Magnetic Resonance Imaging of Diverticular Disease and its Association with Adipose Tissue Compartments and Constitutional Risk Factors in Subjects from a Western General Population

Corinna Storz; Susanne Rospleszcz; Esther Askani; Theresa Rothenbacher; Jakob Linseisen; Helmut Messmann; Carlo N. De Cecco; Jürgen Machann; Lena Sophie Kiefer; Stefanie Elser; Wolfgang Rathmann; Annette Peters; Christopher L. Schlett; Fabian Bamberg

doi:10.1055/a-1212-5669

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Table of Contents

Rofo 2021; 193(01): 33-41
DOI: 10.1055/a-1212-5669

Abdomen

Magnetic Resonance Imaging of Diverticular Disease and its Association with Adipose Tissue Compartments and Constitutional Risk Factors in Subjects from a Western General Population

Zusammenhang zwischen Divertikulose mittels Magnetresonanztomografie Körperfettkompartimenten und konstitutionellen Risikofaktoren in einem westlichen Normalkollektiv

Corinna Storz

¹Department of Neuroradiology, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany

,

Susanne Rospleszcz

²Institute of Epidemiology, Helmholtz Centre Munich, German Research Center for Environmental Health, Neuherberg, Germany

,

Esther Askani

³Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Freiburg, Germany

,

Theresa Rothenbacher

⁴Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany

,

Jakob Linseisen

⁵Chair of Epidemiology, Ludwig-Maximilians University of Munich, UNIKA-T Augsburg, Augsburg, Germany

⁶IRG Clinical Epidemiology, Helmholtz Centre Munich, German Research Center for Environmental Health, Neuherberg, Germany

,

Helmut Messmann

⁷Department of Internal Medicine III, Klinikum Augsburg, Augsburg, Germany

,

Carlo N. De Cecco

⁸Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA

,

Jürgen Machann

⁹Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany

¹⁰Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tuebingen, Germany

¹¹German Center for Diabetes Research (DZD), Tuebingen, Germany

,

Lena Sophie Kiefer

⁴Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany

,

Stefanie Elser

⁴Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany

,

Wolfgang Rathmann

¹²Department of Biometry and Epidemiology, German Diabetes Center, Duesseldorf, Germany

,

Annette Peters

²Institute of Epidemiology, Helmholtz Centre Munich, German Research Center for Environmental Health, Neuherberg, Germany

¹³German Center for Cardiovascular Disease Research (DZHK e. V.), Munich, Germany

¹⁴Institute for Cardiovascular Prevention, Ludwig-Maximilians-University-Hospital, Munich, Germany

¹⁵Chair of Epidemiology, Ludwig-Maximilians-University, Munich, Germany

,

Christopher L. Schlett

³Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Freiburg, Germany

,

Fabian Bamberg

³Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Freiburg, Germany

› Author Affiliations

Abstract

Purpose To determine the association of asymptomatic diverticular disease as assessed by magnetic resonance imaging (MRI) with adipose tissue compartments, hepatic steatosis and constitutional risk factors within a cohort drawn from a Western general population.

Materials and Methods Asymptomatic subjects enrolled in a prospective case-control study underwent a 3 Tesla MRI scan, including an isotropic VIBE-Dixon sequence of the entire trunk. The presence and extent of diverticular disease were categorized according to the number of diverticula in each colonic segment in a blinded fashion. The amount of visceral, subcutaneous, and total adipose tissue (VAT, SAT, and TAT) was quantified by MRI. Additionally, the degree of hepatic steatosis, indicated as hepatic proton density fat fraction (hepatic PDFF) was determined using a multi-echo T1w sequence. Constitutional cardiometabolic risk factors were obtained and univariate and multivariate associations were calculated.

