Active depression is associated with regional adiposity in the upper abdomen and the neck.

OBJECTIVE: In major depression, the incidence of overweight, the risk of type 2 diabetes, as well as cardiovascular disease is increased. Aim was to determine body fat distribution in depressive and healthy females using whole body Magnetic Resonance Imaging (MRI). Measurements of total adipose tissue (TAT), visceral (VAT), and subcutaneous adipose tissue (SCAT) at the trunk and the whole body fat distribution along the body axis were performed and compared. Differences in body fat distribution between depressive and healthy females and their location were evaluated. METHODS: In total, 11 women with a depressive syndrome (major depression, MD) and 45 healthy female volunteers (HC) matched for age and body mass index were compared. Total tissue (TT), TAT, VAT, and SCAT were quantified using T1-weighted whole body MRI. Adipose tissue distribution was compared along the body axis. RESULTS: MD patients showed higher adipose tissue volumes than the HC group. Especially in the upper abdomen, at the upper extremities and the neck, MD patients are characterized by a significantly higher adipose tissue mass compared to the HC group. CONCLUSIONS: The results of this study confirm the hypothesis of a high stress level with a disturbed hypothalamic-pituitary-adrenal (HPA) axis leading to a Cushing-like habitus and high visceral fat levels. The increased fat levels at the arms, as well as the whole body fat may be well-founded by a lack of activity in depression. These effects should be evaluated in further longitudinal studies investigating patients with a depressive syndrome and after remission.

Determination of the rCBF in the amygdala and rhinal cortex using a FAIR-TrueFISP sequence.

OBJECTIVE: Brain perfusion can be assessed non-invasively by modern arterial spin labeling MRI. The FAIR (flow-sensitive alternating inversion recovery)-TrueFISP (true fast imaging in steady precession) technique was applied for regional assessment of cerebral blood flow in brain areas close to the skull base, since this approach provides low sensitivity to magnetic susceptibility effects. The investigation of the rhinal cortex and the amygdala is a potentially important feature for the diagnosis and research on dementia in its early stages. MATERIALS AND METHODS: Twenty-three subjects with no structural or psychological impairment were investigated. FAIR-True-FISP quantitative perfusion data were evaluated in the amygdala on both sides and in the pons. A preparation of the radiofrequency FOCI (frequency offset corrected inversion) pulse was used for slice selective inversion. After a time delay of 1.2 sec, data acquisition began. Imaging slice thickness was 5 mm and inversion slab thickness for slice selective inversion was 12.5 mm. Image matrix size for perfusion images was 64 × 64 with a field of view of 256 × 256 mm, resulting in a spatial resolution of 4 × 4 × 5 mm. Repetition time was 4.8 ms; echo time was 2.4 ms. Acquisition time for the 50 sets of FAIR images was 6:56 min. Data were compared with perfusion data from the literature. RESULTS: Perfusion values in the right amygdala, left amygdala and pons were 65.2 (± 18.2) mL/100 g/minute, 64.6 (± 21.0) mL/100 g/minute, and 74.4 (± 19.3) mL/100 g/minute, respectively. These values were higher than formerly published data using continuous arterial spin labeling but similar to (15)O-PET (oxygen-15 positron emission tomography) data. CONCLUSION: The FAIR-TrueFISP approach is feasible for the quantitative assessment of perfusion in the amygdala. Data are comparable with formerly published data from the literature. The applied technique provided excellent image quality, even for brain regions located at the skull base in the vicinity of marked susceptibility steps.

Subcutaneous adipose tissue thickness in adults - correlation with BMI and recommendations for pen needle lengths for subcutaneous self-injection.

OBJECTIVE: One of the aims of a subcutaneous (SC) injection is to avoid intradermal or intramuscular injections. Pen systems are an alternative solution to single-use syringes and have become standard for example diabetes therapy. Shorter and smaller needles minimize pain and the risk of intramuscular injections. The thickness of subcutaneous adipose tissue (SCAT) varies with position and with body mass index (BMI). The aim of this study was the creation of a map of SCAT thickness at typical spots for SC self-injection. MATERIALS AND METHODS: MRI scans of 116 prospectively enroled volunteers (56 men and 60 women) were analysed. SCAT thickness was determined at 17 spots over the abdominal wall, left thigh, buttocks and upper arm, typical sites for subcutaneous self-injection. SCAT thicknesses were correlated with BMI and waist-to-hip ratio (WHR), and a linear curve fit was performed. The best fitting linear functions for the prediction of the SCAT thickness dependent on BMI and WHR were derived. RESULTS: Correlations between SCAT and BMI were higher (0·67-0·21) than with WHR (-0·67 to 0·09). In women, correlation coefficients between SCAT data at the abdomen and BMI/WHR were higher than in men. On the other hand, data showed better correlations at the extremities in men. CONCLUSIONS: The data, with correlation between BMI and fat thickness at different injection sites in relation to gender, provide guidance in selecting an adequate pen needle length for deep and safe subcutaneous self-injection. WHR was a much weaker predictor when compared to BMI.

