MRI-Derived Subcutaneous and Visceral Adipose Tissue Reference Values for Children Aged 6 to Under 18 Years

Abstract

The assessment of body composition in pediatric population is essential for proper nutritional support during hospitalization. However, currently available methods have limitations. This study aims to propose a novel approach for nutrition status assessment and introduce magnetic resonance imaging (MRI)-derived subcutaneous and visceral fat normative reference values. A total of 262 healthy subjects aged from 6 to 18 years underwent MRI examinations and anthropometric measurements. MRI images at the second lumbar vertebrae were used by two radiologists to perform the semi-automatic tissue segmentation. Based on obtained adipose tissue surface areas and body mass index (BMI) scores sex-specific standard percentile curves (3rd, 10th, 25th, 50th, 75th, 90th, 97th) and z-scores were constructed using LMS method. Additionally, 85th and 95th centiles of subcutaneous and visceral adipose tissue were proposed as equivalents of overweight and obesity. Bland-Altman plots revealed an excellent intra-observer reproducibility and inter-observer agreement. In conclusion, our findings demonstrate highly reproducible method and suggest that MRI-derived reference values can be implemented in clinical practice.

A Combined Region- and Pixel-Based Deep Learning Approach for Quantifying Abdominal Adipose Tissue in Adolescents Using Dixon Magnetic Resonance Imaging

“…A similar study quantifying abdominal adipose tissues in children and adolescents was presented recently [ 11 ]. In that study, a single MRI slice at the level of the second lumbar vertebra (L2) was selected for a longitudinal assessment of adipose tissue in healthy subjects aged from 6 to 18 years.…”

“…In this study, we studied young healthy volunteers between the ages of 8 and 18 years old, because research shows that intra-abdominal adipose fat accumulation begins in this unique age group and is associated with significant adverse health effects occurring in obese children and adolescents either before or after they become adults [ 35 , 36 ]. Similar to the prior study by Marunowski et al [ 11 ], our fat quantification was focused on cross-sectional images at the level of L2–L3 and L4–L5 interspaces due to the considerable changes in physical and body composition during adolescence. Nevertheless, previous studies have shown that the adipose tissue area quantified from a single-slice image sampled at various intervertebral disc levels had strong correlations with total abdominal and visceral adipose tissue volumes [ 37 , 38 ].…”

“…Children and young people who have obesity are more likely to develop obesity-related cardiovascular and metabolic diseases in their lifetime [ 4 , 9 ]. Therefore, fat quantification in early life may be used for initial assessments of significant risks of cardiovascular disease [ 10 , 11 ].…”

Quantification of Visceral Fat at the L5 Vertebral Body Level in Patients with Crohn’s Disease Using T2-Weighted MRI

“…One study that quantified visceral adipose tissue at the level of the umbilicus using T1-weighted and T2-weighted MRI showed that T2-weighted images have slightly higher inter-observer reproducibility compared to T1-weighted images [ 28 ]. In another study that derived subcutaneous and visceral adipose tissue reference values for children using T2-weighted images, the inter-observer agreement between randomly selected sets of MRI was also high, with a mean difference of 0.07 cm 2 and 0.08 cm 2 for subcutaneous adipose tissue and visceral adipose, respectively [ 13 ]. Using T2 HASTE is also advantageous due to its standard inclusion in most MRI protocols and its reduced motion artifact compared to the Dixon technique.…”

“…Nevertheless, MRI may be the preferred modality when aiming to limit ionizing radiation, leading to the use of T1 fat-only images acquired and reconstructed using the Dixon technique [ 11 , 12 ]. However, due to the absence of Dixon sequences in certain abdominal and pelvic MR protocols, some studies have explored T2-weighted half-Fourier acquisition single-shot turbo spin echo (T2 HASTE) as a potential alternative [ 13 , 14 ].…”