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Diagnostic imaging in the management of patients with metabolic syndrome

Published:November 02, 2017DOI:https://doi.org/10.1016/j.trsl.2017.10.009
      Metabolic syndrome (MetS) is the constellation of metabolic risk factors that might foster development of type 2 diabetes and cardiovascular disease. Abdominal obesity and insulin resistance play a prominent role among all metabolic traits of MetS. Because intervention including weight loss can reduce these morbidity and mortality in MetS, early detection of the severity and complications of MetS could be useful. Recent advances in imaging modalities have provided significant insight into the development and progression of abdominal obesity and insulin resistance, as well as target organ injuries. The purpose of this review is to summarize advances in diagnostic imaging modalities in MetS that can be applied for evaluating each components and target organs. This may help in early detection, monitoring target organ injury, and in turn developing novel therapeutic target to alleviate and avert them.

      Abbreviations:

      ASL (arterial spin labeling), BMI (body mass index), BOLD (blood oxygen level-dependent), BP (blood pressure), CAD (coronary artery disease), CIMT (carotid intima-media thickness), CT (computed tomography), D (dimensional), DCE (dynamic contrast-enhanced), DTI (diffusion tensor imaging), DWI (diffusion-weighted imaging), DXA (dual-energy x-ray absorptiometry), FDG (fluorodeoxyglucose), GFR (glomerular filtration rate), HU (Hounsfield units), IMCL (intramyocellular lipid), IVUS (intravascular ultrasound), LV (left ventricle), LVH (left ventricular hypertrophy), MetS (metabolic syndrome), MRE (magnetic resonance elastography), MRI (magnetic resonance imaging), MRS (magnetic resonance spectroscopy), MTI (magnetization-transfer imaging), NAFLD (non-alcoholic fatty liver disease), NAFPD (non-alcoholic fatty pancreatic disease), NASH (non-alcoholic steatohepatitis), OCT (optical coherence tomography), PET (positron emission tomography), PWV (pulse wave velocity), SAT (subcutaneous adipose tissue), SPECT (-photon emission computed tomography), TCD (transcranial Doppler), US (ultrasonography), VAT (visceral adipose tissue)
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      References

        • Carr D.B.
        • Utzschneider K.M.
        • Hull R.L.
        • et al.
        Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome.
        Diabetes. 2004; 53: 2087-2094
        • Mongraw-Chaffin M.
        • Foster M.C.
        • Kalyani R.R.
        • et al.
        Obesity severity and duration are associated with incident metabolic syndrome: evidence against metabolically healthy obesity from the multi-ethnic study of atherosclerosis.
        J Clin Endocrinol Metab. 2016; 101: 4117-4124
        • Nguyen N.T.
        • Magno C.P.
        • Lane K.T.
        • Hinojosa M.W.
        • Lane J.S.
        Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004.
        J Am Coll Surg. 2008; 207: 928-934
        • McKenney R.L.
        • Short D.K.
        Tipping the balance: the pathophysiology of obesity and type 2 diabetes mellitus.
        Surg Clin North Am. 2011; 91 (vii): 1139-1148
        • Kee C.C.
        • Sumarni M.G.
        • Lim K.H.
        • et al.
        Association of BMI with risk of CVD mortality and all-cause mortality.
        Public Health Nutr. 2017; 20: 1226-1234
        • Flegal K.M.
        • Kit B.K.
        • Orpana H.
        • Graubard B.I.
        Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis.
        JAMA. 2013; 309: 71-82
        • Cohen J.B.
        • Cohen D.L.
        Cardiovascular and renal effects of weight reduction in obesity and the metabolic syndrome.
        Curr Hypertens Rep. 2015; 17: 34
        • Selwyn A.P.
        Weight reduction and cardiovascular and metabolic disease prevention: clinical trial update.
        Am J Cardiol. 2007; 100: 33P-37P
        • Eckel R.H.
        • Grundy S.M.
        • Zimmet P.Z.
        The metabolic syndrome.
        Lancet. 2005; 365: 1415-1428
        • Eckel R.H.
        • Alberti K.G.
        • Grundy S.M.
        • Zimmet P.Z.
        The metabolic syndrome.
        Lancet. 2010; 375: 181-183
        • Machann J.
        • Horstmann A.
        • Born M.
        • Hesse S.
        • Hirsch F.W.
        Diagnostic imaging in obesity.
        Best Pract Res Clin Endocrinol Metab. 2013; 27: 261-277
        • Tsukiyama H.
        • Nagai Y.
        • Matsubara F.
        • et al.
        Proposed cut-off values of the waist circumference for metabolic syndrome based on visceral fat volume in a Japanese population.
        J Diabetes Investig. 2016; 7: 587-593
        • Gast K.B.
        • den Heijer M.
        • Smit J.W.
        • et al.
        Individual contributions of visceral fat and total body fat to subclinical atherosclerosis: the NEO study.
        Atherosclerosis. 2015; 241: 547-554
        • Radmard A.R.
        • Poustchi H.
        • Ansari L.
        • et al.
        Abdominal fat distribution and carotid atherosclerosis in a general population: a semi-automated method using magnetic resonance imaging.
        Jpn J Radiol. 2016; 34: 414-422
        • Pickhardt P.J.
        • Jee Y.
        • O'Connor S.D.
        • del Rio A.M.
        Visceral adiposity and hepatic steatosis at abdominal CT: association with the metabolic syndrome.
        AJR Am J Roentgenol. 2012; 198: 1100-1107
        • Albanese C.V.
        • Diessel E.
        • Genant H.K.