Quantitative analysis of adipose tissue in single transverse slices for estimation of volumes of relevant fat tissue compartments: a study in a large cohort of subjects at risk for type 2 diabetes by MRI with comparison to anthropometric data.

OBJECTIVES: Aim of the study was to assess the potential value of cross-sectional adipose tissue evaluation in well defined single transverse slices for estimation of volumes of metabolically important adipose tissue compartments as visceral adipose tissue (VAT), nonvisceral adipose tissue (NVAT), and total body adipose tissue (TAT). In addition, validity of easily accessible anthropometric indices (waist-to-hip-ratio [WHR] and body mass index [BMI]) for prediction of volumes of those adipose tissue compartments were validated and compared. MATERIALS AND METHODS: True volumes of main adipose tissue compartments VAT, TAT, and NVAT were carefully assessed based on whole-body magnetic resonance (MR) examinations in 367 volunteers (227 females, 140 males, age 18-69 years) at increased risk for type 2 diabetes. Volumes of VAT, NVAT, and TAT were compared with cross-sectional areas of adipose tissue in single transverse slices recorded on the level of (1) umbilicus (u), (2) head of humerus (h), (3) head of femur (f), and anthropometric data such as BMI and WHR. Separate analyses were performed in males and females. RESULTS: In both genders, strong correlations were found between TAT and the cross-sectional areas: subcutaneous adipose tissue (u) with r = 0.88 in females and r = 0.92 in males, TAT(h) with r = 0.80 in females and r = 0.82 in males, and TAT(f) with r = 0.90 in females and r = 0.90 in males. VAT assessed by MR single slice evaluation at the umbilical level (VAT(u)) showed a strong correlation with total VAT in both genders (r = 0.93 in females, r = 0.87 in males). Suitable algorithms for predicting VAT in liter from fat planimetry in a slice recorded at the umbilical level were derived: VAT = 0.16 x (VAT(u) x body height) + 0.3 in women and VAT = 0.15 x (VAT(u) x body height) + 1.2 in men. Disregarding the body height, the best equations were as follows: VAT = 0.03 x VAT(u) + 0.3 in women and VAT = 0.02 x VAT(u) + 1.4 in men. In contrast, BMI versus VAT showed a lower correlation in both genders: r = 0.71 in females, r = 0.56 in males, and WHR versus VAT was only weakly correlated in females and in males (r = 0.49 and r = 0.55, respectively). For WHR versus TAT, significant results were only found in males (r = 0.44). CONCLUSIONS: Axial MRI at the umbilical level allowed for a fast and reliable estimation, especially for VAT and TAT in a collective at risk for type 2 diabetes. WHR and BMI were found clearly worse in prediction of VAT volumes compared with single slice evaluation at the umbilical level.

Interscapular fat is strongly associated with insulin resistance.

CONTEXT: Subcutaneous abdominal adipose tissue (SCAAT), visceral adipose tissue (VAT), fat in the neck area [interscapular fat (IF)], and liver fat (LF) are associated with metabolic traits related to insulin resistance. Whole-body magnetic resonance imaging and spectroscopy offer a unique approach to quantify fat depots in larger cohorts. OBJECTIVE: The objective was to study 1) the impact of the aforementioned fat depots on insulin sensitivity in a cross-sectional design and 2) changes in these fat depots and in insulin sensitivity during a lifestyle intervention (LI). DESIGN: One hundred eighty-seven subjects were included in the cross-sectional study. Follow-up data during LI were available in 172 subjects. Body fat depots were quantified by whole-body magnetic resonance imaging, and representative reference slices at the umbilical level (SCAAT, VAT) and at the level of the shoulder joint (IF) were analyzed. LF was measured by (1)H-magnetic resonance spectroscopy. Insulin sensitivity was estimated from an oral glucose tolerance test. RESULTS: Cross-sectionally, SCAAT, VAT, IF, and LF were negatively associated with IS (all P < 0.0001). The change in insulin sensitivity during LI was associated with the changes in these fat depots (all P < 0.001). In a multivariate model, the change in insulin sensitivity during LI adjusted for gender, age, LF, and IF at baseline was associated with change in IF (P < 0.01) and with change in LF (P < 0.0001). CONCLUSIONS: IF represents a subcutaneous fat depot determining whole-body IS, both cross-sectionally and during LI. The impact of LF and IF on insulin sensitivity appears to be independent from each other. Additional studies are needed to clarify the metabolic properties of IF.

