MRI scans and measuring visceral fat

[BRC2]

Hopefully I'm allowed some leeway with this question. I'm located in The Netherlands.

I approached a local company that offers MRI scans, to be performed in Germany.

From reading the literature, I know that MRI scans can be used to measure visceral fat. The company in question offers an MRI abdomen. When I specifically asked them if those scans could be used to measure visceral fat, I got the 'it is not possible' response.

Obviously visceral fat can be seen on a MRI. Measuring (often done in cm2, MRI/DEXA) ?
Does this require some particular skill or education for the radiologist ? I know it's not the usual 'looking for pathologies' stuff.

There are similar clinics in Germany, but before I ask around:
Does this require some particular skill or education for the radiologist ?

My interpretation was that they just didn't feel like doing it.

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[preDoGuy24]

Why are you looking for visceral fat measurements? Seems to be a strange request to call a radiology group with.

Not something I have seen commonly commented on in a report.


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[DrfluffyMD]

You should approach your local radiology group. If this is something you are interested in it falls into the realm of screening total body MR that is paid out of pocket.

 

[BRC2]

I know it is not common. From a medical perspective, it is usually considered 'too expensive'. As for the 'why', I doubt you are interested in the background story !

In this country 'preventive' MRI scans are not allowed, that's why people do it abroad. And diagnostic MRIs are usually only done when considered absolutely necessary.
So asking the local hospital probably would not be the best approach.

For reference: Comparison of 3 T MRI and CT for the measurement of visceral and subcutaneous adipose tissue in humans

I was hoping to get an answer here. The link above actually says something about how it could be done '
Image processing
Analyze v. 7.0 (AnalyzeDirect, Inc., Overland Park, KS), was used for processing, segmentation and measurement of compartments for both CT and MR images. A blinded analyst manually traced the abdominal wall muscle layer, thus delineating SAT from VAT. This program also allowed us to exclude intracolonic contents from the image, in order to prevent non-adipose tissue components from being counted as adipose tissue. Hounsfield unit cut-off values of −190 to −30 were assigned for adipose tissue in the CT images. Post-processing required approximately 20 min per image.
'
But what do I know ? I was hoping a radiologist could comment. Or do you need a different kind of doctor/specialist for that ?

I can get an MRI abdomen and even a full body scan for not that much money. Just not locally. Crossing the border into Germany (20-30 miles) would do it.

 

[DrBowtie]

I know it is not common. From a medical perspective, it is usually considered 'too expensive'. As for the 'why', I doubt you are interested in the background story !

In this country 'preventive' MRI scans are not allowed, that's why people do it abroad. And diagnostic MRIs are usually only done when considered absolutely necessary.
So asking the local hospital probably would not be the best approach.

For reference: Comparison of 3 T MRI and CT for the measurement of visceral and subcutaneous adipose tissue in humans

I was hoping to get an answer here. The link above actually says something about how it could be done '
Image processing
Analyze v. 7.0 (AnalyzeDirect, Inc., Overland Park, KS), was used for processing, segmentation and measurement of compartments for both CT and MR images. A blinded analyst manually traced the abdominal wall muscle layer, thus delineating SAT from VAT. This program also allowed us to exclude intracolonic contents from the image, in order to prevent non-adipose tissue components from being counted as adipose tissue. Hounsfield unit cut-off values of −190 to −30 were assigned for adipose tissue in the CT images. Post-processing required approximately 20 min per image.
'
But what do I know ? I was hoping a radiologist could comment. Or do you need a different kind of doctor/specialist for that ?

I can get an MRI abdomen and even a full body scan for not that much money. Just not locally.

What is the end result? So you have a calculated number, what next? There are plenty of other methods for body fat analysis.

20 minutes per image is prohibitively time intensive.

 

[DrfluffyMD]

It's probably doable with just T1 and T2, depends on the accuracy desired.

If your country cannot do it, you need to go to a country that offer cash whole body MRI. I think those things cost thousands in the states, may cost you more for your special request.