        Clinical applications of body composition measurements using DXA.
        J Clin Densitom. 2003; 6: 75-85
        • Hayashi T.
        • Boyko E.J.
        • Leonetti D.L.
        • et al.
        Visceral adiposity and the prevalence of hypertension in Japanese Americans.
        Circulation. 2003; 108: 1718-1723
        • Seabolt L.A.
        • Welch E.B.
        • Silver H.J.
        Imaging methods for analyzing body composition in human obesity and cardiometabolic disease.
        Ann N Y Acad Sci. 2015; 1353: 41-59
        • Kaul S.
        • Rothney M.P.
        • Peters D.M.
        • et al.
        Dual-energy X-ray absorptiometry for quantification of visceral fat.
        Obesity (Silver Spring). 2012; 20: 1313-1318
        • Choi Y.J.
        • Seo Y.K.
        • Lee E.J.
        • Chung Y.S.
        Quantification of visceral fat using dual-energy x-ray absorptiometry and its reliability according to the amount of visceral fat in Korean adults.
        J Clin Densitom. 2015; 18: 192-197
        • Bi X.
        • Seabolt L.
        • Shibao C.
        • et al.
        DXA-measured visceral adipose tissue predicts impaired glucose tolerance and metabolic syndrome in obese Caucasian and African-American women.
        Eur J Clin Nutr. 2015; 69: 329-336
        • Guo Y.
        • Franks P.W.
        • Brookshire T.
        • Antonio Tataranni P.
        The intra- and inter-instrument reliability of DXA based on ex vivo soft tissue measurements.
        Obes Res. 2004; 12: 1925-1929
        • Wagner D.R.
        Ultrasound as a tool to assess body fat.
        J Obes. 2013; 2013 (280713)
        • Shuster A.
        • Patlas M.
        • Pinthus J.H.
        • Mourtzakis M.
        The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis.
        Br J Radiol. 2012; 85: 1-10
        • De Lucia Rolfe E.
        • Sleigh A.
        • Finucane F.M.
        • et al.
        Ultrasound measurements of visceral and subcutaneous abdominal thickness to predict abdominal adiposity among older men and women.
        Obesity (Silver Spring). 2010; 18: 625-631
        • Suzuki R.
        • Watanabe S.
        • Hirai Y.
        • et al.
        Abdominal wall fat index, estimated by ultrasonography, for assessment of the ratio of visceral fat to subcutaneous fat in the abdomen.
        Am J Med. 1993; 95: 309-314
        • Stolk R.P.
        • Wink O.
        • Zelissen P.M.
        • Meijer R.
        • van Gils A.P.
        • Grobbee D.E.
        Validity and reproducibility of ultrasonography for the measurement of intra-abdominal adipose tissue.
        Int J Obes Relat Metab Disord. 2001; 25: 1346-1351
        • Kuchenbecker W.K.
        • Groen H.
        • Pel H.
        • et al.
        Validation of the measurement of intra-abdominal fat between ultrasound and CT scan in women with obesity and infertility.
        Obesity (Silver Spring). 2014; 22: 537-544
        • Ono T.
        • Taniguchi N.
        • Osawa M.
        • et al.
        The usefulness of mesenterium thickness as an index of visceral fat accumulation.
        J Med Ultrason (2001). 2003; 30: 153-161
        • Onuma T.
        • Kamishima T.
        • Sasaki T.
        • Sakata M.
        Absolute reliability of adipose tissue volume measurement by computed tomography: application of low-dose scan and minimal detectable change—a phantom study.
        Radiol Phys Technol. 2015; 8: 312-319
        • Garg K.
        • Chang S.
        • Scherzinger A.
        Obesity and diabetes: newer concepts in imaging.
        Diabetes Technol Ther. 2013; 15: 351-361
        • Ryo M.
        • Kishida K.
        • Nakamura T.
        • Yoshizumi T.
        • Funahashi T.
        • Shimomura I.
        Clinical significance of visceral adiposity assessed by computed tomography: a Japanese perspective.
        World J Radiol. 2014; 6: 409-416
        • Britton K.A.
        • Massaro J.M.
        • Murabito J.M.
        • Kreger B.E.
        • Hoffmann U.
        • Fox C.S.
        Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality.
        J Am Coll Cardiol. 2013; 62: 921-925
        • Lee Y.H.
        • Hsiao H.F.
        • Yang H.T.
        • Huang S.Y.
        • Chan W.P.
        Reproducibility and repeatability of computer tomography-based measurement of abdominal subcutaneous and visceral adipose tissues.
        Sci Rep. 2017; 7: 40389
        • Baum T.
        • Cordes C.
        • Dieckmeyer M.
        • et al.
        MR-based assessment of body fat distribution and characteristics.
        Eur J Radiol. 2016; 85: 1512-1518
        • Schick F.
        • Eismann B.
        • Jung W.I.
        • Bongers H.
        • Bunse M.
        • Lutz O.
        Comparison of localized proton NMR signals of skeletal muscle and fat tissue in vivo: two lipid compartments in muscle tissue.
        Magn Reson Med. 1993; 29: 158-167
        • Machann J.
        • Thamer C.
        • Schnoedt B.
        • et al.
        Standardized assessment of whole body adipose tissue topography by MRI.
        J Magn Reson Imaging. 2005; 21: 455-462
        • Klopfenstein B.J.
        • Kim M.S.
        • Krisky C.M.
        • Szumowski J.
        • Rooney W.D.
        • Purnell J.Q.
        Comparison of 3 T MRI and CT for the measurement of visceral and subcutaneous adipose tissue in humans.
