Daphne J. Theodorou

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Accurate classification of obesity levels is of clinical importance for public health and decision making. Body mass index (BMI) is the most broadly used measure of obesity on a population scale. But, as with other diagnostic indicators, BMI can have potential pitfalls. We attempted to explore the diagnostic performance of BMI for assessing obesity. 330 healthy Caucasian women (native Greeks) (ages, 20 to 85 years) volunteers participated in the study. Dual-energy X-ray absorptiometry (DXA) was used to measure percentage of fat mass (%FM). The diagnostic performance of BMI was assessed using the widely used indicator for obesity of %FM > 35% in women. Receiver operating characteristic (ROC) analysis was performed to evaluate the ability of BMI to discriminate obesity from non obesity. The correlation between BMI and %FM, and lean mass (LM) and %LM, was also investigated. Logistic regression was performed to assess for associations between DXA-derived fat metrics and age. BMI-defined obesity (≥ 30 kg/m ² ) was present in 40.3% of women, while %FM DXA-defined obesity was present in 72% of the subjects. The largest discrepancy between BMI- and DXA-defined obesity was noted in women over 80 years (p = 0.0002). A BMI ≥ 30 kg/m ² had excellent sensitivity [99%, 95% confidence interval (CI), 95.8–99.9], but poor specificity [45%, 95% CI 38–52] to detect %FM-based obesity. BMI ≥ 25 kg/m ² had high sensitivity (92%, 95% CI 87.5–94.8) and good specificity (79%, 95% CI 68.7–86.6). The optimal cut point for BMI in the entire cohort found to correspond closer to the criterion value of 35%FM was 26.32 kg/m ² (p < 0.001). At this level, BMI had excellent sensitivity (96.7%, 95% CI 93.3–98.6) and moderate specificity (71.5%, 95% CI 62.4–79.5). In all women, BMI correlated better with %FM (r = 0.74 to 0.84, p < 0.05) than with %LM (r= −0.68 to −0.86, p < 0.05). Logistic regression analysis found age was a significant predictor of obesity (OR = 1.074, 95% CI 1.036–1.114, p < 0.05), increasing odds for excess adiposity by 7.4% each year. The diagnostic performance of BMI for assessing obesity is limited particularly in women with BMI ≥ 30 kg/m ² . A BMI cut point ≥ 30 kg/m ² has very high sensitivity, but misclassifies as obese 55% of normal women. At the BMI cut off ≥ 25 kg/m ² sensitivity was high, but 21% of women were still misclassified as obese. A BMI cut point value of 26.32 kg/m ² has higher sensitivity and falsely classifies as obese 28% of the women. In light of these findings, revision of current BMI criteria for obesity screening may be warranted in white women of Mediterranean origin such as Greek women, and perhaps other populations.

Ultrasound (US) equipped with high-frequency linear transducers is a convenient, first-line imaging modality for evaluating a wide spectrum of musculoskeletal abnormalities. In complex cases, the US findings may need to be correlated with findings on the magnetic resonance (MR) imaging studies to generate an accurate diagnosis. Periosteal chondroma is a rare, benign bone surface tumor arising from the periosteum. The lesions are composed of hyaline cartilage and tend to be small, superficial, and slow-growing. Despite an indolent clinical course, this neoplasm may cause scalloping of the outer bone cortex, necessitating detailed imaging investigation to rule out malignancy. Interestingly, the imaging appearances of periosteal chondroma may overlap with those of chondrosarcoma, and in addition, the histological differentiation of these tumors can be difficult. Sporadic cases of MR imaging findings in periosteal chondroma have been published; however, the usefulness of US in diagnosing surface-based bone tumors has not been adequately studied. In this illustrated case, we describe the US features of periosteal chondroma, emphasizing the versatile role of US for diagnosing a tumor of the bone surface, and the correlation with MR imaging findings.

The "tumbling gallstone sign" is a diagnostic imaging finding described on radiologic examinations of the abdomen, in patients with cholelithiasis associated with intermittent episodes of gallstone obstructive ileus. Best seen on serial radiographs or CT studies of the abdomen, this sign indicates a sudden change in position of the gallstone(s) within the intestinal lumen from the upper segments of the bowel to the lower segments of the bowel, causing transient mechanical bowel obstruction. The tumbling gallstone sign has been likened to that of the classic childrens' tumbling tower balancing game. On repeat CT scans, the dislodged gallstone(s) may be seen proceeding distally and impact in the ileum at a level lower than that seen on the previous CT scans, analogous to the tumbling gallstone sign.

As the global population of older persons increases, age-related medical conditions will have a greater impact on public health. DXA-derived bone and soft tissue metrics are associated with adverse clinical events in aging persons. This study aims to investigate the regional body composition of the appendices by whole-body DXA scans, and the age-related relationships between measures of bone and soft tissue in healthy Caucasian females of a Greek origin residing in the Mediterranean area. Body composition of the legs and the arms was analyzed, and lean mass (LM) and fat mass (FM) metrics were calculated in 330 women aged 20–85 years, using DXA. Peak bone mineral density (BMD) of the legs and arms was achieved between ages 20–30 and 41–50 years, respectively. The overall BMD reduction with age was for the legs 43% and the arms 32.2% (p < 0.001). Peak %LM of the legs and the arms was achieved between ages 20–30. The overall reduction of %LM with age was for the legs 22.5% (p < 0.001) and arms 6.6% (p < 0.05). Peak %FM of the legs and arms was attained between ages 31–40 and 61–70, respectively. The overall %FM reduction with age was for the legs and arms 7.5% and 1.9% (p > 0.05). In appendicular sites, Greek women reach peak values of bone mass in the legs first, in early adulthood. Bone loss predominates in the legs as women age. Also, with advancing age Greek women show preferential significant decreases of %LM and %FM in the legs as opposed to the arms. Although variation in appendicular bone and soft tissue metrics is present, the implications of variable biological crosstalks among the tissue components as women age may ultimately lay the foundation for future clinical trials aimed at healthy aging.