Correlation of fat distribution in whole body MRI with generally used anthropometric data.

OBJECTIVES: : Obesity is a commonly known risk for many diseases such as metabolic syndrome and cardiovascular disease. Especially important is the discrimination of the adipose tissue inside the abdomen and the subcutaneous adipose tissue. Aim of this study was to compare the whole body fat distribution, and the volume of different adipose tissue compartments respectively, with anthropometric data. MATERIALS AND METHODS: : Sixty-eight volunteers (20 males, 48 females, 42.3 +/- 15.4 years) were investigated in the context of 2 whole body magnetic resonance imaging (MRI) studies which compared the body fat distribution of depressive and bulimic patients with healthy controls. Unpublished data acquired in these studies were analyzed retrospectively.The sample consisted of 38 healthy volunteers, 17 patients with a depressive syndrome and 13 women suffering from bulimia nervosa. Individual body volume, total adipose tissue (TAT) volume, subcutaneous adipose tissue (SCAT) volume at the trunk, and visceral adipose tissue (VAT) volume were determined, using whole body MRI. Additionally, body fat profiles were standardized and a mean body distribution was calculated. Other modalities to acquire body fat content were: skin fold caliper, body impedance (3 different devices) and simple anthropometric data (Waist to Hip Ratio [WHR], Body Mass Index [BMI], distance of the aponeurosis of the rectus abdominis muscle to the ventral rim of the abdominal aorta (measured in MRI images on umbilical level) (AD) and subcutaneous adipose tissue thickness at the same level). The different modalities were correlated with the MRI data. RESULTS: : There were highly significant correlations between the skin fold data and TAT (Spearman coefficient 0.668, P >/= 0.0004) and SCAT (0.662, P >/= 0.0004). But there was no correlation with VAT. Impedance data revealed significant correlations of TAT and SCAT (Spearman 0.7, P >/= 0.0004).Simple anthropometric data like waist and hip circumference, WHR, and BMI revealed significant correlations (Spearman coefficient around 0.7-0.4, P < 0.05) with the fat compartments TAT, VAT, and SCAT.The standardized body fat slices and the VAT slices were correlated with the anthropometric data and impedance data to explore specific areas along the body axis where the correlations were higher or weaker. Skinfold data, BMI, and body impedance data yielded significant correlations with TAT along the whole body axis, as well as with VAT in almost the whole analyzed area. However, there was no special body region with locally higher correlations. WHR depicted high correlations with whole VAT, and regional TAT at the abdomen (and not with the other body regions) especially in women. Therefore, it seems to be the best marker for abdominal fat and VAT in this study. CONCLUSIONS: : We compared different body measures and body fat devices with the whole body fat distribution acquired by MRI. Generally, there were significant correlations of all modalities with body fat content (TAT) and mainly with SCAT. Correlations with VAT compartment were much weaker and an adequate estimation of VAT is, therefore, not possible. Only WHR revealed significant correlations with the fat in the body center, but only in women. If it is important to investigate especially the VAT which is responsible for a higher cardiovascular risk, risk for a metabolic syndrome and that is correlated with the course of different psychiatric diseases, cross sectional techniques such as MRI can not be substituted by simpler methods.

Changes of body composition in bulimia nervosa: increased visceral fat and adrenal gland size.

OBJECTIVE: To study the hypothesis that young women suffering from active bulimia nervosa (BN) have more visceral fat and increased adrenal gland volumes (AGV) than healthy controls (HC). METHODS: Thirteen patients with BN of purging type and 11 healthy age and weight matched women (HC), aged between 19 and 36 years (mean 24 +/- 3 years), with a BMI of 19 to 29 (mean 24 +/- SD 3) were examined. BN was diagnosed by DSM-IV criteria and the severity of illness by the Eating Disorder Inventory (EDI-2). Whole body fat distribution and AGV were determined using a whole body magnetic resonance (MR) scan (T1w) and a 3D-sequence (T1w) at 1.5 Tesla. Salivary cortisol was determined at 9 AM and 4 PM. RESULTS: BN patients had significantly more visceral adipose tissue (VAT) (HC, 1589.3 +/- 967.6 ml versus 927.2 +/- 428.4 ml, p < .05) and an increased relative AGV (0.068% of body volume versus 0.048% of body volume, p < .05) compared with HC, although waist circumference and BMI did not differ. Although the VAT part in the upper abdomen was increased, especially the VAT of lower abdomen along with the pelvis or any subcutaneous fat compartment was not increased. CONCLUSIONS: The increase of the VAT volume and the increased AGV in BN women with purging point to chronic high stress levels associated with a hyperactivity of the hypothalamic-pituitary-adrenal axis in these patients. This is the first MR study showing morphological changes in stress associated endocrine organs of young BN patients.