If money is not a problem that's the way to go.

 

[BRC2]

@DrBowtie, @DrfluffyMD,

Not that many. I know of DEXA (DXA) and CT. Getting a CT scan tends to be a problem because of radiation concerns ... not my concerns, but the rules ... DEXA, a drive of 2.5 hours ... And it has its limitations. Scales with bioelectrical impedance analysis are unreliable. (especially in my situation, which would require some explanation).
Just taking measurements (waist etc.) ... no ... too unreliable. No guesswork or averages.

I guess part of the background is that I'm very dissatisfied with this country's healthcare system, especially with the treatment by the GP. It's very different from the USA. I'm sick of the GPs opinion (just that, very little diagnostics). We can't just pick our doctors like in the USA etc.
As far as this is concerned, I'd appreciate some real facts.

Btw, the company that gave my the line 'it is not possible' (my interpretion was: they didn't want to bother, they just want to check for common pathologies) is located in The Netherlands, but the MRI scans are done in Germany. CT abdomen, full body scan and more.

About that company's MRI device ' the latest Siemens and Philips scanners: Philips Achieva 1,5 and 3,0T MRI scanner and the Siemens Avanto 1,5 and 3,0T MRI scanner'

'20 minutes per image is prohibitively time intensive.' I'm not sure if that is for the specific visceral fat analysis ? That particular company (Prescan) states 'an average MRI scan lasts 15-30 minutes' A visual image is one thing, a measurement (cm, weight, volume/whatever) is something else.

MRI abdomen about 500 USD, total body scan about 1000 USD.

I guess one question of mine is this requires some special skill/knowledge/learning curve/software to actually measure this ? Indeed, not the regular checking for 'pathologies', or 'illnesses'. Is this perhaps usually only done in academic studies ?

There are also plenty of customer service oriented clinics in Germany, probably more expensive.

 

[DrBowtie]

@DrBowtie, @DrfluffyMD,

Not that many. I know of DEXA (DXA) and CT. Getting a CT scan tends to be a problem because of radiation concerns ... not my concerns, but the rules ... DEXA, a drive of 2.5 hours ... And it has its limitations. Scales with bioelectrical impedance analysis are unreliable. (especially in my situation, which would require some explanation).
Just taking measurements (waist etc.) ... no ... too unreliable. No guesswork or averages.

I guess part of the background is that I'm very dissatisfied with this country's healthcare system, especially with the treatment by the GP. It's very different from the USA. I'm sick of the GPs opinion (just that, very little diagnostics). We can't just pick our doctors like in the USA etc.
As far as this is concerned, I'd appreciate some real facts.

Btw, the company that gave my the line 'it is not possible' (my interpretion was: they didn't want to bother, they just want to check for common pathologies) is located in The Netherlands, but the MRI scans are done in Germany. CT abdomen, full body scan and more.

About that company's MRI device ' the latest Siemens and Philips scanners: Philips Achieva 1,5 and 3,0T MRI scanner and the Siemens Avanto 1,5 and 3,0T MRI scanner'

'20 minutes per image is prohibitively time intensive.' I'm not sure if that is for the specific visceral fat analysis ? That particular company (Prescan) states 'an average MRI scan lasts 15-30 minutes' A visual image is one thing, a measurement (cm, weight, volume/whatever) is something else.

MRI abdomen about 500 USD, total body scan about 1000 USD.

I guess one question of mine is this requires some special skill/knowledge/learning curve/software to actually measure this ? Indeed, not the regular checking for 'pathologies', or 'illnesses'. Is this perhaps usually only done in academic studies ?

There are also plenty of customer service oriented clinics in Germany, probably more expensive.

Your request would require post processing software that I doubt any clinical practice would have. The study you quoted was 20 minutes per image post processing. Unless you have a grant to support research in this, you'd be hard pressed to find anyone doing this.

