ARRS 2022 Abstracts

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1405. Macroscopic Visceral Adipose Tissue (mVAT) and Visceral Adipose Quotient (VAQ) Change Early After TIPS Placement
Authors * Denotes Presenting Author
  1. Tisileli Tuifua *; Cleveland Clinic Imaging Institute; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
  2. Sameer Gadani; Cleveland Clinic Foundation; Cleveland Clinic Imaging Institute
  3. Baljendra Kapoor; Cleveland Clinic Foundation; Cleveland Clinic Imaging Institute
  4. Shetal Shah; Cleveland Clinic Foundation; Cleveland Clinic Imaging Institute
Objective:
Early impact of transjugular intrahepatic portosystemic shunt (TIPS) placement on body composition remains unclear. We investigated the impact of TIPS on adipose and muscle tissue in cirrhotic patients at 3 months after TIPS.

Materials and Methods:
For this IRB-approved, HIPAA-compliant retrospective analysis of an institutional TIPS registry (1995–2021), contrast-enhanced CT scans were obtained up to 1 month prior to and 3 months after TIPS in cirrhotic patients. Psoas, paraspinal and core (psoas plus paraspinal) muscle area, as well as macroscopic visceral adipose tissue (mVAT) and subcutaneous adipose tissue (mSAT) areas were calculated at the third lumbar (L3) vertebral level (TeraRecon Aquarius workstation). Visceral adipose quotient (VAQ), defined as mVAT as a percentage of mVAT plus mSAT, was also determined. Impact of ascites was also considered in a sub-group analysis. Wilcoxon signed-rank or one sample t-test were utilized for statistical comparison.

Results:
Forty-nine patients (28 men; 20 women; mean age 57.7 years) met the inclusion criteria. Etiology of cirrhosis was variable (nonalcoholic steatohepatitis [12]; hepatitis B/C [10]; alcohol [10]; multifactorial [4]; biliary [3]; miscellaneous [7]; and unknown [2]). Mean psoas, paraspinal and core muscle area did not change from pre- to post-TIPS (all p > 0.05). Mean mVAT, mSAT and VAQ were 134.15 + 96.85 (standard deviation) cm2, 128.72 + 121.80 cm2, and 53.91 + 18.65% before TIPS respectively. Mean mVAT significantly decreased 21.8 + 37.69 cm2 to 112.33 + 90.97 cm2 (p = 0.0002) and VAQ decreased 7.74 + 8.57% to 46.17 + 18.58% (p < 0.0001). Reduction in mVAT was significant in patients with ascites (p = 0.0006), while the decrease in VAQ was significant in patients with (p < 0.0001) and without (p = 0.017) ascites.

Conclusion:
A statistically significant decrease in mVAT (with ascites) and VAQ (with or without ascites) was observed with no measurable change in muscle area at 3 months following TIPS. This finding necessitates investigation of underlying mechanisms and the possible impacts of adipose chage on patient outcome.