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Noncontrast Chest Computed Tomographic Imaging of Obesity and the Metabolic Syndrome

Part II Noncardiovascular Findings

Nattenmüller, Johanna MD*,†; Schlett, Christopher L. MD*,†; Tsuchiya, Nanae MD, PhD‡,§; Reeder, Scott B. MD, PhD§,∥,¶,#,**; Pickhardt, Perry J. MD§; Kramer, Harald MD††; Kauczor, Hans-Ulrich MD*,†; Wielpütz, Mark O. MD*,†; Seo, Joon B. MD, PhD‡‡,§§,∥∥,¶¶,##,***; Hatabu, Hiroto MD, PhD, FACR†††; van Beek, Edwin J.R. MD, PhD‡‡‡; Schiebler, Mark L. MD§ Representing the International Workshop for Pulmonary Functional Imaging (IWPFI)

doi: 10.1097/RTI.0000000000000393

The purpose of this review article is to acquaint the reader with the current state of the art for the noncardiovascular imaging biomarkers of metabolic syndrome found on noncontrast computed tomography (NCCT) of the chest and their prognostic significance. Routine chest NCCT includes quantitative information with regard to tissue density and organ volumes in the neck, chest, and upper abdomen. The specific imaging biomarkers that may be seen in association with metabolic syndrome include low thyroid iodine organification, hepatic steatosis, sarcopenia (muscle volume and density), demineralization of the thoracic and upper lumbar vertebral bodies, loss of axial skeletal muscle mass, premature lung inflammation, and an increased deposition of subcutaneous and visceral fat. These easily identified imaging biomarkers can have prognostic implications, which include nonalcoholic steatohepatitis, cirrhosis, hypothyroidism, early lung fibrosis with interstitial abnormalities, sarcopenia, and osteoporotic thoracic and lumbar spine vertebral body compression fractures. NCCT examinations of the chest have the opportunity to become an important imaging tool for outcomes research.

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

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

††Department of Radiology, Ludwig Maximillian University, Munich, Germany

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

Departments of §Radiology


Biomedical Engineering

#Medical Physics

**Emergency Medicine, University of Wisconsin-Madison, Madison, WI

‡‡University of Ulsan College of Medicine

***Medical Imaging and Intelligent Reality Laboratory (MI2RL), Research Institute of Radiology, University of Ulsan College of Medicine, Ulsan

§§Department of Radiology, Division of Cardiothoracic Radiology, Asan Medical Center

∥∥Planning Division, Biomedical Engineering Research Center, Asan Institute for Life Sciences

¶¶Artificial Intelligence for Medical Imaging R&D Center, Asan Institute for Life Sciences

##Medical Imaging Development Group, Biomedical Engineering Research Center, Asan Institute for Life Sciences, Seoul, South Korea

†††Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA

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

Supported by NHLBI-U10 HL109168-04.

M.L.S.: Shareholder in Stemina Biomarkers Inc. and Healthmyne Inc. The remaining authors declare no conflicts of interest.

Correspondence to: Mark L. Schiebler, MD, Radiology, UW-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252 (e-mail:

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