summaries in English.

Individuals, research teams, or institutions are invited to submit their applications in English not later
than 15 September 1984 to Prof. M. Bergener, M.D., Secretary General, International Association
of Gerontology, Rheinische Landesklinik, Wilhelm-Griesinger-Str. 23, D-5000 Cologne 91, Ger-
many.