Results A total of 371 subjects were included in the analysis (58.2 % male, 56.2 ± 9.2 years). Based on MRI, 154 participants (41.5 %) had diverticular disease with 62 cases (17 %) being advanced diverticular disease. Subjects with advanced diverticular disease had a significantly higher body mass index (BMI) (BMI: 29.9 ± 5.1 vs. 27.5 ± 4.6, p < 0.001; respectively). Furthermore, all adipose tissue compartments were increased in subjects with advanced diverticular disease (e. g. VAT: 6.0 ± 2.8 vs. 4.2 ± 2.6 and SAT: 9.2 ± 3.6 vs. 7.8 ± 3.6, all p < 0.001, respectively). Similarly, subjects with advanced diverticular disease had significantly higher hepatic PDFF (4.9 [2.7, 11.4] vs. 6.1 [5.5, 14.6], p = 0.002).

Conclusion Advanced diverticular disease is associated with an increased volume of adipose tissue compartments and BMI, which may suggest a metabolic role in disease development.

Key Points:

Diverticular disease is associated with constitutional risk factors such as BMI.
Excess of adipose tissue compartments and hepatic steatosis are associated with the prevalence of diverticular disease.
Our results suggest a shared pathological pathway of cardiometabolic alterations and the prevalence of diverticular disease.
MRI is feasible for the assessment of adipose tissue compartments, hepatic steatosis, and diverticular disease and allows identification of patients who are at risk but in an asymptomatic disease state.

Citation Format

Storz C, Rospleszcz S, Askani E et al. Magnetic Resonance Imaging of Diverticular Disease and its Association with Adipose Tissue Compartments and Constitutional Risk Factors in Subjects from a Western General Population. Fortschr Röntgenstr 2021; 193: 33 – 41

Zusammenfassung

Ziel Ziel dieser Studie war es, den Zusammenhang zwischen asymptomatischer Divertikulose und Körperfettkompartimenten, Hepatosteatose sowie konstitutionellen Risikofaktoren, erhoben mittels Magnetresonanztomografie (MRT), in einem westlichen Normalkolletkiv zu untersuchen.

Material und Methoden Gesunde, asymptomatische Teilnehmer wurden in eine prospektive Fall-Kontroll-Studie eingeschlossen und mittels 3-Tesla-Ganzkörper-MRT untersucht. Anhand einer isotropen VIBE-Dixon-Sequenz des Abdomens wurden das Ausmaß einer Divertikulose (Anzahl der Divertikel pro Kolonsegment) sowie das Volumen des viszeralen, subkutanen und totalen Fettgewebes (VAT, SAT und TAT) bestimmt. Zusätzlich wurde der Grad einer Hepatosteatose (hepatic proton density fat fraction (hepatic PDFF)) mittels einer Multiecho-T1w-Sequenz ermittelt. Konstitutionelle kardiometabolische Risikofaktoren wurden erhoben und univariate und multivariate Analysen durchgeführt.

Ergebnisse Insgesamt wurden 371 Teilnehmer in die Analyse eingeschlossen (58,2 % Männer; 56,2 ± 9,2 Jahre alt). Basierend auf den MRT-Ergebnissen hatten 154 Probanden (41,5 %) eine Divertikulose, 62 (17 %) eine fortgeschrittene Divertikulose. Probanden mit fortgeschrittener Divertikulose hatten im Vergleich zu Probanden ohne Divertikulose einen höheren BMI (BMI: 29,9 ± 5,1 vs. 27,5 ± 4,6; p < 0,001). Alle Fettkompartimente waren bei Teilnehmern mit fortgeschrittener Divertikulose erhöht (bspw. VAT: 6,0 ± 2,8 vs. 4,2 ± 2,6 und SAT: 9,2 ± 3,6 vs. 7,8 ± 3,6, jeweils p < 0,001). Ebenfalls wurde eine signifikant höhere Hepatosteatose bei Teilnehmern mit fortgeschrittener Divertikulose gefunden (hepatic PDFF: 4,9 (2,7, 11,4] vs. 6,1 (5,5, 14,6); p = 0,002).

