CT density of mesenteric, retroperitoneal, and subcutaneous fat in cirrhotic patients: comparison with control subjects.

Tyrrel, R T; Montemayor, Kristina; Bernardino, Michael E.

doi:10.2214/ajr.155.1.2112867

Cited by 17 publications

(7 citation statements)

References 5 publications

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“…No imaging of the brain before the traumatic event was presented. The mean density of retroperitoneal fat in a healthy subject has been shown to be 2118 HU [9], which corresponds to the density of the fat globules in our patient. Fat in the subarachnoid space will generally be situated in non-dependent sites, as fat is less dense than cerebrospinal fluid.…”

Section: Discussionsupporting

confidence: 66%

Intracranial transthecal subarachnoid fat emboli and subarachnoid haemorrhage arising from a sacral fracture and dural tear

Woo

Malfair²,

Vertinsky³

et al. 2010

BJR

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ABSTRACT. We present the case of a 28-year-old man with an unusual aetiology of lipid-dense material in the subarachnoid space. CT of the head at presentation was normal. MRI of the spine revealed a defect in the dura at L5/S1, with avulsed left L5 and S1 nerve roots. Haematoma and marrow fat were observed in close relation to the dural tear adjacent to the sacral fracture. Head CT and MRI subsequently demonstrated new lipid-dense material and haemorrhage in the subarachnoid space after sacral instrumentation, presumably owing to transthecal displacement of fatty marrow. The presence of fat droplets within the subarachnoid space is an unusual finding and is most commonly the sequelae of a ruptured dermoid. We present a unique case with CT and MRI that demonstrates the development of subarachnoid fat emboli and subarachnoid haemorrhage secondary to pelvic trauma. A sacral fracture with an adjacent dural tear and nerve root avulsion is the putative source of the subarachnoid fat and blood. Case reportA 28-year-old man presented to the emergency room after being struck by a high-speed vehicle as a pedestrian. He suffered multiple orthopaedic injuries, including an open-book pelvic fracture as well as upper and lower extremity fractures. Pertinent physical examination findings included the absence of left ankle dorsiflexion, plantar flexion, inversion and eversion. An absence of light touch and pinprick sensation in the left L5 and S1 dermatomes was also noted.At presentation, CT of the head did not demonstrate any calvarial or skull base fracture or other intracranial abnormalities (Figure 1a). Specifically, neither subarachnoid haemorrhage nor subarachnoid fat droplets were present. CT of the pelvis demonstrated a transforaminal left sacral fracture and superior and inferior left pubic rami fractures. A mixed fat and blood attenuation collection was also seen within the left aspect of the thecal sac at the L5/S1 level. Fixation of the sacral fracture, with the placement of an iliosacral screw, was performed shortly after initial imaging.Three days post-trauma, repeat CT of the head was performed because of a decreased level of consciousness.Small supernatant globules of fat (2124 Hounsfield units (HU)) were identified in the subarachnoid space in the prepontine cistern (Figure 1b), frontal horns of the lateral ventricles and foramen magnum. Intraventricular blood and subarachnoid haemorrhage in the interpeduncular fossa were also seen. A CT angiogram from the aortic arch to the vertex revealed no evidence of traumatic dissection, aneurysm or vascular malformation that would explain the presence of the new subarachnoid haemorrhage. MRI of the brain performed the same day confirmed the presence of subarachnoid and intraventricular fat and haemorrhage (Figure 2a,b). The MR study also showed several T 2 /FLAIR (fluid-attenuated inversion-recovery) hyperintensities in the cerebral white matter, as well as in the splenium of the corpus callosum, in keeping with diffuse axonal injury.MRI of the post-operative lumbosacral...

