The Clinical Value and Appropriateness Criteria of Upper Abdominal Magnetic Resonance Examinations in Patients Before and After Bariatric Surgery: a Study of 837 Images

Purpose: The abdominal magnetic resonance (MR) examinations have been increasingly applied in patients with obesity. However, few studies analyzed the appropriateness of this examination. This study is aimed to evaluate the feasibility and clinical value of upper abdominal MR in quantification of visceral/subcutaneous adipose tissue (VAT/SAT) and liver fat fraction (LFF) in patients before and after bariatric surgery.

Methods: All patients who underwent bariatric surgery from November 2017 to November 2019 in the prospectively maintained, IRB-approved database of our institution were queried. The images of all MR studies were retrospectively reviewed and analyzed.

Results: In total, 570 patients with 837 upper abdominal MR examinations were analyzed. The VAT/SAT can be clearly visualized and quantified on fat liver acquisition with volume acceleration-flexible (LAVA-Flex) sequence. The present rate of a single axial slice at the level of the L1-L2 intervertebral disc was 93.1% (779/837). The LFF could be quantitatively evaluated on all of the proton density fat fraction (PDFF) maps (100%, 837/837). Occasional findings may include cholelithiasis, cysts, hepatic hemangioma, and renal angiomyolipoma, which can be clearly diagnosed by MR.

Conclusion: The upper abdominal MR is featured by well feasibility and clear clinical value when applying in patients with obesity. We can use the results to do clinical research and evaluate obesity-related disease risks before and after surgery, thus providing suggestions to choose the type of surgery for patients with different risk levels in the future. MR scanning including fat LAVA-Flex images with the inclusion of L1-L2 level and PDFF measurements is suggested for the VAT/SAT/LFF quantification.

Trial registration: NCT03520699.

Keywords: Adipose tissue; Bariatric surgery; Liver fat fraction; MR; Obesity.