• Alexander Valentinitsch, Dimitrios C Karampinos, Hamza Alizai, Karupppasamy Subburaj, Deepak Kumar, Thomas M Link, and Sharmila Majumdar.
• Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA. alexander.valentinitsch@meduniwien.ac.at
• J Magn Reson Imaging. 2013 Apr 1; 37 (4): 917-27.

PurposeTo introduce and validate an automated unsupervised multi-parametric method for segmentation of the subcutaneous fat and muscle regions to determine subcutaneous adipose tissue (SAT) and intermuscular adipose tissue (IMAT) areas based on data from a quantitative chemical shift-based water-fat separation approach.Materials And MethodsUnsupervised standard k-means clustering was used to define sets of similar features (k = 2) within the whole multi-modal image after the water-fat separation. The automated image processing chain was composed of three primary stages: tissue, muscle, and bone region segmentation. The algorithm was applied on calf and thigh datasets to compute SAT and IMAT areas and was compared with a manual segmentation.ResultsThe IMAT area using the automatic segmentation had excellent agreement with the IMAT area using the manual segmentation for all the cases in the thigh (R(2): 0.96) and for cases with up to moderate IMAT area in the calf (R(2): 0.92). The group with the highest grade of muscle fat infiltration in the calf had the highest error in the inner SAT contour calculation.ConclusionThe proposed multi-parametric segmentation approach combined with quantitative water-fat imaging provides an accurate and reliable method for an automated calculation of the SAT and IMAT areas reducing considerably the total postprocessing time.Copyright © 2012 Wiley Periodicals, Inc.

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