Organ distribution bias in chest computed tomography scans: A methodological pitfall for visceral adipose tissue measurement

The assessment of body composition using chest computed tomography (CT) scans is often performed at the level of the twelfth thoracic vertebra (T12) as an alternative to the third lumbar vertebra (L3) reference point. Based on personal observations and data from the literature, we highlight here (1) the significant variability in organ distribution at the T12 level and (2) the potential impact of this variability on the measurement of visceral adipose tissue. Unlike the reference method at L3, body composition analysis at T12 is therefore more susceptible to organs distribution-related bias, indicating that measurements made at T12 should be interpreted with caution and suggesting the need for an alternative method for reliably determining body composition from chest CT scans.