        Br J Radiol. 2012; 85: e826-e830
        • Al-Radaideh A.
        • Tayyem R.
        • Al-Fayomi K.
        • et al.
        Assessment of abdominal fat using high-field magnetic resonance imaging and anthropometric and biochemical parameters.
        Am J Med Sci. 2016; 352: 593-602
        • Vogt L.J.
        • Steveling A.
        • Meffert P.J.
        • et al.
        Magnetic resonance imaging of changes in abdominal compartments in obese diabetics during a low-calorie weight-loss program.
        PLoS ONE. 2016; 11: e0153595
        • Kahn S.E.
        • Hull R.L.
        • Utzschneider K.M.
        Mechanisms linking obesity to insulin resistance and type 2 diabetes.
        Nature. 2006; 444: 840-846
        • Pan D.A.
        • Lillioja S.
        • Kriketos A.D.
        • et al.
        Skeletal muscle triglyceride levels are inversely related to insulin action.
        Diabetes. 1997; 46: 983-988
        • Phillips D.I.
        • Caddy S.
        • Ilic V.
        • et al.
        Intramuscular triglyceride and muscle insulin sensitivity: evidence for a relationship in nondiabetic subjects.
        Metabolism. 1996; 45: 947-950
        • Howald H.
        • Boesch C.
        • Kreis R.
        • et al.
        Content of intramyocellular lipids derived by electron microscopy, biochemical assays, and (1)H-MR spectroscopy.
        J Appl Physiol. 2002; 92: 2264-2272
        • Sinha R.
        • Dufour S.
        • Petersen K.F.
        • et al.
        Assessment of skeletal muscle triglyceride content by (1)H nuclear magnetic resonance spectroscopy in lean and obese adolescents: relationships to insulin sensitivity, total body fat, and central adiposity.
        Diabetes. 2002; 51: 1022-1027
        • Krssak M.
        • Falk Petersen K.
        • Dresner A.
        • et al.
        Intramyocellular lipid concentrations are correlated with insulin sensitivity in humans: a 1H NMR spectroscopy study.
        Diabetologia. 1999; 42: 113-116
        • Bredella M.A.
        • Ghomi R.H.
        • Thomas B.J.
        • Miller K.K.
        • Torriani M.
        Comparison of 3.0 T proton magnetic resonance spectroscopy short and long echo-time measures of intramyocellular lipids in obese and normal-weight women.
        J Magn Reson Imaging. 2010; 32: 388-393
        • Roden M.
        Muscle triglycerides and mitochondrial function: possible mechanisms for the development of type 2 diabetes.
        Int J Obes (Lond). 2005; 29: S111-S115
        • Nuutila P.
        • Koivisto V.A.
        • Knuuti J.
        • et al.
        Glucose-free fatty acid cycle operates in human heart and skeletal muscle in vivo.
        J Clin Invest. 1992; 89: 1767-1774
        • Kelley D.E.
        • Mintun M.A.
        • Watkins S.C.
        • et al.
        The effect of non-insulin-dependent diabetes mellitus and obesity on glucose transport and phosphorylation in skeletal muscle.
        J Clin Invest. 1996; 97: 2705-2713
        • Sokoloff L.
        • Reivich M.
        • Kennedy C.
        • et al.
        The [14C]deoxyglucose method for the measurement of local cerebral glucose utilization: theory, procedure, and normal values in the conscious and anesthetized albino rat.
        J Neurochem. 1977; 28: 897-916
        • Williams K.V.
        • Price J.C.
        • Kelley D.E.
        Interactions of impaired glucose transport and phosphorylation in skeletal muscle insulin resistance: a dose-response assessment using positron emission tomography.
        Diabetes. 2001; 50: 2069-2079
        • Yokoyama I.
        • Inoue Y.
        • Moritan T.
        • Ohtomo K.
        • Nagai R.
        Measurement of skeletal muscle glucose utilization by dynamic 18F-FDG PET without arterial blood sampling.
        Nucl Med Commun. 2005; 26: 31-37
        • Bertoldo A.
        • Pencek R.R.
        • Azuma K.
        • et al.
        Interactions between delivery, transport, and phosphorylation of glucose in governing uptake into human skeletal muscle.
        Diabetes. 2006; 55: 3028-3037
        • Goodpaster B.H.
        • Bertoldo A.
        • Ng J.M.
        • et al.
        Interactions among glucose delivery, transport, and phosphorylation that underlie skeletal muscle insulin resistance in obesity and type 2 diabetes: studies with dynamic PET imaging.
        Diabetes. 2014; 63: 1058-1068
        • Ng J.M.
        • Bertoldo A.
        • Minhas D.S.
        • et al.
        Dynamic PET imaging reveals heterogeneity of skeletal muscle insulin resistance.
        J Clin Endocrinol Metab. 2014; 99: E102-E106
        • Johansson E.
        • Lubberink M.
        • Heurling K.
        • et al.
        Whole-body imaging of tissue-specific insulin sensitivity and body composition by using an integrated PET/MR system: a feasibility study.
        Radiology. 2017; (162949)https://doi.org/10.1148/radiol.2017162949
        • Tune J.D.
        • Goodwill A.G.
        • Sassoon D.J.
        • Mather K.J.
        Cardiovascular consequences of metabolic syndrome.
        Transl Res. 2017; 183: 57-70
        • Grassi G.
        • Seravalle G.
        • Quarti-Trevano F.
        • et al.
        Excessive sympathetic activation in heart failure with obesity and metabolic syndrome: characteristics and mechanisms.
