Rationale and Objectives
To introduce a simple magnetic resonance imaging (MRI) protocol for quantitative assessment of intraperitoneal, retroperitoneal, and subcutaneous adipose tissue (AT) and to compare AT distribution between diabetic and nondiabetic individuals.
Materials and Methods
Thirty-eight consecutive male diabetic patients (group A) and 38 males (who matched for body mass index [BMI]) without metabolic syndrome (group B) underwent abdominal MRI with a three-dimensional spoiled gradient echo T1-weighted sequence. The amounts of intraperitoneal, retroperitoneal, and subcutaneous AT were calculated on a workstation, after manual anatomic segmentation and were correlated with 10 anthropometric measurements. Pearson product–moment correlation coefficients were used for correlation of AT volumes with anthropometric measurements, Wilcoxon test to compare AT measurements between automatic and manual technique used, and unpaired t test to compare volumes of AT compartments between group A and B.
Results
Diabetic patients exhibited larger amount of intraperitoneal and retroperitoneal AT than normal individuals at all levels ( t = 2.02, P < .05). Among anthropometric measurements, the waist circumference, BMI, and body fat percentage exhibited the best correlations with intraperitoneal and retroperitoneal AT (group A ( r ) = 0.88/0.78/0.0.69 and group B ( r ) = 0.91/0.87/0.81). The L2–L5 set of images was found to be the most representative of the amount of AT volumes.
Conclusions
Amount and distribution of AT can be accurately and easily assessed on MRI. Quantification of intraabdominal AT may promote the role of imaging in the study of metabolic syndrome.
Obesity has emerged as one of the most serious public health concerns in the 21st century in both developed and developing countries, because it is strongly related with the modern dietary habits and lifestyle. Increased body mass index (BMI) and especially increased visceral fat have been recognized as the major contributors to metabolic disturbances and the development of diseases including type 2 diabetes, cardiovascular disease, hypertension, and stroke. Quantification of obesity and adipose tissue (AT) distribution within the body is fundamental for the evaluation of patients with diabetes and metabolic syndrome. It is usually performed by simple anthropometric measurements, including BMI for rough estimation of total body fat, waist circumference (WC) for visceral AT (VAT), hip circumference for subcutaneous AT (SAT), and waist-to-hip ratio (WHR) . Although these measurements can be easily acquired, they are not precise, they may suffer from systematic errors , and they cannot accurately assess the most crucial AT compartment, that is, the VAT, proven to be closely related with the development of metabolic syndrome . Alternatively, computed tomography (CT) and magnetic resonance imaging (MRI) have been used for direct (in vivo) measurements of total body AT and of the major AT compartments, that is, visceral and subcutaneous AT . Various strategies have been proposed for AT assessment using imaging, including measurements of head-to-toes body fat, those of whole abdominal fat, or those of fat on a single-slice CT or MRI at different predetermined levels in the abdomen . However, there is no consensus on the most appropriate measurement methodology on imaging examinations.
The purpose of this study was to introduce a simple MRI protocol for the assessment of AT distribution in the body, to evaluate differences in AT distribution between diabetic patients and nondiabetic subjects on MRI, and to correlate common anthropometric measurements with MRI assessment of visceral and subcutaneous AT.
Materials and methods
Patients
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Anthropometric Measurements
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Magnetic Resonance Imaging
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Image Analysis
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Statistics
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Results
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Table 1
Anthropometric Measurements—Descriptive Statistics
Diabetics ( n = 38) Normal ( n = 38) Weight (kg) 88.68 ± 13.41 88.1 ± 15.7 Height (cm) 167 ± 5.6 171 ± 6.7 Body mass index (kg/m 2 ) 31.51 ± 4.45 30.02 ± 4.7 Waist circumference (cm) 107.89 ± 10.16 104.1 ± 12.3 Hips circumference (cm) 105.64 ± 7.42 105 ± 8.98 WHR 1.02 ± 0.05 0.98 ± 0.05 Femur (cm) 62.33 ± 7.89 64.04 ± 10.56 Waist-to-height ratio 0.64 ± 0.05 0.6 ± 0.06 Waist-to-thigh ratio 1.74 ± 0.17 1.67 ± 0.47 Arm span 173.9 ± 7.23 177.94 ± 7.34 Skin fold (cm) 15.16 ± 7.04 15.13 ± 12.0 Abdominal VAT (mm 2 ) 22229.03 ± 1379.96 18915.24 ± 1246.75 Intraperitoneal (mm 2 ) 13026.36 ± 1014.37 11598.82 ± 763.97 Retroperitoneal (mm 2 ) 8849.47 ± 635.39 7316.42 ± 532.57 Abdominal SAT (mm 2 ) 21148.07 ± 1462.16 20893.2 ± 1673.74 Abdominal SAT + VAT (mm 2 ) 43377.1 ± 2275.18 39808.45 ± 2347.78 Hip SAT (mm 2 ) 20666.37 ± 1288.67 19474.35 ± 1536.47
SAT, subcutaneous adipose tissue; VAT, visceral adipose tissue, WHR, waist-to-hip ratio.
