Abdominal wall morphometric variability based on computed tomography: Influence of age, gender, and body mass index

• Published in: Clinical anatomy (New York, N.Y.) Vol. 33; no. 8; pp. 1110 - 1119
• Main Authors: Jourdan, Arthur, Soucasse, Andrea, Scemama, Ugo, Gillion, Jean F., Chaumoitre, Kathia, Masson, Catherine, Bege, Thierry
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-11-2020; Wiley Subscription Services, Inc; Wiley
• Subjects: Abdomen; Abdominal Muscles - anatomy & histology; Abdominal Muscles - diagnostic imaging; Abdominal wall; Abdominal Wall - anatomy & histology; Abdominal Wall - diagnostic imaging; Adolescent; Adult; Age; Aged; Aged, 80 and over; Anatomic Variation; aponeurosis; Aponeurosis - anatomy & histology; Aponeurosis - diagnostic imaging; Asymmetry; Biomechanics; Body Mass Index; Body size; Cancer; Computed tomography; Engineering Sciences; Female; Hernia; Hernias; Humans; Life Sciences; Male; Mechanics; Medical imaging; Men; Middle Aged; Morphometry; muscle; Muscles; Reference Values; Retrospective Studies; Surgery; Tomography, X-Ray Computed; Young Adult; computed tomography; morphometry; abdominal wall; muscle; aponeurosis; Abdominal wall; Muscle; Computed tomography; Morphometry; Aponeurosis
• ISSN: 0897-3806; 1098-2353
• DOI: 10.1002/ca.23548

Introduction
Ventral hernia surgery does not usually account for the individuality of the abdominal wall anatomy. This could be both because medical imaging is rarely performed before surgery and because data on abdominal wall variability are limited. The objective of the present study was to perform an exhaustive morphometric analysis of abdominal wall components based on computed tomography (CT) scans.
Materials and Methods
A retrospective study was performed on 120 abdominopelvic CT scans of clinically normal adults aged 18–86 years equally divided between women and men and into four age groups. Each abdominal wall muscle was evaluated in terms of area, thickness, shape ratio, fat infiltration, and aponeuroses width. The influence of age, gender, and body mass index (BMI) was investigated, as well as muscular asymmetry.
Results
The abdominal wall muscle area represented 8.5 ± 2.5% of the abdominal area. The internal oblique muscle had the largest area, the rectus abdominis was the thickest, the transversus abdominis was the narrowest and had the smallest area. The width of the linea alba was 20.3 ± 12.0 mm. The evolution of the abdominal wall with age was quantified, as well as the large differences between the sexes and BMI groups, resulting in strong correlations and highlighting the specific pattern of the transversus abdominis. The asymmetry of the left and right muscle areas oscillated around 17%.
Conclusions
The various components of the abdominal wall have been precisely described. Knowledge of their variability could be used to enhance the planning of ventral hernia surgery or to develop numerical modeling of the abdominal wall.