        Hypertension. 2007; 49: 535-541
        • Alpert M.A.
        Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome.
        Am J Med Sci. 2001; 321: 225-236
        • von Bibra H.
        • St John Sutton M.
        Diastolic dysfunction in diabetes and the metabolic syndrome: promising potential for diagnosis and prognosis.
        Diabetologia. 2010; 53: 1033-1045
        • Merabet N.
        • Fang Y.
        • Nicol L.
        • et al.
        Selective heart rate reduction improves metabolic syndrome-related left ventricular diastolic dysfunction.
        J Cardiovasc Pharmacol. 2015; 66: 399-408
        • Bender S.B.
        • DeMarco V.G.
        • Padilla J.
        • et al.
        Mineralocorticoid receptor antagonism treats obesity-associated cardiac diastolic dysfunction.
        Hypertension. 2015; 65: 1082-1088
        • Halldin M.
        • Fahlstadius P.
        • de Faire U.
        • Vikstrom M.
        • Hellenius M.L.
        The metabolic syndrome and left ventricular hypertrophy—the influence of gender and physical activity.
        Blood Press. 2012; 21: 153-160
        • Cuspidi C.
        • Sala C.
        • Lonati L.
        • et al.
        Metabolic syndrome, left ventricular hypertrophy and carotid atherosclerosis in hypertension: a gender-based study.
        Blood Press. 2013; 22: 138-143
        • Turkbey E.B.
        • McClelland R.L.
        • Kronmal R.A.
        • et al.
        The impact of obesity on the left ventricle: the Multi-Ethnic Study of Atherosclerosis (MESA).
        JACC Cardiovasc Imaging. 2010; 3: 266-274
        • Myerson S.G.
        • Bellenger N.G.
        • Pennell D.J.
        Assessment of left ventricular mass by cardiovascular magnetic resonance.
        Hypertension. 2002; 39: 750-755
        • Yu C.M.
        • Sanderson J.E.
        • Marwick T.H.
        • Oh J.K.
        Tissue Doppler imaging a new prognosticator for cardiovascular diseases.
        J Am Coll Cardiol. 2007; 49: 1903-1914
        • Aksoy S.
        • Durmus G.
        • Ozcan S.
        • et al.
        Is left ventricular diastolic dysfunction independent from presence of hypertension in metabolic syndrome? An echocardiographic study.
        J Cardiol. 2014; 64: 194-198
        • Wang Q.
        • Sun Q.W.
        • Wu D.
        • et al.
        Early detection of regional and global left ventricular myocardial function using strain and strain-rate imaging in patients with metabolic syndrome.
        Chin Med J. 2015; 128: 226-232
        • Almeida A.L.
        • Teixido-Tura G.
        • Choi E.Y.
        • et al.
        Metabolic syndrome, strain, and reduced myocardial function: multi-ethnic study of atherosclerosis.
        Arq Bras Cardiol. 2014; 102: 327-335
        • Tadic M.
        • Cuspidi C.
        • Majstorovic A.
        • et al.
        Does the metabolic syndrome impact left-ventricular mechanics? A two-dimensional speckle tracking study.
        J Hypertens. 2014; 32: 1870-1878
        • Crendal E.
        • Walther G.
        • Vinet A.
        • et al.
        Myocardial deformation and twist mechanics in adults with metabolic syndrome: impact of cumulative metabolic burden.
        Obesity (Silver Spring). 2013; 21: E679-E686
        • Moaref A.
        • Faraji M.
        • Tahamtan M.
        Subclinical left ventricular systolic dysfunction in patients with metabolic syndrome: a case-control study using two-dimensional speckle tracking echocardiography.
        ARYA Atheroscler. 2016; 12: 254-258
        • Fang N.N.
        • Sui D.X.
        • Yu J.G.
        • et al.
        Strain/strain rate imaging of impaired left atrial function in patients with metabolic syndrome.
        Hypertens Res. 2015; 38: 758-764
        • Gong H.P.
        • Tan H.W.
        • Fang N.N.
        • et al.
        Impaired left ventricular systolic and diastolic function in patients with metabolic syndrome as assessed by strain and strain rate imaging.
        Diabetes Res Clin Pract. 2009; 83: 300-307
        • Pennell D.J.
        • Firmin D.N.
        • Kilner P.J.
        • Manning W.J.
        • Mohiaddin R.H.
        • Prasad S.K.
        Review of journal of cardiovascular magnetic resonance 2010.
        J Cardiovasc Magn Reson. 2011; 13: 48
        • Roes S.D.
        • Dehnavi R.A.
        • Westenberg J.J.
        • et al.
        Effect of lifestyle intervention plus rosiglitazone or placebo therapy on left ventricular mass assessed with cardiovascular magnetic resonance in the metabolic syndrome.
        J Cardiovasc Magn Reson. 2011; 13: 65
        • Wu V.
        • Chyou J.Y.
        • Chung S.
        • Bhagavatula S.
        • Axel L.
        Evaluation of diastolic function by three-dimensional volume tracking of the mitral annulus with cardiovascular magnetic resonance: comparison with tissue Doppler imaging.
        J Cardiovasc Magn Reson. 2014; 16: 71
        • van der Meer R.W.
        • Lamb H.J.
        • Smit J.W.
        • de Roos A.
        MR imaging evaluation of cardiovascular risk in metabolic syndrome.
        Radiology. 2012; 264: 21-37
        • Jung B.
        • Schneider B.
        • Markl M.
        • Saurbier B.
        • Geibel A.
