Measuring visceral fat with water-selective suppression methods (SPIR, SPAIR) in patients with metabolic syndrome

We attempted to measure the area and volume of visceral fat using magnetic resonance (MR) imaging to avoid radiation exposure. We used water suppression-spectral attenuation with inversion recovery (WS-SPAIR) as prepulses and conducted T(1) high-resolution isotropic volume examination (THRIVE). Image processing software can be used to estimate the area and volume of fat and separate the fat and water signals at a visually optimal threshold in the MR image, which requires contrast enhancement between intestinal contents and visceral fat. In 14 volunteers, we evaluated WS-SPAIR and water suppression-spectral presaturation with inversion recovery (WS-SPIR) with respect to the relationship between the flip angle of THRIVE and signal contrast. We used flip angles of 5 degrees, 10 degrees, and 20 degrees. The minimum threshold that allowed exclusion of intestinal contents from the masked region was determined for each technique. The volume and area of the masked region, which included subcutaneous fat, were measured at the umbilicus level. Both volume and area increased with a smaller flip angle. The masked region was larger with WS-SPIR-THRIVE (flip angle 5 degrees ). The size of the masked region was determined according to the minimum threshold that allowed exclusion of the intestinal contents from the masked region, expressing the contrast between the intestinal contents and fat in a relative manner. It was speculated that by separating the signals at the threshold, WS-SPIR-THRIVE (flip angle 5 degrees) was a more suitable technique for measuring the area and volume of visceral fat.