Results are presented as mean ± standard deviation.
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Table 2
Pearson Correlations ( r ) between Anthropometric Measurements and Adipose Tissue
Waist Circumference BMI Hip Circumference WHR Body Fat (%) Gr. A Gr. B Gr. A Gr. B Gr. A Gr. B Gr. A Gr. B Gr. A Gr. B SAT average 0.708
( P <.001) 0.785
( P <.001) 0.692
( P <.001) 0.733
( P <.001) 0.856
( P <.001) 0.850
( P <.001) 0.138 0.333
( P <.05) 0.565
( P <.001) 0.644
( P <.001) VAT average 0.682
( P <.001) 0.672
( P <.001) 0.536
( P <.001) 0.658
( P <.001) 0.495
( P <.001) 0.424
( P <.001) 0.604
( P <.001) 0.736
( P <.001) 0.552
( P <.001) 0.662
( P <.001) Retroperitoneal AT average 0.596
( P <.001) 0.521
( P <.001) 0.478
( P <.001) 0.508
( P <.001) 0.423
( P <.001) 0.260 0.541
( P <.001) 0.673
( P <.001) 0.561
( P <.001) 0.544
( P <.001) Peritoneal AT average 0.653
( P <.001) 0.734
( P <.001) 0.507
( P <.001) 0.719
( P <.001) 0.479
( P <.001) 0.510
( P <.001) 0.570
( P <.001) 0.732
( P <.001) 0.485
( P <.001) 0.709
( P <.001) Total AT (SAT + VAT) 0.884
( P <.001) 0.917
( P <.001) 0.784
( P <.001) 0.872
( P <.001) 0.867
( P <.001) 0.831
( P <.001) 0.460
( P <.001) 0.628
( P <.001) 0.691
( P <.001) 0.814
( P <.001) SAT L2–L3 0.668
( P <.001) 0.770
( P <.001) 0.674
( P <.001) 0.698
( P <.001) 0.828
( P <.001) 0.822
( P <.001) 0.104 0.340
( P <.05) 0.566
( P <.001) 0.614
( P <.001) VAT L2–L3 0.729
( P <.001) 0.700
( P <.001) 0.651
( P <.001) 0.682
( P <.001) 0.553
( P <.001) 0.470
( P <.001) 0.612
( P <.001) 0.720
( P <.001) 0.604
( P <.001) 0.688
( P <.001) SAT + VAT L2–L3 0.882
( P <.001) 0.900
( P <.001) 0.837
( P <.001) 0.844
( P <.001) 0.874
( P <.001) 0.800
( P <.001) 0.447
( P <.001) 0.636
( P <.001) 0.721
( P <.001) 0.796
( P <.001) SAT L3–L4 0.681
( P <.001) 0.776
( P <.001) 0.671
( P <.001) 0.718
( P <.001) 0.842
( P <.001) 0.839
( P <.001) 0.108 0.329
( P <.05) 0.543
( P <.001) 0.637
( P <.001) VAT L3–L4 0.657
( P <.001) 0.658
( P <.001) 0.512
( P <.001) 0.642
( P <.001) 0.498
( P <.001) 0.422
( P <.001) 0.551
( P <.001) 0.711
( P <.001) 0.530
( P <.001) 0.666
( P <.001) SAT + VAT L3–L4 0.864
( P <.001) 0.906
( P <.001) 0.765
( P <.001) 0.856
( P <.001) 0.868
( P <.001) 0.828
( P <.001) 0.422
( P <.001) 0.612
( P <.001) 0.671
( P <.001) 0.814
( P <.001) SAT L4–L5 0.621
( P <.001) 0.643
( P <.001) 0.430
( P <.001) 0.611
( P <.001) 0.448
( P <.001) 0.427
( P <.05) 0.551
( P <.001) 0.709
( P <.001) 0.446
( P <.001) 0.612
( P <.001) VAT L4–L5 0.853
( P <.001) 0.928
( P <.001) 0.712
( P <.001) 0.899
( P <.001) 0.825
( P <.001) 0.884
( P <.001) 0.477
( P <.001) 0.634
( P <.001) 0.621
( P <.001) 0.821
( P <.001) SAT + VAT L4–L5 0.754
( P <.001) 0.790
( P <.001) 0.775
( P <.001) 0.838
( P <.001) 0.880
( P <.001) 0.876
( P <.001) 0.182 0.288 0.650
( P <.001) 0.782
( P <.001)
AT, adipose tissue; BMI, Body Mass Index; Gr., group; SAT, subcutaneous adipose tissue; VAT, visceral adipose tissue; WHR, waist-to-hip ratio.
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Discussion
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