        • Hennig J.
        Measurement of left ventricular velocities: phase contrast MRI velocity mapping versus tissue-doppler-ultrasound in healthy volunteers.
        J Cardiovasc Magn Reson. 2004; 6: 777-783
        • Finn J.P.
        • Nael K.
        • Deshpande V.
        • Ratib O.
        • Laub G.
        Cardiac MR imaging: state of the technology.
        Radiology. 2006; 241: 338-354
        • Yoneyama K.
        • Gjesdal O.
        • Choi E.Y.
        • et al.
        Age, sex, and hypertension-related remodeling influences left ventricular torsion assessed by tagged cardiac magnetic resonance in asymptomatic individuals: the multi-ethnic study of atherosclerosis.
        Circulation. 2012; 126: 2481-2490
        • Obert P.
        • Gueugnon C.
        • Nottin S.
        • et al.
        Two-dimensional strain and twist by vector velocity imaging in adolescents with severe obesity.
        Obesity (Silver Spring). 2012; 20: 2397-2405
        • Haggerty C.M.
        • Mattingly A.C.
        • Kramer S.P.
        • et al.
        Left ventricular mechanical dysfunction in diet-induced obese mice is exacerbated during inotropic stress: a cine DENSE cardiovascular magnetic resonance study.
        J Cardiovasc Magn Reson. 2015; 17: 75
        • Deng Y.
        • Alharthi M.S.
        • Thota V.R.
        • et al.
        Evaluation of left ventricular rotation in obese subjects by velocity vector imaging.
        Eur J Echocardiogr. 2010; 11: 424-428
        • Neugarten J.
        • Golestaneh L.
        Blood oxygenation level-dependent MRI for assessment of renal oxygenation.
        Int J Nephrol Renovasc Dis. 2014; 7: 421-435
        • Li Z.L.
        • Ebrahimi B.
        • Zhang X.
        • et al.
        Obesity-metabolic derangement exacerbates cardiomyocyte loss distal to moderate coronary artery stenosis in pigs without affecting global cardiac function.
        Am J Physiol Heart Circ Physiol. 2014; 306: H1087-H1101
        • Khaliq A.
        • Johnson B.D.
        • Anderson R.D.
        • et al.
        Relationships between components of metabolic syndrome and coronary intravascular ultrasound atherosclerosis measures in women without obstructive coronary artery disease: the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation Study.
        Cardiovasc Endocrinol. 2015; 4: 45-52
        • Amano T.
        • Matsubara T.
        • Uetani T.
        • et al.
        Impact of metabolic syndrome on tissue characteristics of angiographically mild to moderate coronary lesions integrated backscatter intravascular ultrasound study.
        J Am Coll Cardiol. 2007; 49: 1149-1156
        • Bonamichi B.D.
        • Parente E.B.
        • Campos A.C.
        • Cury A.N.
        • Salles J.E.
        Hyperglycemia effect on coronary disease in patients with metabolic syndrome evaluated by intracoronary ultrasonography.
        PLoS ONE. 2017; 12: e0171733
        • Yonetsu T.
        • Kato K.
        • Uemura S.
        • et al.
        Features of coronary plaque in patients with metabolic syndrome and diabetes mellitus assessed by 3-vessel optical coherence tomography.
        Circ Cardiovasc Imaging. 2013; 6: 665-673
        • Synetos A.
        • Papanikolaou A.
        • Toutouzas K.
        • et al.
        Metabolic syndrome predicts plaque rupture in patients with acute myocardial infarction. An optical coherence study.
        Int J Cardiol. 2016; 209: 139-141
        • Faustino A.
        • Providencia R.
        • Mota P.
        • et al.
        Can cardiac computed tomography predict cardiovascular events in asymptomatic type-2 diabetics? Results of a long term follow-up.
        BMC Cardiovasc Disord. 2014; 14: 2
        • Ahmadi A.
        • Leipsic J.
        • Feuchtner G.
        • et al.
        Is metabolic syndrome predictive of prevalence, extent, and risk of coronary artery disease beyond its components? Results from the multinational coronary CT angiography evaluation for clinical outcome: an international multicenter registry (CONFIRM).
        PLoS ONE. 2015; 10: e0118998
        • Cademartiri F.
        • Seitun S.
        • Clemente A.
        • et al.
        Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography.
        Cardiovasc Diagn Ther. 2017; 7: 129-150
        • Saeed M.
        • Van T.A.
        • Krug R.
        • Hetts S.W.
        • Wilson M.W.
        Cardiac MR imaging: current status and future direction.
        Cardiovasc Diagn Ther. 2015; 5: 290-310
        • Ebrahimi B.
        • Textor S.C.
        • Lerman L.O.
        Renal relevant radiology: renal functional magnetic resonance imaging.
        Clin J Am Soc Nephrol. 2014; 9: 395-405
        • Kim R.J.
        • Wu E.
        • Rafael A.
        • et al.
        The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction.
        N Engl J Med. 2000; 343: 1445-1453
        • Miller T.D.
        • Sciagra R.
        • Gibbons R.J.
        Application of technetium-99m sestamibi single photon emission computed tomography in acute myocardial infarction: measuring the efficacy of therapy.
        Q J Nucl Med Mol Imaging. 2010; 54: 213-229
        • Angelidis G.
        • Giamouzis G.
        • Karagiannis G.
        • et al.
        SPECT and PET in ischemic heart failure.
        Heart Fail Rev. 2017; 22: 243-261
        • Shaw L.J.
        • Berman D.S.
        • Hendel R.C.
        • et al.
