1. Radiological Society of North America
Body Composition Changes at Computed Tomography After Left Gastric Artery Embolization in Overweight and Obese Individuals
Edwin A. Takahashi, Naoki Takahashi, Christopher J. Reisenauer, Michael R. Moynagh, Sanjay Misra
Radiological Society of North America
2018
test

2. Disclosures
The authors have none

3. Introduction
Left gastric artery embolization (LGAE) has been recognized for inducing weight loss
Ongoing studies investigating the efficacy as a bariatric procedure
Limited data on the effect of LGAE on body composition
CT is a validated technology for assessing body composition

4. Purpose
Characterize CT body composition changes in overweight and obese individuals who underwent LGAE

5. Methods and Materials IRB approval was obtained
Retrospective single institution study
Evaluate CT body composition before and after LGAE

6. Methods and Materials
All patients who underwent LGAE for gastric bleeding between 1/2006 and 3/2018 were reviewed
89 patients were identified
Exclusion criteria
Incomplete medical history
Unavailable imaging
Interval surgery
Active malignancy
BMI <25 kg/m2

7. Complete medical history and imaging
LGAE patients, n=89
Excluded, n=61
Incomplete medical history
Unavailable imaging
Interval surgery
Active malignancy
LGAE patients, n=28
Complete medical history and imaging
Excluded, n=12
BMI <25 kg/m2
LGAE group, n=16

8. Embolization Technique
Right groin access
5F catheter advanced into celiac artery
Selective catheterization of left gastric artery with microcatheter
Embolization to stasis
7 polyvinyl alcohol (PVA)
5 coil
1 PVA+coil
1 Gelfoam+coil
2 Gelfoam only

9. Body composition analysis
Abdominal CT body composition analyzed at L1, L3 and L5 levels
Semi-automated imaging processing algorithms used to determine body composition
MATLAB 13.0 software
Tissue attenuation thresholds
Adipose tissue
-190 to -30 HU
Skeletal muscle
-29 to +150 HU

10. Body composition analysis
VF = visceral fat
SM = skeletal muscle
SF = subcutaneous fat

11. Body composition analysis
Measured parameters
Body weight
Excess body weight
Body mass index
Body fat index
Subcutaneous fat index
Visceral fat index
Intramuscular fat index
Skeletal muscle index

12. Body composition analysis
Excess body weight (EBW)
Determined using Lorentz formula for ideal
body weight
For males:
Ideal body weight = (height [cm]−100)−([height (cm) – 150]/4)
For females:
Ideal body weight = (height [cm]−100)−([height (cm) – 150]/2)

13. Statistical analysis
Changes in weight and CT body composition was calculated
Wilcoxon signed-rank test or paired t-test based on normality of the distributions

14. Results Patients Mean age: 57.6 ± 12.9 years Females: 7 (44%)
Interval between CT scans: 1.5 ± 0.8 months

15. Results Pre-LGAE Post-LGAE % Change P Body weight, mean (SD), kg
87.9(12.5)
82.3(13.9)
-6.4
0.003
Body mass index, mean (SD), kg
30.0(4.3)
28.1(4.9)
-6.3
0.005
Excess body weight, mean (SD), kg
23.3(10.6)
17.7(12.6)
-24.1
Total body fat index, mean (SD), cm2/m2
128.6(54.6)
123.9(59.5)
-3.7
0.03
Subcutaneous fat index, mean (SD), cm2/m2
81.7(44.5)
78.4(43.7)
-4.1
Visceral fat index, mean (SD), cm2/m2
35.8(17.8)
34.3(21.6)
-4.2
0.13
Intramuscular fat index, mean (SD), cm2/m2
10.2(4.8)
10.1(4.7)
-1.6
0.83
Skeletal muscle index, mean (SD), cm2/m2
44.5(7.2)
41.5(6.9)
-6.9
<0.001

16. Discussion
The decrease in tissue mass correlating to weight loss does not necessarily occur symmetrically throughout the body
Body composition with CT may be a useful surrogate for weight loss after LGAE
Assess lean tissue loss
Highlights the importance of nutritional monitoring after LGAE

17. Conclusion
Patients who underwent LGAE for gastric bleeding had significant weight loss from decreased abdominal fat and lean skeletal muscle
Body composition analysis can readily assess the extent of desired fat loss, as well as identify unintended muscle wasting, which can then be managed appropriately

18. Thank you