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Cardiovascular Disease and Adiposity / Liver Disease Diagnosis and Treatment · Journal article
Journal of Magnetic Resonance Imaging · August 12, 2026
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This prospective MRI study in 81 obese children demonstrates heterogeneous intra-organ fat distribution using automated segmentation: hepatic fat is higher in the right lobe and increases away from the portal vein, while pancreatic fat concentrates in body and tail. Hepatic but not pancreatic fat correlates with triglycerides and apolipoprotein B, suggesting distinct metabolic origins, though correlations between liver and pancreatic fat are weak (r 0.29–0.38) and pancreatic fat shows no association with insulin resistance markers.
Prospective observational cohort study. Eighty-one pediatric patients (median age 12 [11, 13] years, 57 males) with overweight or obesity based on BMI z-score.. Intervention: MRI with automated segmentation of hepatic and pancreatic fat distribution. n = 81. Not stated.
Hepatic fat fraction significantly higher in right lobe (median 16.22%) than left lobe (median 10.43%) Hepatic fat variance increased with degree of fat deposition: Level 0 (4.10), Level 1 (11.53), Level 2 (28.94), Level 3 (31.21) Pancreatic fat fraction and variance in body and tail significantly higher than in head
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This descriptive study establishes that ectopic fat in obese children distributes heterogeneously by region and that hepatic and pancreatic fat accumulation may reflect distinct metabolic processes. The weak correlation and divergent biochemical associations suggest that single-organ fat assessment may miss important metabolic phenotyping opportunities, but these findings require replication and validation against clinical outcomes before informing clinical management.
Single-centre prospective observational study with modest sample size mapping spatial fat distribution patterns using MRI; descriptive and correlational findings without a comparator group or intervention, establishing feasibility of automated segmentation and raising questions about regional ectopic fat heterogeneity.
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This descriptive study establishes that ectopic fat in obese children distributes heterogeneously by region and that hepatic and pancreatic fat accumulation may reflect distinct metabolic processes. The weak correlation and divergent biochemical associations suggest that single-organ fat assessment may miss important metabolic phenotyping opportunities, but these findings require replication and validation against clinical outcomes before informing clinical management.
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ABSTRACT Background Ectopic fat deposition in the liver and pancreas is closely linked to metabolic dysfunction, a key driver of the global burden of chronic disease. However, studies on intra‐organ distribution of ectopic fat in the pediatric obese population remain limited. Purpose To assess MRI‐based spatial distribution patterns of hepatic and pancreatic fat using a fully automated nnU‐Net model and evaluate their association with biochemical risk markers. Study Type Prospective. Subject Eighty‐one pediatric patients (age: 12 [11, 13] years, 57 males) with overweight or obesity based on body mass index z ‐score. Field Strength/Sequence 1.5 T, gradient‐echo modified‐DIXON T 1 W. Assessment The spatial distribution of fat in liver and pancreas, the correlations between hepatic and pancreatic fat fraction (FF), and the association between the fat measures and biochemical risk markers were evaluated. Statistical Tests Paired Wilcoxon test or t ‐test, repeated measure ANOVA or Friedman's test, Kruskal–Wallis test, Spearman correlation analysis. Significance was set at p < 0.05. Results Hepatic FF was significantly higher in the right lobe (median, 16.22%) than in the left lobe (median, 10.43%), and increased with distance from the portal vein. The degree of hepatic fat heterogeneity increased with the amount of fat deposition (whole variance: Level 0: 4.10; Level 1: 11.53; Level 2: 28.94; Level 3: 31.21). Then, the FF and its variance in the pancreatic body and tail were significantly higher than those in the head. A weak but statistically significant correlation ( r range, 0.29–0.38) was observed between hepatic and pancreatic FF. Hepatic FF correlated with triglyceride and apolipoprotein B, but pancreatic fat showed no association ( p range, 0.096–0.994) with lipid profiles, HOMA‐IR, or HOMA‐β. Data Conclusion Intra‐hepatic and intra‐pancreatic fat were heterogeneously distributed in pediatric obese population. Although fat accumulation in the liver and pancreas was weakly correlated, hepatic and pancreatic fat may arise from distinct metabolic disorders. Evidence Level 2. Technical Efficacy Stage 1.
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