Adipose tissue composition determines its computed tomography radiodensity

Amani Zoabi, Einav Bentov-Arava, Adan Sultan, Anna Elia, Ori Shalev, Marina Orevi, Ofer N. Gofrit, Katherine Margulis*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: Adipose tissue radiodensity in computed tomography (CT) performed before surgeries can predict surgical difficulty. Despite its clinical importance, little is known about what influences radiodensity. This study combines desorption electrospray ionization mass spectrometry imaging (DESI-MSI) and electrospray ionization (ESI) with machine learning to unveil how chemical composition of adipose tissue determines its radiodensity. Methods: Patients in the study underwent abdominal surgeries. Before surgery, CT radiodensity of fat near operated sites was measured. Fifty-three fat samples were collected and analyzed by DESI-MSI, ESI, and histology, and then sorted by radiodensity, demographic parameters, and adipocyte size. A non-negative matrix factorization (NMF) algorithm was developed to differentiate between high and low radiodensities. Results: No associations between radiodensity and patient age, gender, weight, height, or fat origin were found. Body mass index showed negative correlation with radiodensity. A substantial difference in chemical composition between adipose tissues of high and low radiodensities was observed. More radiodense tissues exhibited greater abundance of high molecular weight species, such as phospholipids of various types, ceramides, cholesterol esters and diglycerides, and about 70% smaller adipocyte size. Less radiodense tissue showed high abundance of short acyl-tail fatty acids. Conclusions: This study unveils the connection between abdominal adipose tissue radiodensity and its chemical composition. Because the radiodensity of the fat around the surgical site is associated with surgical difficulty, it is important to understand how adipose tissue composition affects this parameter. We conclude that fat tissue with a higher content of various phospholipids and waxy lipids is more CT radiodense. Clinical relevance statement: This study establishes the connection between the CT radiodensity of adipose tissue and its chemical composition. Clinicians may use this information for preoperative planning of surgical procedures, potentially modifying their surgical approach (for example, performing partial nephrectomy openly rather than laparoscopically). Key Points: • Adipose tissue radiodensity values in computed tomography images taken prior to the surgery can potentially predict surgery difficulty. • Fifty-three human specimens were analyzed by advanced mass spectrometry, molecular imaging, and machine learning to establish the key features that determine Hounsfield units’ values of adipose tissue. • The findings of this research will enable clinicians to better prepare for surgical procedures and select operative strategies. Graphical abstract: (Figure presented.).

Original languageAmerican English
Pages (from-to)1635-1644
Number of pages10
JournalEuropean Radiology
Issue number3
Early online date1 Sep 2023
StatePublished - Mar 2024

Bibliographical note

Publisher Copyright:
© The Author(s), under exclusive licence to European Society of Radiology 2023.


  • Adipose tissue
  • Computed tomography
  • Mass spectrometry
  • Molecular imaging
  • Radiodensity


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