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Noncontrast Chest Computed Tomographic Imaging of Obesity and the Metabolic Syndrome

Part I Cardiovascular Findings

Schlett, Christopher L. MD, MPH*,†,‡; Nattenmüller, Johanna MD*,†; Tsuchiya, Nanae MD, PhD§,∥; Vogel-Claussen, Jens MD; Kauczor, Hans-Ulrich MD*,†; Levin, David MD, PhD#; Hatabu, Hiroto MD, PhD, FACR**; Estépar, Jose R. MD††; Wu, Ming-Ting MD‡‡,§§; van Beek, Edwin J.R. MD, PhD∥∥; Schiebler, Mark L. MD Representing the International Workshop for Pulmonary Functional Imaging (IWPFI)

doi: 10.1097/RTI.0000000000000391

There are physiological consequences of overeating that can lead to increased morbidity and mortality. The purpose of this review article is to acquaint the reader with the current state of the art in the non–cardiac-gated, noncontrast chest computed tomographic (NCCT) imaging biomarkers of the metabolic syndrome and their prognostic significance found in the lower neck and chest. NCCT imaging biomarkers associated with metabolic syndrome in the chest include premature coronary artery calcification, acceleration of large vessel arterial and valvular calcifications associated with atherosclerosis, and pulmonary arterial enlargement from pulmonary hypertension associated with sleep apnea. These easily identified imaging biomarkers have prognostic implications for major adverse cardiac events (MACE). These NCCT chest-imaging biomarkers are likely targets for artificial intelligence algorithms to harvest for longitudinal assessment of their individual and multifactorial contributions to chronic disease, MACE, and mortality. Early recognition and treatment of these common disorders may help improve patient outcomes and quality of life while decreasing medical costs.

*Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg

Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg

Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg

Department of Radiology, University Hospital Hannover, Hannover, Germany

§Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan

Department of Radiology, University of Wisconsin-Madison, Madison, WI

#Department of Radiology, Mayo Clinic, Rochester, MN

Departments of **Radiology

††Pulmonary Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA

‡‡Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung

§§Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

∥∥Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

The authors declare no conflicts of interest.

Correspondence to: Mark L. Schiebler, MD, UW-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792 (e-mail:

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