        Cardiovascular disease risk stratification with stress single-photon emission computed tomography technetium-99m tetrofosmin imaging in patients with the metabolic syndrome and diabetes mellitus.
        Am J Cardiol. 2006; 97: 1538-1544
        • Lim S.P.
        • Arasaratnam P.
        • Chow B.J.
        • Beanlands R.S.
        • Hessian R.C.
        Obesity and the challenges of noninvasive imaging for the detection of coronary artery disease.
        Can J Cardiol. 2015; 31: 223-226
        • Di Carli M.F.
        Measurement of MBF by PET is ready for prime time as an integral part of clinical reports in diagnosis and risk assessment of patients with known or suspected CAD-PRO.
        J Nucl Cardiol. 2017; https://doi.org/10.1007/s12350-017-1035-4
        • Marchesseau S.
        • Seneviratna A.
        • Sjoholm A.T.
        • et al.
        Hybrid PET/CT and PET/MRI imaging of vulnerable coronary plaque and myocardial scar tissue in acute myocardial infarction.
        J Nucl Cardiol. 2017; https://doi.org/10.1007/s12350-017-0918-8
        • Petibon Y.
        • El Fakhri G.
        • Nezafat R.
        • Johnson N.
        • Brady T.
        • Ouyang J.
        Towards coronary plaque imaging using simultaneous PET-MR: a simulation study.
        Phys Med Biol. 2014; 59: 1203-1222
        • Rischpler C.
        • Nekolla S.G.
        • Dregely I.
        • Schwaiger M.
        Hybrid PET/MR imaging of the heart: potential, initial experiences, and future prospects.
        J Nucl Med. 2013; 54: 402-415
        • Nyman K.
        • Graner M.
        • Pentikainen M.O.
        • et al.
        Cardiac steatosis and left ventricular function in men with metabolic syndrome.
        J Cardiovasc Magn Reson. 2013; 15: 103
        • Iozzo P.
        Myocardial, perivascular, and epicardial fat.
        Diabetes Care. 2011; 34: S371-S379
        • Sacks H.S.
        • Fain J.N.
        Human epicardial adipose tissue: a review.
        Am Heart J. 2007; 153: 907-917
        • Reingold J.S.
        • McGavock J.M.
        • Kaka S.
        • Tillery T.
        • Victor R.G.
        • Szczepaniak L.S.
        Determination of triglyceride in the human myocardium by magnetic resonance spectroscopy: reproducibility and sensitivity of the method.
        Am J Physiol Endocrinol Metab. 2005; 289: E935-E939
        • Korosoglou G.
        • Humpert P.M.
        • Ahrens J.
        • et al.
        Left ventricular diastolic function in type 2 diabetes mellitus is associated with myocardial triglyceride content but not with impaired myocardial perfusion reserve.
        J Magn Reson Imaging. 2012; 35: 804-811
        • Rijzewijk L.J.
        • van der Meer R.W.
        • Smit J.W.
        • et al.
        Myocardial steatosis is an independent predictor of diastolic dysfunction in type 2 diabetes mellitus.
        J Am Coll Cardiol. 2008; 52: 1793-1799
        • Rosito G.A.
        • Massaro J.M.
        • Hoffmann U.
        • et al.
        Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study.
        Circulation. 2008; 117: 605-613
        • Ruberg F.L.
        • Chen Z.
        • Hua N.
        • et al.
        The relationship of ectopic lipid accumulation to cardiac and vascular function in obesity and metabolic syndrome.
        Obesity (Silver Spring). 2010; 18: 1116-1121
        • Mazurek T.
        • Zhang L.
        • Zalewski A.
        • et al.
        Human epicardial adipose tissue is a source of inflammatory mediators.
        Circulation. 2003; 108: 2460-2466
        • Iacobellis G.
        • Assael F.
        • Ribaudo M.C.
        • et al.
        Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction.
        Obes Res. 2003; 11: 304-310
        • Iacobellis G.
        • Ribaudo M.C.
        • Assael F.
        • et al.
        Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk.
        J Clin Endocrinol Metab. 2003; 88: 5163-5168
        • Meng K.
        • Lee C.H.
        • Saremi F.
        Metabolic syndrome and ectopic fat deposition: what can CT and MR provide?.
        Acad Radiol. 2010; 17: 1302-1312
        • Fluchter S.
        • Haghi D.
        • Dinter D.
        • et al.
        Volumetric assessment of epicardial adipose tissue with cardiovascular magnetic resonance imaging.
        Obesity (Silver Spring). 2007; 15: 870-878
        • Tesauro M.
        • Cardillo C.
        Obesity, blood vessels and metabolic syndrome.
        Acta Physiol (Oxf). 2011; 203: 279-286
        • Mendizabal Y.
        • Llorens S.
        • Nava E.
        Hypertension in metabolic syndrome: vascular pathophysiology.
        Int J Hypertens. 2013; 2013 (230868)
        • Safar M.E.
        • Thomas F.
        • Blacher J.
        • et al.
        Metabolic syndrome and age-related progression of aortic stiffness.
        J Am Coll Cardiol. 2006; 47: 72-75
        • Pereira T.
        • Correia C.
        • Cardoso J.
        Novel methods for pulse wave velocity measurement.
        J Med Biol Eng. 2015; 35: 555-565
        • Scuteri A.
        • Cunha P.G.
        • Rosei E.A.
        • et al.
        Arterial stiffness and influences of the metabolic syndrome: a cross-countries study.
        Atherosclerosis. 2014; 233: 654-660
        • Wentland A.L.
