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Morrison, 1995) and may re ect visceral fat mass more closely than WHR (Pouliot et al., 1994), but neither measure distinguishes between accumulations of deep visceral or subcutaneous abdominal fat; this requires the imaging techniques described below. Waist circumference and/or WHR should therefore be recorded routinely in obese patients. The waist circumference is generally measured using a horizontal tape at the midpoint between the iliac crest and the lower rib margin at the end of gentle expiration (Figure 15.3), and the hip circumference at the level of the greater trochanters (Klein et al., 2007). Training and attention to detail are important to ensure consistent readings. Waist circumference or WHR can be used to stratify risk and guide management (see Table 15.11), and both are adequate in routine clinical practice. Waist circumference is useful in patients with a BMI of up to 35 kg/m2, but seems to add little to the risk prediction

Figure 9-4 Consolidated storage accessed by server using network protocols such as NFS, CIFS, and HTTP.

Table 8-1: (continued)

Multiple sclerosis (MS) is a progressive neurological disease affecting myelin pathways in the brain. Multiple lesions in the white matter can cause paralysis and severe motor disabilities of the affected patient. Symptoms are changes in sensation, visual problems, muscle weakness, and depression. Currently MRI T1 and FLAIR pulse sequences are used for radiological diagnosis. In these images MS appears as multiple white lesions in the white matter area of the brain. MRI is also used to follow up and monitor the progress of the disease and the effectiveness of therapy after the patient is treated with drugs. Since MRI provides excellent delineation of MS, it is fairly easy for radiologists to make the diagnosis. However, due to the possibility of a large number of multiple lesions in the MRI 3-D volume set of the brain, it is tedious and time-consuming to identify the 3-D aspect of each lesion and quantify the number and size of these lesions. Moreover the quantitative reproducibility through human observers is poor. Augmenting CAD with imaging informatics methods, a 3-D CAD MS package would facilitate the physician s timely diagnosis, improve accuracy, and assess quantitatively the progress of therapy treatment.

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