This is unlike DXA in that this measurement is not used to guide clinical management.

If your number is low, medium, or high, what clinical change are you going to make that you couldn't make without that data? I also think you overestimate the precision with this measurement technique.

 

[DrfluffyMD]

A couple questions

1. Why doesn't other methods work for you?

2. What are you looking to achieve with this measurement?

 

[BRC2]

@DrfluffyMD,

DEXA: one locally available, 2.5 hour drive. But I guess it is doable. Other methods I know of (bioimpedance, waist circumference) are mostly guesswork or not reliable.

What I'm looking for: real hard numbers, along with knowing where the fat is actually located. I know I have accumulated visceral fat, depending on the time and situation I can actually feel it aroud my organs. The GP's attitude: not possible since I'm not overweight or it doesn't matter.
This is not subcutaneous fat. Actually, it's even visible. This has accumulated a lot in the past two years.
It is mostly for me, although possibly I could use it in a medical setting if the results warrant it.

Cause: mostly unknown, although I suspect prescription drugs and undiagnosed health conditions.

Different country, different rules: the healthcare system relies mostly on the GP's opinion rather than real diagnostics or specialist care.

@DrBowtie,
Thanks for that clarification. I can imagine that would be the obstacle. Still, visceral fat would be visible on an MRI, including where it's located ? A quote from wiki 'Visceral fat is composed of several adipose depots, including mesenteric, epididymal white adipose tissue (EWAT), and perirenal depots'

I guess a lot is possible that is not commonly done in clinical practice.

 

[DrfluffyMD]

I am not really familiar with clinical implication of quantifying visceral fat. We all learned about central obesity and it's implication in med school, but I never really heard of anything quantifying it.

I am also unsure if there is any intervention for too much visceral fat besides going on a good diet (and watch calorie intake) as well as exercise.

 

[newdoc2013]

Do a T1 and T1 fatsat though the abdomen; draw a region of interest excluding subcutaneous fat and calculate the relative pixel dropout.

Publish your work that proves that it has clinical utility.

Just because you CAN do something doesn't mean you SHOULD.

 

[BRC2]

It is indeed 'not an illness'. Although sometimes it can be considered pathological. I was just going by the literature ... which mentions MRI.
It seems it is considered 'too expensive' for clinical use. Which is why radiologists generally don't know about it

'I am also unsure if there is any intervention for too much visceral fat besides going on a good diet (and watch calorie intake) as well as exercise' Taking away the cause of the increase. Which is not always laziness or eating too much. So from my perspective it makes sense to quantify things, but that MRI is not a practical way to measure that seems settled. But it's almost (?) the gold standard according to the literature.

As a last and final question and mostly out of curiosity, would you actually be able to see the different visceral fat depots of visceral fat (wiki) 'Visceral fat is composed of several adipose depots, including mesenteric, epididymal white adipose tissue (EWAT), and perirenal depots.' on a regular MRI with the naked eye ?

 

[newdoc2013]

I think if it can be shown that the information is actionable and clinically relevant it could be useful.

A lot of MR research sequences are NOT used in clinical practice because of time constraints and limited contribution to patient care above standard sequences. Again, just because we CAN do something doesn't always mean we SHOULD.

Keep thinking critically though!

 

[DrfluffyMD]

It is indeed 'not an illness'. Although sometimes it can be considered pathological. I was just going by the literature ... which mentions MRI.
It seems it is considered 'too expensive' for clinical use. Which is why radiologists generally don't know about it

'I am also unsure if there is any intervention for too much visceral fat besides going on a good diet (and watch calorie intake) as well as exercise' Taking away the cause of the increase. Which is not always laziness or eating too much. So from my perspective it makes sense to quantify things, but that MRI is not a practical way to measure that seems settled. But it's almost (?) the gold standard according to the literature.

As a last and final question and mostly out of curiosity, would you actually be able to see the different visceral fat depots of visceral fat (wiki) 'Visceral fat is composed of several adipose depots, including mesenteric, epididymal white adipose tissue (EWAT), and perirenal depots.' on a regular MRI with the naked eye ?

