Diagnostyka obrazowa w zaburzeniach metabolicznych. Od metod tradycyjnych do nowoczesnych
Diagnostic imaging in metabolic disorders. From traditional to modern methods
Department of Endocrinology, Medical Center of Postgraduate Education, Bielański Hospital, Warszawa
Head of Department: prof. Wojciech Zgliczynski, MD, PhD
For ages, physicians have been strived to observe structures and functions of the human body. The great discoveries: of X-rays (in 1895) or ultrasounds (first technological application in 1917) have made possible to use these phenomena in medicine. At present, modern diagnostic departments use ultrasonography (US), radiology, computed tomography (CT), positron emission tomography (PET), single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), and other techniques for the diagnosis and control of therapy of a range of diseases. In numerous biomedical research centers efforts are made in attempt to look inside the living cells and to observe life at its molecular level. So called molecular imaging is the non-invasive technique to visualize cellular processes at a molecular or genetic level. It includes the imaging of endogenous molecules, use of activable agents that sense specific cellular processes, use of labeled particles to follow particular metabolic pathways and exploit of genetic engineering to express specific protein products.
Naturally, these techniques lend themselves to all medical fields. However, given that metabolic disorders has emerged as a growing public health problem worldwide that reached epidemic proportion use of diagnostic imaging in patients with suspected or establish metabolic problems seems to be of crucial significance. Metabolism is the complex set of chemical reactions that organism uses to maintain life, including energy production and utilization. Food, made up of proteins, carbohydrates, and fats is a fuel, that is used right away, or is transferred into energy stored in body tissues. This energy is afterwards utilize for everyday activity. A metabolic disorder occurs when abnormal chemical reactions disrupt this process.
Starting point to look into metabolic disorders may be the metabolic syndrome (MS), for the first time described by Reaven in 1993 (1). Now function different definitions of this syndrome, but according to all of them MS integrates a group of abnormalities that enhance the risk of cardiovascular diseases. Central obesity, hyperinsulinemia, dyslipidemia and hypertension are regarded as an elements of the metabolic syndrome (2).
Fig. 1. Example of the regions of interest (ROI) delimiting abdominal (A) and gynoid (B) fat in one of woman examined in author’s clinic.
The phenomenon related directly to general obesity is ectopic lipid accumulation, i.e. in organs other than white adipose tissue, such as liver, muscles or heart. At present, magnetic resonance (MRI) is thought to be the most suitable method to visualize lipids content in peripheral tissues. In this technique, aided with 1-diamentinal magnetic resonance spectroscopy (MRS) measurement of total body fat mass with subsequent three-dimensional reconstruction and quantification of various fat depots is performed. Still present limitations of this method result from difficulties in precise determining the extend of saturated and unsaturated lipids within a tissue compartment, what is very important for cardiovascular risk prediction. To overcome these limitations use of spatially resolved MRS techniques were recently proposed (4-6). MRS is an analytical technique complement the MRI in the characterization of tissues. MRI uses the information to create 2-dimensional images of the structure, while MRS uses proton signals to determine the relative concentrations of target metabolites (7).
Fig. 2. An optical sensor for visualizing insulin granulate exocytosis (10).
Fig. 3. Basic concept and applications of surface-enhanced Raman spectroscopy (10).
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