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

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

Publication History

Received: 27 January 2020

Accepted: 21 June 2020

Article published online:
12 August 2020

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