Obesity and Musculoskeletal Imaging

Improving Western socioeconomic standards combined with the adoption of a ‘Western diet’ have led to both an improved life expectancy and increased individual morbidity due to increasing levels of obesity. This alteration in a patient’s body habitus has led to multiple difficulties arising for clinicians trying to investigate and image these cohorts. The larger size and weight of some such patients create an immediate physical barrier to accessing some modalities, most notably fitting into the bore aperture of a magnetic resonance imaging (MRI) machine or being too heavy for the standard radiographic imaging table in most departments. There is a further concern for radiologists that imaging modalities may produce suboptimal images unless further alterations are made: such as increasing the dosing of ionising radiation in radiographs and computed tomography (CT) scans, a weakening of the signal-to-noise ratio in MRI producing poorer quality images and not forgetting the extreme complexity of taking an ultrasound on a patient with high levels of sound-reflecting adipose tissue. That said, the industry has adapted to this population change and new modern modifications have been made to allow satisfactory quality imaging to be obtained. An unforeseen benefit to higher levels of visceral fat is that it isolates and highlights individual organs well on CT scans aiding diagnostic evaluation. The developing use of imaging to help in the management and treatment of obese patients, DEXA scans, CT scans and whole-body MRIs are being used to assess total body fat.