Total body fat content and fat topography are associated differently with in vivo glucose metabolism in nonobese and obese nondiabetic women.

In this study, total body fat content and fat topography were related to glucose metabolism in the basal and insulin-stimulated states in 18 nonobese and 18 obese premenopausal nondiabetic women. All subjects received a euglycemic insulin (20 mU.min-1.m2) clamp study in combination with [3-3H]-D-glucose infusion and indirect calorimetry to quantitate total body glucose uptake, glucose oxidation, and nonoxidative glucose disposal. Total body fat content was determined with tritiated water, whereas body fat distribution was estimated from the WHR, the STR, and the VSR (measured by magnetic resonance imaging). In the postabsorptive state, total body glucose utilization, glucose oxidation, and nonoxidative glucose disposal rates were similar in nonobese and obese women, whereas during the insulin clamp all three metabolic parameters were reduced significantly in the obese group. In nonobese women, total body fat content was related inversely to both total and nonoxidative glucose disposal during the insulin clamp, whereas no relationship was found between glucose metabolism (total, oxidative, and nonoxidative) and WHR, STR, or VSR. In contrast, in obese women, no relationship was observed between total body fat content and any measure of insulin-mediated glucose metabolism. However, both WHR and VSR were related inversely to total, oxidative, and nonoxidative glucose disposal rates during the insulin clamp. These results suggest that total body fat content and body fat topography are associated differently with insulin-mediated glucose metabolism in nonobese and obese women. In the nonobese women, total body fat mass appears to be a primary determinant of tissue sensitivity to insulin, whereas in obese women, body fat topography exerts a more dominant effect.

Is it possible to derive a reliable estimate of human visceral and subcutaneous abdominal adipose tissue from simple anthropometric measurements?

The aim of the study was to generate equations predicting visceral (VAT) and subcutaneous (SAT) abdominal adipose tissue (AT) from simple anthropometric measurements. Magnetic resonance imaging (MRI) was used to measure VAT and SAT cross-sectional areas at the level of L4 in 49 subjects (19 men and 30 women) with a large range of age and body mass index (BMI). BMI, waist and hip circumferences, waist to hip ratio (WHR), subscapular and paraumbilical skinfolds (i.e., "simple" anthropometric measurements), total body fat content by the isotope-dilution method, and abdominal sagittal diameter by MRI (i.e., "nonsimple" anthropometric measurements) were also measured. Equations to estimate VAT and SAT from age and simple anthropometric measurements (i.e., excluding total body fat and abdominal sagittal diameter) were developed. These equations were then used in 24 subjects (nine men and 15 women) to cross-validate them. The best regression equations, including waist circumference in men and waist circumference and age in women, explained 56% and 68% of VAT variability, respectively. The corresponding standard error of the estimate (SEE) in men was approximately 40% and in women approximately 37% of the mean value of VAT measured by MRI. The best regression equations developed to predict SAT had a higher explained variability (approximately 87% in both men and women) and a lower SEE (< 20% of the mean values of SAT measured by MRI). In men, the equation included BMI and hip circumference, and in women, BMI and age. The inclusion of a higher number of simple anthropometric parameters in the predictive models neither significantly increased the explained variability of VAT or SAT nor significantly decreased the SEE of VAT or SAT. Also, inclusion in the multiple regression analysis of total body fat content and abdominal sagittal diameter did not improve prediction. In the cross-validation study, differences between predicted and observed values of VAT were large, with a tendency to overestimation in both men and women. In contrast, differences between predicted and observed values of SAT were small. We suggest that SAT but not VAT can be estimated from age and simple anthropometric measurements. Direct methods (MRI, computed tomography [CT], or other options) should be used for assessment of VAT.

A geometric model for measurement of surface distance, surface area, and volume from tomographic images.

Surface area and volume are essential measurements in the morphometric assessment of anatomical structures. New algorithms were developed to measure (1) distance along a curve, (2) surface area, and (3) volume using data extracted from tomographic images as a geometrical surface model. The model is a list of coordinates and normal vectors for each voxel or point gathered from the surface of a selected object. The resulting surface-based pointlist is also used for high-speed rendering of surfaces. Differential arclength and surface area are measured with high numeric precision by using the absolute value of the maximum component of the unit normal vector (MUNC) to approximate their values. These differential values are summed to measure distance along a curve and surface area. A discrete form of the Divergence theorem, also using the MUNC, is used to calculate volume. The intrinsic accuracy of the measurement algorithms was evaluated using computer generated pointlists of circles, ellipses, spheres, and ellipsoids. Compared to standard measurement techniques, the new algorithms provided the greatest accuracy and least shape-related bias for measurement of distance, surface area, and volume. Feasibility of using the new algorithms to measure physical objects was tested with CT images of spherical, egg-shaped, and irregular shaped objects. The Dividing Cubes algorithm was used to segment and create pointlists from the CT data. Volume and surface area measurements from CT data compared extremely well with reference values for most objects tested (errors less than 2%).

Evaluation of new algorithms for the interactive measurement of surface area and volume.