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Section: Discussionsupporting

confidence: 66%

Intracranial transthecal subarachnoid fat emboli and subarachnoid haemorrhage arising from a sacral fracture and dural tear

Woo

Malfair²,

Vertinsky³

et al. 2010

BJR

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“…In that study, mean attenuation of mesenteric fat was higher than that of retroperitoneal and subcutaneous depots. 10 Further, Hu et al 11 observed higher attenuation values in brown compared to white adipose tissue. More recently, Fox et al 12 examined associations between SAT and VAT attenuation values and cardiometabolic risk factors.…”

Section: Introductionmentioning

confidence: 98%

“…Using this scale, most soft tissues are characterized by positive HUs while adipose tissue attenuation is located in the negative range. 9 In 1990, Tyrrel et al 10 compared mean adipose tissue attenuation between patients with and without cirrhosis and found that patients with biopsy-proven cirrhosis were characterized by higher fat attenuation compared to controls. In that study, mean attenuation of mesenteric fat was higher than that of retroperitoneal and subcutaneous depots.…”

Section: Introductionmentioning

confidence: 99%

Computed tomography-measured adipose tissue attenuation and area both predict adipocyte size and cardiometabolic risk in women

et al. 2015

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Objective: To assess the ability of CT-derived measurements including adipose tissue attenuation and area to predict fat cell hypertrophy and related cardiometabolic risk. Methods: Abdominal adipose tissue areas and radiologic attenuation were assessed using 4 CT images in 241 women (age: 47 years, BMI: 26.5 kg/m 2 ). Fat cell weight was measured in paired VAT and SAT samples. Fasting plasma lipids, glucose and insulin levels were measured. Results: Adipose tissue attenuation was negatively correlated with SAT (rD-0.46) and VAT (rD-0.67) fat cell weight in the corresponding depot (p<0.0001 for both). Women with visceral adipocyte hypertrophy had higher total-, VLDL-, LDL-and HDL-triglyceride and apoB levels as well as a higher cholesterol/HDL-cholesterol ratio, fasting glucose and insulin levels compared to women with smaller visceral adipocytes. Adjustment for VAT area minimized these differences while subsequent adjustment for attenuation eliminated all differences, with the exception of fasting glycaemia. In SAT, adjustment for VAT area and attenuation eliminated all adipocyte hypertrophy-related alterations except for fasting hyperglycaemia. Conclusion: CT-derived adipose tissue attenuation and area both contribute to explain variation in the cardiometabolic risk profile associated with the same biological parameter: visceral fat cell hypertrophy.

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“…In addition, hypoalbuminaemia and decreased aldosterone catabolism due to the underlying liver dysfunction leads to a state of persistent fluid overload ( Figure 17). 66, 67 Tyrrel et al 67 compared the CT densities of mesenteric, retroperitoneal and subcutaneous fat in patients with and without liver cirrhosis and found a visually evident and statistically significant increase in the density of mesenteric fat in patients with cirrhosis. The increase in density was also seen in the retroperitoneal and subcutaneous fat (Figure 18), although the difference was not statistically significant.…”

Section: Muscle Wasting or Sarcopeniamentioning

confidence: 99%

Cirrhosis-related musculoskeletal disease: radiological review

Arora¹,

Rajesh²,

Bansal³

et al. 2016

BJR

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Musculoskeletal problems in patients with liver disease are common; however, they are not so well described in the literature. Therefore, there is a need to collate information on these disorders, as their incidence is on a constant rise and some of these pathologies can severely debilitate the patient's quality of life. These disorders are parietal wall varices with or without bleeding, spontaneous intramuscular haematoma (e.g. rectus sheath), abdominal wall hernia, anasarca, hepatic osteodystrophy, septic arthritis, osteomyelitis, necrotizing fasciitis, osseous metastases from hepatocellular carcinoma etc. While portal hypertension plays a key role in disorders, in others, dysregulation of the coagulation system or a compromised immune system are responsible. Imaging plays an essential role in the assessment of these complications and awareness of these musculoskeletal manifestations is vital for establishing a timely diagnosis and planning of appropriate therapy, as these disorders can significantly impact the morbidity and mortality and also influence candidacy for liver transplantation. We herein comprehensively appraise various musculoskeletal complications associated with chronic liver disease/liver cirrhosis especially from an imaging perspective which, to the best of our knowledge, have not been collectively described in English literature.

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CT density of mesenteric, retroperitoneal, and subcutaneous fat in cirrhotic patients: comparison with control subjects.

Cited by 17 publications

References 5 publications

Intracranial transthecal subarachnoid fat emboli and subarachnoid haemorrhage arising from a sacral fracture and dural tear

Intracranial transthecal subarachnoid fat emboli and subarachnoid haemorrhage arising from a sacral fracture and dural tear

Computed tomography-measured adipose tissue attenuation and area both predict adipocyte size and cardiometabolic risk in women

Cirrhosis-related musculoskeletal disease: radiological review

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