Authors
Christian J Mertens, Hartmut Häntze, Sebastian Ziegelmayer, Jakob Nikolas Kather, Daniel Truhn, Su Hwan Kim, Felix Busch, Dominik Weller, Benedikt Wiestler, Markus Graf, Fabian Bamberg, Christopher L Schlett, Jakob B Weiss, Steffen Ringhof, Elif Can, Jeanette Schulz-Menger, Thoralf Niendorf, Jacqueline Lammert, Isabel Molwitz, Avan Kader, Alessa Hering, Aymen Meddeb, Jawed Nawabi, Matthias B Schulze, Thomas Keil, Stefan N Willich, Lilian Krist, Martin Hadamitzky, Anke Hannemann, Florian Bassermann, Daniel Rueckert, Tobias Pischon, Alexander Hapfelmeier, Marcus R Makowski, Keno K Bressem, Lisa C Adams
Published in
Communications medicine. Volume 6. Issue 1. Aug 29, 2026. Epub Aug 29, 2026.
Abstract
Body mass index fails to capture variation in fat and muscle distribution that determines metabolic health and disease risk. MRI enables radiation-free quantification of regional body composition, yet scalable open-source tools applied in pooled cohorts with differing acquisition protocols have been lacking.
MRSegmentator, an open-source nnU-Net-based pipeline, was applied to quantify visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (ASAT), gluteofemoral adipose tissue (GFAT), trunk musculature, and the liver mask used for liver fat-fraction estimation in 45,851 adults from the German National Cohort (n = 26,877, 3 T multi-centre Siemens) and UK Biobank (n = 18,974, 1.5 T Siemens). Population-scale compartment volumes were segmented from stitched in-phase gradient-echo (GRE) images in both cohorts; liver fat fraction was calculated from fat-only and water-only images. The annotated development data comprised NAKO T2-HASTE and UKB Dixon reconstructions. A single pooled model was applied without site-specific adaptation. A separate two-reader agreement study used 50 scans from these annotated development-sequence domains. Associations between BMI-adjusted body composition and cardiometabolic conditions were estimated using generalized linear mixed-effects models. Incremental discrimination beyond age, BMI, and waist-to-hip ratio was assessed.
Five-fold participant-stratified internal cross-validation against curated human-in-the-loop development references comprising UKB Dixon and NAKO T2-HASTE yielded a mean Dice of 0.91. In a separate 50-scan reader study on these annotated development-sequence images, overall reader-reader Dice was 0.937 and overall algorithm-reader Dice was 0.908. The trained pipeline was then used to segment compartment volumes from stitched in-phase GRE inputs in both cohorts, while liver fat fraction was calculated from fat-only and water-only images; direct sequence-matched validation on NAKO GRE was not performed. VAT showed the strongest positive associations with cardiometabolic conditions, while GFAT showed inverse associations, most prominently for type 2 diabetes (OR 0.69, 95% CI 0.66 to 0.72). Disease-specific body-composition phenotypes were identified, with type 2 diabetes characterized by elevated VAT, reduced GFAT, and increased liver fat. MRI-derived compartments modestly improved discrimination for type 2 diabetes and hyperlipidemia beyond anthropometric measures.
A single open-source deep-learning pipeline enabled pooled body-composition phenotyping in two cohorts and captured distributional variation in fat and muscle beyond BMI. High agreement in internal cross-validation (mean Dice 0.91) and the separate two-reader study support the annotated development-sequence analysis, while the population-scale application identified distinct disease-associated phenotypes and modest incremental discrimination beyond conventional anthropometry.
PMID:
42668286
Bibliographic data and abstract were imported from PubMed on 30 Aug 2026.
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