        • Grist T.M.
        • Wieben O.
        Review of MRI-based measurements of pulse wave velocity: a biomarker of arterial stiffness.
        Cardiovasc Diagn Ther. 2014; 4: 193-206
        • Wang Z.
        • Yang Y.
        • Yuan L.J.
        • Liu J.
        • Duan Y.Y.
        • Cao T.S.
        Noninvasive method for measuring local pulse wave velocity by dual pulse wave Doppler: in vitro and in vivo studies.
        PLoS ONE. 2015; 10 (e0120482)
        • Laurent S.
        • Marais L.
        • Boutouyrie P.
        The noninvasive assessment of vascular aging.
        Can J Cardiol. 2016; 32: 669-679
        • Blasco G.
        • Balocco S.
        • Puig J.
        • et al.
        Carotid pulse wave velocity by magnetic resonance imaging is increased in middle-aged subjects with the metabolic syndrome.
        Int J Cardiovasc Imaging. 2015; 31: 603-612
        • Achike F.I.
        • To N.H.
        • Wang H.
        • Kwan C.Y.
        Obesity, metabolic syndrome, adipocytes and vascular function: a holistic viewpoint.
        Clin Exp Pharmacol Physiol. 2011; 38: 1-10
        • Schlett C.L.
        • Massaro J.M.
        • Lehman S.J.
        • et al.
        Novel measurements of periaortic adipose tissue in comparison to anthropometric measures of obesity, and abdominal adipose tissue.
        Int J Obes (Lond). 2009; 33: 226-232
        • Ruminska M.
        • Witkowska-Sedek E.
        • Majcher A.
        • et al.
        Carotid intima-media thickness and metabolic syndrome components in obese children and adolescents.
        Adv Exp Med Biol. 2017; https://doi.org/10.1007/5584_2017_29
        • Jung J.M.
        • Young Kwon D.
        • Han C.
        • Park M.H.
        Metabolic syndrome and early carotid atherosclerosis in the elderly.
        J Atheroscler Thromb. 2014; 21: 435-444
        • Paoletti R.
        • Bolego C.
        • Poli A.
        • Cignarella A.
        Metabolic syndrome, inflammation and atherosclerosis.
        Vasc Health Risk Manag. 2006; 2: 145-152
        • Naqvi T.Z.
        • Lee M.S.
        Carotid intima-media thickness and plaque in cardiovascular risk assessment.
        JACC Cardiovasc Imaging. 2014; 7: 1025-1038
        • Owen D.R.
        • Lindsay A.C.
        • Choudhury R.P.
        • Fayad Z.A.
        Imaging of atherosclerosis.
        Annu Rev Med. 2011; 62: 25-40
        • Hitchner E.
        • Zayed M.A.
        • Lee G.
        • Morrison D.
        • Lane B.
        • Zhou W.
        Intravascular ultrasound as a clinical adjunct for carotid plaque characterization.
        J Vasc Surg. 2014; 59: 774-780
        • Shindo S.
        • Fujii K.
        • Shirakawa M.
        • et al.
        Morphologic features of carotid plaque rupture assessed by optical coherence tomography.
        AJNR Am J Neuroradiol. 2015; 36: 2140-2146
        • Corti R.
        • Fuster V.
        Imaging of atherosclerosis: magnetic resonance imaging.
        Eur Heart J. 2011; 32 (1709–19b)
        • Orbay H.
        • Hong H.
        • Zhang Y.
        • Cai W.
        Positron emission tomography imaging of atherosclerosis.
        Theranostics. 2013; 3: 894-902
        • Tahara N.
        • Kai H.
        • Yamagishi S.
        • et al.
        Vascular inflammation evaluated by [18F]-fluorodeoxyglucose positron emission tomography is associated with the metabolic syndrome.
        J Am Coll Cardiol. 2007; 49: 1533-1539
        • Chen J.
        • Muntner P.
        • Hamm L.L.
        • et al.
        The metabolic syndrome and chronic kidney disease in U.S. adults.
        Ann Intern Med. 2004; 140: 167-174
        • Zhang X.
        • Lerman L.O.
        The metabolic syndrome and chronic kidney disease.
        Transl Res. 2017; 183: 14-25
        • Wong Y.
        • Cook P.
        • Roderick P.
        • Somani B.K.
        Metabolic syndrome and kidney stone disease: a systematic review of literature.
        J Endourol. 2016; 30: 246-253
        • Wang G.S.
        • Tong D.M.
        • Chen X.D.
        • Yang T.H.
        • Zhou Y.T.
        • Ma X.B.
        Metabolic syndrome is a strong risk factor for minor ischemic stroke and subsequent vascular events.
        PLoS ONE. 2016; 11: e0156243
        • Wollin D.A.
        • Skolarikos A.
        • Preminger G.M.
        Obesity and metabolic stone disease.
        Curr Opin Urol. 2017; 27: 422-427
        • Mostbeck G.H.
        • Kain R.
        • Mallek R.
        • et al.
        Duplex Doppler sonography in renal parenchymal disease. Histopathologic correlation.
        J Ultrasound Med. 1991; 10: 189-194
        • Buscemi S.
        • Verga S.
        • Batsis J.A.
        • et al.
        Intra-renal hemodynamics and carotid intima-media thickness in the metabolic syndrome.
        Diabetes Res Clin Pract. 2009; 86: 177-185
        • Taylor A.T.
        Radionuclides in nephrourology, part 2: pitfalls and diagnostic applications.
        J Nucl Med. 2014; 55: 786-798
        • Mohsin N.
        • Mourad G.