The maximum unit normal component (MUNC) method used for surface area measurement and the divergence theorem algorithm (DTA) used for volume measurement were evaluated. The accuracy and precision of these methods were investigated at varying signal-to-noise ratios (SNRs), sampling, spatial averaging, and orientation. The accuracy of the MUNC measured surface area, as indicated by the mean error, was 2.0% for seven spherical samples, with SNRs ranging from 5:1 to 39:1. The precision, as indicated by the percent coefficient of variation (% CV) for these samples, was less than 3.0%. Likewise, the accuracy and precision of the DTA measured volume for these samples were both less than 1.0%. MUNC surface area measurement from 23 samples of a computed tomography (CT) image of a wooden sphere (51.44-mm diameter) with x,y voxel size ranging from 1 to 10 mm and z voxel size ranging from 2 to 14 mm yielded an accuracy of 1.3% and a precision of 2.2%. The DTA volume measurements from 18 samples of the wooden sphere with x,y vowel size ranging from 1 to 8 mm and z size ranging from 2 to 14 mm provided an accuracy of 1.2% and a precision of 1.8%. Measurement of surface area for a cylindrical rod scanned by CT in five different orientations, ranging from along each axis to between all three axes, yielded an accuracy of 3.7% and a precision of 2.0%. The volume of the cylindrical rod measured by the DTA method for these orientations produced an accuracy of 4.0% and a precision of 3.7%. The volume measured by DTA compared well with the volume measured by a modified voxel counting method. The MUNC surface area method was superior to counting surface voxels. The accuracy and precision for five interactive surface area and volume measurements, using paired cut planes to select subsets of a computer-generated sphere with radius 25 pixels, were both less than 1.0%.

Microcomputed tomography: an advanced system for detailed endodontic research.

This study evaluated the value of microcomputed tomography (MCT) for use in endodontic research. Four periodontally involved highly calcified maxillary first molars were extracted and then scanned for evaluation by a MCT system. The teeth were then instrumented, and 2 of the 4 obturated before rescanning for comparison evaluation. Several capabilities of the MCT to advance endodontic research significantly were observed: the ability of the MCT to present accurately the external and internal morphologies of the tooth without tooth destruction; the possibility of showing changes over time in surface areas and volumes of tissues; the ability to assess area and volume changes after instrumentation or obturation; and the capability of evaluating canal transportation following instrumentation or instrumentation and obturation. The tremendous potential of this scientific tool was discussed.

Virtual laryngoscopy.

Virtual endoscopy enables computer-generated 3-dimensional visualization of a cavity by reconstructing 2-dimensional computed tomographic or magnetic resonance data. The technique has been used experimentally to study the colon, bronchi, ears, and other structures. Here, virtual laryngoscopies were created from the cross-sectional image data of 3 patients. The cases represented a normal airway, a squamous cell carcinoma of the glottic fold, and a posterior glottic stenosis. These reconstructions included extraluminal anatomy that is not typical of current virtual endoscopic techniques. The 2-dimensional computed tomographic and magnetic resonance images of the patients underwent post-processing for 3-dimensional reconstruction. The resulting models were imported into an experimental virtual endoscopy program for 1) airway lumen generation and 2) interactive viewing. Though they could not be used for biopsy, the virtual laryngoscopies provided, in a noninvasive fashion, good simulation of endoscopy. Virtual endoscopy also gave the added benefits of the ability to assess the transmural extent of disease and view the airway distal to areas of luminal compromise. This technology may well provide clinical benefit in preoperative planning, staging, and intraprocedural guidance for head and neck disease and merits further study.

SU-E-I-100: Feasibility Study of Gamma-Ray Medical Radiography.

PURPOSE: The purpose of this research is to study an alternative technique to conventional x-ray radiography that requires less patient radiation dose, less cost, portable, requires less maintenance, and less power consumption. This research explores the feasibility of using gamma-ray radiography in medical imaging. Gamma-ray medical radiography has the potential to provide alternative diagnostic medical information to X-ray radiography. METHODS: Approximately one Ci of Am-241 radioactive source which emits monoenergetic 59.5 KeV gamma rays was used in this study. Several factors that influence this feasibility were studied. These were the radiation source uniformity, image uniformity, image quality parameters such as contrast, noise, and spatial resolution. In addition, visual assessment of several human phantom gamma-ray and x-ray images were conducted. The images were recorded on computed radiography image receptors and displayed on a standard monitor. RESULTS: The radioactive source provided a relatively uniform radiation exposure and uniform images. Image noise was mainly dependent on the exposure time and the source size. Although the contrast depended on the window and level setting, it was also dependent on the exposure time and the source size. Spatial resolution was dependent on the source size and the magnification. The generated gamma-ray images were of lower quality than the X-ray images which was mainly due to the low radioactivity used. However, the gamma-ray images displayed most of the main structures contained in the humanoid phantoms. CONCLUSIONS: Thisresearch explored the feasibility of using gamma-ray radiography in medical imaging and showed that gamma-ray medical radiography has the potential to provide alternative diagnostic medical information to X-ray radiography. Finally, this research also paves the way for the usage and production of high radioactive Am-241 source that will show high quality medical gamma-ray radiography is feasible.

Measurement of abdominal fat with T1-weighted MR images.

The cross-sectional area of visceral and subcutaneous fat in the abdomen was measured with T1-weighted spin-echo images acquired with a 1.5-T magnetic resonance (MR) imager. Four axial images centered on L-4 were acquired in each patient. Outline regions of interest (ROIs) were drawn manually for subcutaneous and visceral fat. The subcutaneous fat cross-sectional area was calculated from the ROIs drawn around the outer and inner margins of subcutaneous fat. Several adaptive processing methods were evaluated for measuring fat in the complex structure of the viscera. These methods were compared with an existing MR imaging measurement method for abdominal fat in 18 patients. The adaptive method that uses the valley between the fat and nonfat distributions in the average histogram curve was judged best for research evaluations because it reduces the effects of volume averaging while using a more natural division between fat and nonfat data. Another adaptive method that yielded comparable measurements was thought to be more suitable for clinical applications. Cross-sectional area measurements of abdominal fat were compared in 18 nonobese and 17 obese women to illustrate the utility of these measurements.