Schlussfolgerung Die fortgeschrittene Divertikulose geht signifikant mit höheren metabolischen Fettgewebsveränderungen, insbesondere vermehrten Körperfettkompartimenten und erhöhten BMI-Werten einher. Dies lässt einen metabolischen Pathomechanismus in der Entstehung der Divertikulose vermuten.

Kernaussagen:

Das Vorhandensein einer Divertikulose ist mit konstitutionellen Risikofaktoren (bspw. BMI) assoziiert.
Vermehrte Körperfettmengen und Hepatosteatose sind mit einer Divertikulose assoziiert.
Unsere Ergebnisse lassen einen geteilten Pathomechanismus durch kardiometabolische Veränderungen und das Vorhandensein einer Divertikulose vermuten.
Die MRT ermöglicht die Erfassung von Körperfettkompartimenten, einer Hepatosteatose sowie einer Divertikulose und ermöglicht somit eine Identifikation von Risikofaktoren in einem asymptomatischen Krankheitsstatus.

Key words

epidemiology - diverticular disease - abdomen - MRI - metabolic Disorders

Full Text

References

References
1 Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology 2009; 136: 741-754 . doi:10.1053/j.gastro.2009.01.015
2 Wang FW, Chuang HY, Tu MS. et al Prevalence and risk factors of asymptomatic colorectal diverticulosis in Taiwan. BMC Gastroenterol 2015; 15: 40 . doi:10.1186/s12876-015-0267-5
3 Peery AF, Keku TO, Martin CF. et al Distribution and Characteristics of Colonic Diverticula in a United States Screening Population. Clin Gastroenterol Hepatol 2016; 14: 980-985, e981 . doi:10.1016/j.cgh.2016.01.020
4 Crowe FL, Appleby PN, Allen NE. et al Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians. BMJ 2011; 343: d4131 . doi:10.1136/bmj.d4131
5 Strate LL, Liu YL, Aldoori WH. et al Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology 2009; 136: 115-122, e111 . doi:10.1053/j.gastro.2008.09.025
6 Usai P, Ibba I, Lai M. et al Cigarette smoking and appendectomy: effect on clinical course of diverticulosis. Dig Liver Dis 2011; 43: 98-101 . doi:10.1016/j.dld.2010.05.008
7 Feuerstein JD, Falchuk KR. Diverticulosis and Diverticulitis. Mayo Clin Proc 2016; 91: 1094-1104 . doi:10.1016/j.mayocp.2016.03.012
8 Faucheron JL, Roblin X, Bichard P. et al The prevalence of right-sided colonic diverticulosis and diverticular haemorrhage. Colorectal Dis 2013; 15: e266-270 . doi:10.1111/codi.12137
9 Yamamichi N, Shimamoto T, Takahashi Y. et al Trend and risk factors of diverticulosis in Japan: age, gender, and lifestyle/metabolic-related factors may cooperatively affect on the colorectal diverticula formation. PLoS One 2015; 10: e0123688 . doi:10.1371/journal.pone.0123688
10 Storz C, Rothenbacher T, Rospleszcz S. et al. Characteristics and associated risk factors of diverticular disease assessed by magnetic resonance imaging in subjects from a Western general population. Eur Radiol 2018;
11 Kopylov U, Ben-Horin S, Lahat A. et al Obesity, metabolic syndrome and the risk of development of colonic diverticulosis. Digestion 2012; 86: 201-205 . doi:10.1159/000339881
12 Hjern F, Wolk A, Hakansson N. Obesity, physical inactivity, and colonic diverticular disease requiring hospitalization in women: a prospective cohort study. Am J Gastroenterol 2012; 107: 296-302 . doi:10.1038/ajg.2011.352
13 Holle R, Happich M, Lowel H. et al KORA – a research platform for population based health research. Gesundheitswesen 2005; 67 (Suppl. 01) S19-25 . doi:10.1055/s-2005-858235
