Ultrasound: Which role in body composition?

Ultrasound is a non-invasive, fast, relatively inexpensive and available tool for estimating adiposity in clinical practice, and in several research settings. It does not expose patients to ionizing radiation risks, making the method ideal for the evaluation, and for follow-up studies. Several parameters and indexes based on adipose tissue thickness have been introduced and tested, and these have been correlated with clinical and laboratoristic parameters. Moreover, ultrasound can also be directed to the estimation of adipose tissue and intracellular fat indirectly, at cellular-molecular level: an opportunity for many radiologists who already and sometimes unconsciously perform "body composition" assessment when looking at the liver, at muscle as well as at other organs. However, standardized procedure and parameters are needing to improve accuracy and reproducibility. The purposes of this review are: 1) to provide a complete overview of the most used and shared measurements of adiposity; 2) to analyze technical conditions, accuracy, and clinical meaning of ultrasound in the study of body composition; 3) to provide some elements for the use of ultrasound in the evaluation of intra-cellular lipids accumulation, in two hot spots: liver and skeletal muscle

Accuracy, Reproducibility and Repeatability of Ultrasonography in the Assessment of Abdominal Adiposity

RATIONALE AND OBJECTIVES: Despite improvements in the methods used in body composition analysis, some goals remain far from clinical practice. Among them, the most important is the quantification of intra-abdominal adipose tissue. Fat distribution is a key point in the assessment of cardiovascular and metabolic risk status. The aim of this study was to define the accuracy, reproducibility, and repeatability of ultrasonography in the evaluation of abdominal adiposity. MATERIALS AND METHODS: Twenty-six nonobese patients (group A) who underwent computed tomographic (CT) abdominal imaging and 29 obese patients (group B) were enrolled. Patients from both groups were independently evaluated using ultrasound by three radiologists; computed tomography-like conditions were reproduced, and six main parameters of subcutaneous and internal adiposity were measured (as well as three derived indexes) with both linear and convex probes. In group A, the same measurements were also obtained on CT images. Time spent for every ultrasound session was recorded. Results were analyzed using Lin's concordance correlation (\u3c1), intraclass correlation, and linear regression analysis (and analysis of variance). RESULTS: Three patients were excluded from group A after CT scans because of technical problems. Mesenteric fat thickness did not show significant correlations and reliability. Strong correlations between ultrasound and CT measurements were observed for all other visceral and subcutaneous parameters (\u3c1 = 0.85-0.96). Intraobserver and interobserver agreement was excellent in both groups (repeatability: \u3c1 = 0.83-0.99 for group A, \u3c1 = 0.90-0.99 for group B; reproducibility: intraclass correlation coefficient = 0.90-0.99 for groups A and B). The mean time spent was 95 \ub1 21 seconds for group A (mean body mass index, 27.4 \ub1 2.4 kg/m(2)) and 129 \ub1 33 seconds for group B (mean body mass index, 37.3 \ub1 11.9 kg/m(2)). CONCLUSIONS: Ultrasound is accurate, reproducible, and fast in the analysis of abdominal adiposity. It offers a regional, easy, and close-at-hand evaluation of subcutaneous and visceral fat compartments. This should be taken into consideration when clinical routine examinations are performed or to evaluate patients with specific metabolic diseases before and after treatment

The Role of Ultrasonography in the Evaluation of Abdominal Fat

RATIONALE AND OBJECTIVES: Ultrasonography (US) is becoming popular for the assessment of adiposity, but no one has studied this tool in the light of its potential limitations. Our purpose was to investigate the impact of technical conditions on the evaluation of abdominal fat by US. MATERIALS AND METHODS: Forty-five healthy males and 45 healthy females were consecutively enrolled in the study, randomly assigned to three groups equally distributed by sex, and examined accordingly to three technical points: fasting state (before and after meal [A]), breathing (expiration and inspiration [B]), and US equipment from different generations: 2003 and 1998 (C). Two blinded radiologists performed US in the these opposite conditions, acquiring five parameters representative of subcutaneous and visceral adiposity in two times. Student's t-test and Lin's correlation coefficient were used for statistical analysis to assess differences in the measures as well as in inter- and intra-observer agreements. RESULTS: The maximum and the only statistically significant changes were observed for intra-abdominal fat thickness regarding fasting state and breathing (\u394% = 24.1 \ub1 21.3 and \u394% = 9.2 \ub1 20.4, respectively; P < .0001). Reproducibility and repeatability, especially for visceral fat, were proved more stable in the following conditions: fasting state, expiration, and newer machine (2003). CONCLUSION: This article provides essential information and "range of confidence" for variations that can be expected from using different conditions in the measurement of abdominal adiposity by US to be carefully addressed as well as considered by US users and by researchers involving this technique in the field of body composition

