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

Disclosures The authors have none

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

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

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

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

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

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

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

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

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

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)

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

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

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

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

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

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