A total of 190 participants were enrolled (mean age, 60.4 ± 14.8 years). Ninety patients (47.4%) met OAB criteria. The mean age in the OAB group was higher than that in the non-OAB group (non-OAB group, 54.2 ± 15.2 years; OAB group, 67.4 ± 10.9 years; P < 0.001). In addition, the mean body weight in the OAB group was significantly higher than that in the non-OAB group (non-OAB group, 54.5 ± 10.2 Kg; OAB group, 57.6 ± 13.0 Kg; P = 0.035). However, the mean BMI was not significantly different between two groups (non-OAB group, 22.2 ± 3.5 Kg/m2; OAB group, 22.9 ± 4.7 kg/m2; P = 0.265). On abdominal CT, the non-OAB and OAB groups were significantly different in the VFA (73.8 ± 5.8 cm2 vs 112.1 ± 71.3 cm2, respectively; P < 0.001), VFA/SFA ratio (0.53 ± 0.29 vs 1.07 ± 0.97, respectively; P < 0.001), VFV (1860.8 ± 1234.5 cm3 vs 3167.3 ± 2269.9 cm3, respectively; P < 0.001), VFV/SFV ratio (0.52 ± 0.28 vs 1.55 ± 3.81, respectively; P = 0.008), and VFV/TAV ratio (32.5 ± 10.6 vs 49.7 ± 14.3, respectively; P < 0.001). In addition, among the evaluated imaging factors, the VFV/TAV ratio had the strongest correlation to the total OABSS (r = 0.464, P < 0.001). In the receiver-operating characteristic curve for the VFV/TAV ratio and OAB, the area under the curve was 0.836. A sensitivity and specificity of 0.591 and 0.810, respectively, were obtained using a cutoff value of 0.591. Furthermore, a high VFV/TAV ratio (> 0.591) was an independent risk factor of OAB in the multivariate analysis (odds ratio, 4.66; 95% confidence interval, 1.03–33.2, P = 0.045), which included age, sex, VFV/TAV ratio, and high blood pressure, as these factors were significantly associated with OAB in the univariate analyses.