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Impact of Obesity on Medical Imaging and Image-Guided Intervention

Raul N. Uppot1, Dushyant V. Sahani, Peter F. Hahn, Debra Gervais and Peter R. Mueller

1 All authors: Department of Radiology, Division of Abdominal Imaging and Interventional Radiology, Harvard Medical School and Massachusetts General Hospital, 55 Fruit St., White 270, Boston, MA 02114.


Figure 1
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  		Fig. 1 —Gantry view of CT scanner. Although gantry diameter is listed as 70 cm (black line), once table enters gantry, table thickness must be accounted for and subtracts 15-18 cm from vertical height (arrow).

 

Figure 2
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  		Fig. 2 —Left upper quadrant radiograph in 31-year-old man who weighed 590 lb (268 kg) and exceeded film cassette dimensions of 14 x 17 inches (35.56 x 43.18 cm). Imaging each quadrant separately is important to obtain desired quality abdominal radiograph.

 

Figure 3
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  		Fig. 3A —57-year-old man who weighed 490 lb (223 kg). Reprinted with permission from Uppot R. How obesity hinders image quality and diagnosis in radiology. Bariatrics Today 2005; 1:31-33 (for electronic version, see [4]). Chest radiograph shows limited diagnostic quality image with poor X-ray penetration and poor visualization of lung bases.

 

Figure 4
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  		Fig. 3B —57-year-old man who weighed 490 lb (223 kg). Reprinted with permission from Uppot R. How obesity hinders image quality and diagnosis in radiology. Bariatrics Today 2005; 1:31-33 (for electronic version, see [4]). Chest radiograph in same patient after placement of grid and increase in kVp and mAs. This solution improved visualization of lung bases.

 

Figure 5
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  		Fig. 4A —55-year-old man who weighed 479 lb (218 kg) and exceeded table weight for fluoroscopy. Patient underwent barium swallow examination after gastric bypass. Abdominal radiograph in frontal plane obtained with patient standing as part of sequence shows active extravasation.

 

Figure 6
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  		Fig. 4B —55-year-old man who weighed 479 lb (218 kg) and exceeded table weight for fluoroscopy. Patient underwent barium swallow examination after gastric bypass. Lateral radiograph confirms gastrocutaneous fistula (arrow).

 

Figure 7
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  		Fig. 5A —42-year-old woman who weighed 265 lb (120 kg). Axial CT shows thickness (white line) of subcutaneous tissue ultrasound beam has to penetrate before reaching peritoneum.

 

Figure 8
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  		Fig. 5B —42-year-old woman who weighed 265 lb (120 kg). Sonogram corresponding to A. Ascites is not seen.

 

Figure 9
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  		Fig. 6A —39-year-old woman who weighed 413 lb (188 kg). Axial CT image of abdomen with fixed mAs setting resulted in increased noise. Beam-hardening artifact is visualized where patient's body exceeds field of view (arrows).

 

Figure 10
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  		Fig. 6B —39-year-old woman who weighed 413 lb (188 kg). Repeat axial CT of abdomen with equipment setting switched to automatic mAs, allowing scanner to increase mAs and thereby decrease noise.

 

Figure 11
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  		Fig. 7A —52-year-old woman who weighed 177 lb (80 kg) and had history of carcinoid. Axial CT in PET/CT study for metastasis. Image was cropped to focus on intraabdominal structures.

 

Figure 12
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  		Fig. 7B —52-year-old woman who weighed 177 lb (80 kg) and had history of carcinoid. PET portion of PET/CT, which was not cropped, shows area of 18F-FDG uptake (arrow).

 

Figure 13
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  		Fig. 7C —52-year-old woman who weighed 177 lb (80 kg) and had history of carcinoid. Uncropped axial CT image shows soft-tissue deposit corresponding to area of FDG uptake (arrow).

 

Figure 14
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  		Fig. 8A —Axial images in two patients show advantages of fat for CT evaluation. Axial CT image in 56-year-old man with extensive intraabdominal mesenteric fat shows wide separation of mesentery and internal organs, allowing better visualization of internal structures.

 

Figure 15
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  		Fig. 8B —Axial images in two patients show advantages of fat for CT evaluation. Axial CT in 28-year-old woman with paucity of intraperitoneal fat shows difficulty in visualizing mesenteric structures.

 

Figure 16
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  		Fig. 9 —T1-weighted, fat-saturated axial gadolinium-enhanced MRI in 44-year-old woman. Wraparound artifact (arrows) is seen because of small field of view. Also in areas where patient's body touches bore, there is inadequate fat saturation.

 

Figure 17
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  		Fig. 10 —Technetium-99m bone scans in 60-year-old man with suspected osteomyelitis. Photon scatter and soft-tissue attenuation limit image quality.

 

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