MRgFUS new applications in musculoskeletal pathology: a miscellaneous case review

Magnetic resonance guided focused ultrasound surgery (MRgFUS) of the musculoskeletal system achieved significant results in the treatment of painful bone metastases, and recently showed promise for benign bone lesions (e.g. osteoid osteoma) and osteoarthritis (e.g. facet joint syndrome and knee osteoarthritis). MRgFUS works on the main basis of pain relief and tumor control / killing. In this case review five patients affected by different diseases not commonly treated by MRgFUS are presented

New regions of interest in body composition analysis by dual energy X-ray absorptiometry: "liver adiposity".

Purpose: Hepatic steatosis is an increasing worldwide metabolic disease and the earliest biomarker for the liver fibrosis development. Thus, its detection and quantification during non-invasive examinations should be always considered as clinically relevant. Our aim was to test new designed regions of interest (ROIs) on whole body images acquired by dual energy x-ray absorptiometry (DXA) in comparison with DXA conventional ROIs and ultrasonography (US) in order to evaluate predictive values on liver steatosis detection and grading. Methods and Materials: Ninety-nine subjects directed to body composition assessment by DXA were prospectively enrolled. All patients were submitted to whole body DXA scan (Lunar iDXA, software enCORE 12.0) and underwent US evaluation on the same day to assess hepatic steatosis (mild-moderate-severe). On every DXA image three new liver-suited ROIs were manually created by a skilled radiologist. Fat mass (FM) and FM percentage (FMp) were investigated on whole body and regionally (android and new ROIs). FM and FMp results were correlated with US Results: Out of 99 patients, 70 (70.7%) resulted affected by liver steatosis on US evaluation (32/70&#8722;45.7% mild, 32/70&#8722;45.7% moderate and 6/70&#8722;8.6% severe). FM and FMp of all ROIs were significantly correlated with presence and grading of steatosis (p &lt; 0.001); however, they were able to predict and to distinguish steatosis absence from moderate and severe grade, but not mild. FMp of one among the new liver-suited ROIs showed the best predictive value for liver steatosis. Conclusion: New ROIs should be included in whole body DXA examinations to provide additional information and higher predictive value on liver steatosis

A Comparison of Different Staging Systems for Multiple Myeloma: Can the MRI Pattern Play a Prognostic Role?

The objective of this study is to compare the most recent systems for the staging of multiple myeloma (MM), the Durie-Salmon PLUS system and the International Staging System, according to patients' survival rates and response to therapy. Another objective is to verify whether patterns of bone marrow alteration on MRI (i.e., focal, diffuse, or variegated patterns) can provide prognostic information for patients with MM

A New HRCT Score for Diagnosing SARS-CoV-2 Pneumonia: A Single-Center Study with 1153 Suspected COVID-19 Patients in the Emergency Department

The 2019 coronavirus disease (COVID-19) pandemic is affecting millions of people worldwide. Chest high-resolution computed tomography (HRCT) is commonly used as a diagnostic test for suspected COVID-19; however, despite numerous attempts, there is no single scoring system that is widely accepted and used in clinical practice to estimate the probability of SARS-CoV-2 pneumonia. The aim of this single-center retrospective study is to develop a radiological score to predict the probability of COVID-19 with HRCT. Patients admitted to the emergency department with symptoms suggestive of COVID-19 who underwent both HRCT and RT-PCR on nasopharyngeal swab to detect SARS-CoV-2 infection between 1 March and 30 April 2020 were included. A multivariable regression analysis was conducted to identify all HRCT signs independently associated with a positive RT-PCR assay for SARS-CoV-2 and build the HRCT score. A total of 1153 patients were enrolled in this study. The number of segments with ground glass opacities (OR 1.18, 95% CI 1.11–1.26), number of segments with linear opacities (OR 1.21, 95% CI 1.05–1.42), crazy paving patterns (OR 6, 95% CI 3.79–9.76), and vascular ectasia in each segment (OR 2.46, 95% CI 1.1.5–5.8) were included in the score. The HRCT score showed high discriminatory power (area under the ROC curve of 0.8267 [95% CI 0.8–0.85]) with 72.2% sensitivity, 86.6% specificity, 78% PPV, and 83% NPV for its best cut-off. In summary, the HRCT score has good diagnostic and discriminatory accuracy for COVID-19 and is easy and quick to perform