Increase of visceral fat and adrenal gland volume in women with depression: preliminary results of a morphometric MRI study.

OBJECTIVE: Depression is often accompanied by increased visceral adipose tissue (VAT), stress, enlarged adrenal glands, and an increased risk of cardiovascular disease. VAT turn-over is regulated by adrenal stress hormones such as cortisol. Aim of this study was to investigate the relationship between the adrenal volume as a marker for long-term stress and the volume fractions of several body fat compartments in healthy and depressive women. METHODS: Ten depressive and 12 healthy women were investigated. Fat compartments (VAT, VAT in the upper abdomen, subcutaneous adipose tissue (SCAT), and adrenal volume) were measured by MRI. RESULTS: Depressive women revealed more VAT in the upper abdomen than the healthy. There was a significant correlation of age and Body Mass Index (BMI) with the visceral adipose tissue volume and adrenal gland size. In a partial correlation, Beck Depression Inventory (BDI) was correlated with VAT in the upper abdomen (r = 0.45, p < 0.05). CONCLUSIONS: The increase of adrenal volume and VAT and the correlation of BDI with VAT in the upper abdomen support the hypothesis of long-term production of stress hormones in depression. This study is a further step toward describing morphologic substrates of depression in endocrine organs.

T2- and diffusion-maps reveal diurnal changes of intervertebral disc composition: an in vivo MRI study at 1.5 Tesla.

PURPOSE: To investigate the lumbar intervertebral discs (IVDs) by MRI in the morning and evening after a diurnal load cycle. Changes in MR characteristics (T2-weighted imaging, T2- and apparent diffusion coefficient [ADC] -mapping) during the course of the day were visualized and analyzed visually and quantitatively. The length of the lumbar spine was measured in between the lower anterior edge of Th12 and the upper anterior edge of S1. T2 changes and diffusion characteristics of the vertebral disc tissue were investigated with a higher spatial resolution than in former studies. MATERIALS AND METHODS: In six males, lumbar IVDs were investigated in the morning and evening. T2-maps and ADC maps were generated. Data were analyzed by selecting regions of interest (ROI) in the annulus fibrosus (AF), nucleus pulposus (NP), and an intermediate area. RESULTS: From morning to evening, T2 decreased in the center of the NP (-7.9%; P = 0.001) and the intermediate voxels (-6.4%; P < 0.0005). T2 increased (8.5%; P < 0.048) in the AF. ADC decreased in the AF (-5.2%; P = 0.007) and the intermediate ROIs (-2.2%; P = 0.004). There was no significant change of ADC in the NP (-1.6%; P = 0.242). CONCLUSION: T2 and diffusion (ADC) changes of IVDs in humans were investigated with a spatial differentiation between NP and AF. T2 and ADC turned out to be sensitive parameters in investigating changes in the MR characteristics of the IVD matrix during a day. Highly resolved MR imaging and parameter mapping is expected to be an interesting tool in characterizing structural changes in the vertebral disc architecture in an early stage of degeneration.

Successful coil embolization of a ruptured gastroduodenal artery aneurysm.

Aneurysms of the gastroduodenal artery are rare. Reported here is the case of a 60-year-old woman suffering from the covered rupturing of a twin aneurysm of the gastroduodenal artery. The patient presented herself in the surgical emergency unit with abdominal discomfort. Diagnostics showed free fluid in the abdominal cavity together with anemia of 9.9 g/dL. A computed tomography scan and an angiography revealed the covered rupturing of a twin aneurysm of the gastroduodenal artery, which was treated by endovascular coiling of the gastroduodenal and pancreaticoduodenal arteries. The patient's hemoglobin level remained stable after treatment, and she was released from the hospital after 18 days. Visceral artery aneurysms are rare. Although endovascular therapy is preferred in cases involving active bleeding, surgery remains the primary therapy in those cases in which bleeding becomes uncontrollable.