I am familiar with some genetic syndromes that contribute to central obesity as well as medication use such as steroid intake.

Generally speaking, in the vast majority of people, calorie intake more than energy expenditure lead to deposit of fat.

Most radiologists aren't familiar with precise fat quantification because unlike iron quantification, there really isn't a clinical utility to quantify fat with MR, especially when there are other methods available.

To the OP, if money is not a problem you should try to discuss with radiologists in countries that are open to concierge service. Although to be warned, magnet time is very expensive and we could be looking at a study cost at least thousands of USD

 

[newdoc2013]

Fat is generally liked by radiologists because it adds tissue contrast. We (semi) quantify fat when deposited in the liver using opposed phase imaging. This isn't the technique you'd want to use for OPs interest but simple T1/T2 fat sat would work well. One thing to consider in patients undergoing MRI for fat measurement is dielectric effect and table weight limits.

I think it would be interesting to see if quantification (or semi quantification - mild, moderate, large volume) correlated with metabolic syndrome or adverse cardiovascular outcomes. I bet it would. Especially when weighted against SQ fat. I don't know if it is in the radiology literature.

If there is a very strong correlation, it would be interesting but (probably) not interesting enough for my to put at the impression level for all patients:

IMPRESSION:
3.0 cm LI-RADS 5 HCC in segment 7.
Large volume central obesity. Correlate with laboratory values and exam findings exclude metabolic syndrome.

That just doesn't have a great ring to it and its already diagnosed so well clinically (and cheaply) i don't think imaging has a role. Maybe Im wrong. Let the OP do the study!

 

[DrfluffyMD]

It seems that OP wants a study evaluating for a specific anatomical parameter typically not obtained in clinical medicine because it's deemed low impact in management making.

Typically, central obesity is diagnosed by exam, and my understanding of treatment toward obesity is that you can subdivide people into rough categories and precise measurement won't change management.

OP clearly has the right to desire their (or their friend's) anatomical parameter but it will be a commerical service negotiated between him and an interested party, not under insurance. He will have to pay the magnet time and the radiologist's time out of pocket.

 

[BRC2]

I just looked around, and noticed that the Analyze software used in one study comes with a free trial ! (Analyze 12.0 - AnalyzeDirect) It looks like I could do that myself / the local company supplies a result on DVD or CD. But I doubt if I could make sense of that (MRI) without relevant training or if a doc would take it seriously !

 

[DrfluffyMD]

I just looked around, and noticed that the Analyze software used in one study comes with a free trial ! (Analyze 12.0 - AnalyzeDirect) It looks like I could do that myself / the local company supplies a result on DVD or CD. But I doubt if I could make sense of that (MRI) without relevant training or if a doc would take it seriously !

You will not be able to make sense of the MRI without training, nor can you get a scan without a radiologist. You NEED to work with a radiologist on this.

 

[BRC2]

It would be incredibly difficult to find a concierge service (in Germany or elsewhere in Europe). Googling didn't yield any results.

I once learned to read a CT scan, but obviously only up to a point.

 

[DrfluffyMD]

It would be incredibly difficult to find a concierge service (in Germany or elsewhere in Europe). Googling didn't yield any results.

I once learned to read a CT scan, but obviously only up to a point.

I am sorry to hear that. What you request require specialized knowledge and isn't really something you can teach yourself or do yourself. If you aren't able to obtain opinion from an interested physician it would be difficult.

 

[BRC2]

While I expect it would be too expensive, I'm interested in a concierge service.
It's easy to find something in the USA. For example, Research Concierge Service – MRI/MRS Facility , Magnetic Resonance Imaging | Johns Hopkins Radiology (I'm not sure if this one counts).