14 Bamberg F, Hetterich H, Rospleszcz S. et al. Subclinical Disease Burden as Assessed by Whole-Body MRI in Subjects With Prediabetes, Subjects With Diabetes, and Normal Control Subjects From the General Population: The KORA-MRI Study. Diabetes 2017; 66: 158-169
15 [Anonym]. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i–xii, 1-253
16 De Cecco CN, Ciolina M, Annibale B. et al Prevalence and distribution of colonic diverticula assessed with CT colonography (CTC). Eur Radiol 2016; 26: 639-645 . doi:10.1007/s00330-015-3866-1
17 Storz C, Heber SD, Rospleszcz S. et al The role of visceral and subcutaneous adipose tissue measurements and their ratio by magnetic resonance imaging in subjects with prediabetes, diabetes and healthy controls from a general population without cardiovascular disease. The British Journal of Radiology 2018; 0: 20170808 . doi:10.1259/bjr.20170808
18 Lorbeer R, Rospleszcz S, Schlett CL. et al. Correlation of MRI-derived adipose tissue measurements and anthropometric markers with prevalent hypertension in the community. Journal of hypertension 2018; 36: 1555-1562
19 Lorbeer R, Bayerl C, Auweter S. et al. Association between MRI-derived hepatic fat fraction and blood pressure in participants without history of cardiovascular disease. Journal of hypertension 2017; 35: 737-744
20 Peery AF. Recent Advances in Diverticular Disease. Curr Gastroenterol Rep 2016; 18: 37 . doi:10.1007/s11894-016-0513-1
21 Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. Br Med J 1971; 2: 450-454
22 Wijarnpreecha K, Ahuja W, Chesdachai S. et al Obesity and the Risk of Colonic Diverticulosis: A Meta-analysis. Dis Colon Rectum 2018; 61: 476-483 . doi:10.1097/DCR.0000000000000999
23 Nagata N, Sakamoto K, Arai T. et al Visceral Abdominal Obesity Measured by Computed Tomography is Associated With Increased Risk of Colonic Diverticulosis. J Clin Gastroenterol 2015; 49: 816-822 . doi:10.1097/MCG.0000000000000267
24 Reddy SK, Zhan M, Alexander HR. et al Nonalcoholic fatty liver disease is associated with benign gastrointestinal disorders. World J Gastroenterol 2013; 19: 8301-8311 . doi:10.3748/wjg.v19.i45.8301
25 Ma J, Hwang SJ, Pedley A. et al Bi-directional analysis between fatty liver and cardiovascular disease risk factors. J Hepatol 2017; 66: 390-397 . doi:10.1016/j.jhep.2016.09.022
26 Targher G, Day CP, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med 2010; 363: 1341-1350 . doi:10.1056/NEJMra0912063
27 Yazici C, Arslan DC, Abraham R. et al Breath Methane Levels Are Increased Among Patients with Diverticulosis. Dig Dis Sci 2016; 61: 2648-2654 . doi:10.1007/s10620-016-4174-6
28 Weaver GA, Krause JA, Miller TL. et al Incidence of methanogenic bacteria in a sigmoidoscopy population: an association of methanogenic bacteria and diverticulosis. Gut 1986; 27: 698-704 . doi:10.1136/gut.27.6.698
29 Basseri RJ, Basseri B, Pimentel M. et al. Intestinal methane production in obese individuals is associated with a higher body mass index. Gastroenterol Hepatol (NY) 2012; 8: 22-28
30 Ouchi N. Adipocytokines in Cardiovascular and Metabolic Diseases. J Atheroscler Thromb 2016; 23: 645-654 . doi:10.5551/jat.34918
31 Matsuzawa Y. Therapy Insight: adipocytokines in metabolic syndrome and related cardiovascular disease. Nat Clin Pract Cardiovasc Med 2006; 3: 35-42 . doi:10.1038/ncpcardio0380