title: Anatomical and CT approach of the adipose tissue: application in morbid obesity.
abstract: OBJECTIVE
  The importance and proportion of visceral adipose tissue (VAT) represent the best criterion to define obesity. Because VAT value is difficult to obtain in clinical practice, the indication for bariatric surgery is still based at present on Body Mass index (BMI), even though BMI is a poor predictor of obesity-related morbid complications. This correlation study aimed at determining a simple and accurate computed tomography (CT) anatomic marker, which can be easily used clinically, well correlated with the volume of VAT and consequently with morbid complications.
  
  
  METHODS
  We studied 108 CT scans of patients presenting with morbid obesity. Several simplified measures (external and internal abdominal diameters and circumferences) were conducted on CT scan view, going through the fourth lumbar vertebra (L4), in addition to various vertebral measurements (area of the vertebra, sagittal and transversal diameters), VAT and subcutaneous adipose tissue (SAT). Then, we reported the simplified measures values on the vertebral areas, and we calculated the Bertin index. Finally, we conducted a correlation study between all variables to obtain accurate VAT measurements.
  
  
  RESULTS
  The internal abdominal circumference and the Bertin index showed the best correlations with VAT in morbidly obese patients (r = 0.84 and 0.85, respectively). BMI and anthropometric measures were not correlated with VAT.
  
  
  CONCLUSIONS
  CT scan study allows to simply approximate VAT value in morbidly obese patients. An abdominal CT scan could be part of the tests used in the evaluation of obese patients to base therapeutic strategies on VAT values and not on BMI as it is the case today.
authors.affiliation: Department of Anatomy, Faculté de Médecine de Reims, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France. yrenard@chu-reims.fr.|Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France. yrenard@chu-reims.fr.
authors.forename: Yohann
authors.initials: Y
authors.lastname: Renard
authors.affiliation: Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France.
authors.forename: Anna
authors.initials: A
authors.lastname: Diaz Cives
authors.affiliation: Department of General, Digestive and Metabolic Surgery, Ambroise Pare University Hospital, Université Versailles Saint-Quentin, Assistance Publique-Hôpitaux de Paris, 9, Avenue Charles de Gaulle, 92100, Boulogne, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Veyrie
authors.affiliation: Department of General, Digestive and Metabolic Surgery, Ambroise Pare University Hospital, Université Versailles Saint-Quentin, Assistance Publique-Hôpitaux de Paris, 9, Avenue Charles de Gaulle, 92100, Boulogne, France.
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Bouillot
authors.affiliation: Department of Diabetology, Nutrition, and Metabolism, Robert-Debré University Hospital, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Bertin
authors.affiliation: Department of Anatomy, Faculté de Médecine de Reims, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Labrousse
authors.affiliation: Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France.
authors.forename: Reza
authors.initials: R
authors.lastname: Kianmanesh
authors.affiliation: Department of Anatomy, Faculté de Médecine de Reims, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France.|Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Avisse
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000000981:diagnostic imaging*; D011860:Radiography, Abdominal; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Body fat distribution; Body mass index; Cross-sectional studies; Intra-abdominal fat; Obesity; Tomography, X-ray computed