But in Europe ? A search for MRI and 'concierge service' doesn't yield any results. Of course I could attempt to translate that to other languages ...
But is there any particular type of institution that would likely be able and ready to provide such services ? Other key phrases might yield results. Let's keep in mind, the only European countries that have English as their official language are Ireland and the UK.

Yet I wonder, if I could get an 'ordinary' MRI abdomen on CD or DVD locally: could I have it 'analyzed' in one of those institutions in the USA ? Otherwise the only remaining option is likely DEXA.

 

[DrfluffyMD]

While I expect it would be too expensive, I'm interested in a concierge service.
It's easy to find something in the USA. For example, Research Concierge Service – MRI/MRS Facility , Magnetic Resonance Imaging | Johns Hopkins Radiology (I'm not sure if this one counts).

But in Europe ? A search for MRI and 'concierge service' doesn't yield any results. Of course I could attempt to translate that to other languages ...
But is there any particular type of institution that would likely be able and ready to provide such services ? Other key phrases might yield results. Let's keep in mind, the only European countries that have English as their official language are Ireland and the UK.

Yet I wonder, if I could get an 'ordinary' MRI abdomen on CD or DVD locally: could I have it 'analyzed' in one of those institutions in the USA ? Otherwise the only remaining option is likely DEXA.

If you have an experimental sequence, it's best if the facility performing it is also the facility analyzing it.

I am not sure if the MR research lab is the one you are looking for. Your best bet is to email around private practice and academic radiology departments and see if they can work with you on your request.

 

[BRC2]

@DrfluffyMD,

Thanks.

If I may ask, are you an MD in radiology ?

Ayway, the only other local alternatives are DEXA (2.5 hours drive) and the MRI in Germany (drive of about 30 miles). I take it that if I had any other issues ('pathologies') they would show up on that MRI. Fatty liver too ? I'm not sure where the fat is at.
That German service also offers a DEXA scan, but they use it for osteoporosis. My guess is that it would take some doing to set it up for scanning visceral fat/body composition ?

 

[DrfluffyMD]

@DrfluffyMD,

Thanks.

If I may ask, are you an MD in radiology ?

Ayway, the only other local alternatives are DEXA (2.5 hours drive) and the MRI in Germany (drive of about 30 miles). I take it that if I had any other issues ('pathologies') they would show up on that MRI. Fatty liver too ? I'm not sure where the fat is at.
That German service also offers a DEXA scan, but they use it for osteoporosis. My guess is that it would take some doing to set it up for scanning visceral fat/body composition ?

MD in radiology but the advice I am given here is not medical advice. You seem to have a specific research request and like I said, you gotta talk to the indivdual physicians who are willing to help you with protocoling, performing and analyzing this exam on their magnet.

 

[BRC2]

You will not be able to make sense of the MRI without training, nor can you get a scan without a radiologist. You NEED to work with a radiologist on this.

Just a quick question: I once had a CT abdomen, years ago. Up to a point, I could read the CT scan. Would it be harder to read an MRI abdomen ?

Obviously I cannot read a scan like a radiologist could. Still looking ...

 

[DrfluffyMD]

Just a quick question: I once had a CT abdomen, years ago. Up to a point, I could read the CT scan. Would it be harder to read an MRI abdomen ?

Obviously I cannot read a scan like a radiologist could. Still looking ...

Not sure how to answer this question. "Reading a scan" means to interpret it by a radiologist or a trained physician.

If by "reading" you mean you can understand the images and the organ system behind it, I supposed if someone point out a liver to you by an arrow you can perhaps see for yourself that it's a liver.

The chance of you, as an untrained person, discovering something not previously discovered by a qualified radioloigst, thus completing a "read" or "overread" is essential zero.

As far as I know, when a radiologist complete a clinical exam, an interpretation is always made.

This is the reason why i don't expect to waltz into a 747 cockpit and know how to fly the plane or how to operate a lifting crane. I am not trained in it.

But by all mean you are encourged to look at those images. I think MRI images look a lot less sensical compared to a CT to an untrained eye.