        • Faure M.
        • Szawarc I.
        • Bringer J.
        Metabolic syndrome performs better than the individual factors in predicting renal graft outcome.
        Transplant Proc. 2013; 45: 3517-3519
        • Zhang X.
        • Li Z.L.
        • Woollard J.R.
        • et al.
        Obesity-metabolic derangement preserves hemodynamics but promotes intrarenal adiposity and macrophage infiltration in swine renovascular disease.
        Am J Physiol Renal Physiol. 2013; 305: F265-F276
        • Li Z.
        • Woollard J.R.
        • Wang S.
        • et al.
        Increased glomerular filtration rate in early metabolic syndrome is associated with renal adiposity and microvascular proliferation.
        Am J Physiol Renal Physiol. 2011; 301: F1078-F1087
        • Saade C.
        • Deeb I.A.
        • Mohamad M.
        • Al-Mohiy H.
        • El-Merhi F.
        Contrast medium administration and image acquisition parameters in renal CT angiography: what radiologists need to know.
        Diagn Interv Radiol. 2016; 22: 116-124
        • Abu-Alfa A.K.
        Nephrogenic systemic fibrosis and gadolinium-based contrast agents.
        Adv Chronic Kidney Dis. 2011; 18: 188-198
        • Ritt M.
        • Janka R.
        • Schneider M.P.
        • et al.
        Measurement of kidney perfusion by magnetic resonance imaging: comparison of MRI with arterial spin labeling to para-aminohippuric acid plasma clearance in male subjects with metabolic syndrome.
        Nephrol Dial Transplant. 2010; 25: 1126-1133
        • Grover V.P.
        • Tognarelli J.M.
        • Crossey M.M.
        • Cox I.J.
        • Taylor-Robinson S.D.
        • McPhail M.J.
        Magnetic resonance imaging: principles and techniques: lessons for clinicians.
        J Clin Exp Hepatol. 2015; 5: 246-255
        • Li Q.
        • Li J.
        • Zhang L.
        • Chen Y.
        • Zhang M.
        • Yan F.
        Diffusion-weighted imaging in assessing renal pathology of chronic kidney disease: a preliminary clinical study.
        Eur J Radiol. 2014; 83: 756-762
        • Ebrahimi B.
        • Saad A.
        • Jiang K.
        • et al.
        Renal adiposity confounds quantitative assessment of markers of renal diffusion with MRI: a proposed correction method.
        Invest Radiol. 2017; https://doi.org/10.1097/RLI.0000000000000389
        • Yin W.J.
        • Liu F.
        • Li X.M.
        • et al.
        Noninvasive evaluation of renal oxygenation in diabetic nephropathy by BOLD-MRI.
        Eur J Radiol. 2012; 81: 1426-1431
        • Hirakawa Y.
        • Tanaka T.
        • Nangaku M.
        Renal Hypoxia in CKD; pathophysiology and detecting methods.
        Front Physiol. 2017; 8: 99
        • Dwyer T.M.
        • Mizelle H.L.
        • Cockrell K.
        • Buhner P.
        Renal sinus lipomatosis and body composition in hypertensive, obese rabbits.
        Int J Obes Relat Metab Disord. 1995; 19: 869-874
        • Lamacchia O.
        • Nicastro V.
        • Camarchio D.
        • et al.
        Para- and perirenal fat thickness is an independent predictor of chronic kidney disease, increased renal resistance index and hyperuricaemia in type-2 diabetic patients.
        Nephrol Dial Transplant. 2011; 26: 892-898
        • Ma S.
        • Zhu X.Y.
        • Eirin A.
        • et al.
        Perirenal fat promotes renal arterial endothelial dysfunction in obese swine through tumor necrosis factor-alpha.
        J Urol. 2016; 195: 1152-1159
        • De Pergola G.
        • Campobasso N.
        • Nardecchia A.
        • et al.
        Para- and perirenal ultrasonographic fat thickness is associated with 24-hours mean diastolic blood pressure levels in overweight and obese subjects.
        BMC Cardiovasc Disord. 2015; 15: 108
        • Favre G.
        • Grangeon-Chapon C.
        • Raffaelli C.
        • Francois-Chalmin F.
        • Iannelli A.
        • Esnault V.
        Perirenal fat thickness measured with computed tomography is a reliable estimate of perirenal fat mass.
        PLoS ONE. 2017; 12: e0175561
        • Yokoo T.
        • Clark H.R.
        • Pedrosa I.
        • et al.
        Quantification of renal steatosis in type II diabetes mellitus using dixon-based MRI.
        J Magn Reson Imaging. 2016; 44: 1312-1319
        • Zelicha H.
        • Schwarzfuchs D.
        • Shelef I.
        • et al.
        Changes of renal sinus fat and renal parenchymal fat during an 18-month randomized weight loss trial.
        Clin Nutr. 2017; https://doi.org/10.1016/j.clnu.2017.04.007
        • Hammer S.
        • de Vries A.P.
        • de Heer P.
        • et al.
        Metabolic imaging of human kidney triglyceride content: reproducibility of proton magnetic resonance spectroscopy.
        PLoS ONE. 2013; 8 (e62209)
        • Kotronen A.
        • Westerbacka J.
        • Bergholm R.
        • Pietilainen K.H.
        • Yki-Jarvinen H.
        Liver fat in the metabolic syndrome.
        J Clin Endocrinol Metab. 2007; 92: 3490-3497
        • Arulanandan A.
        • Ang B.
        • Bettencourt R.
        • et al.
        Association between quantity of liver fat and cardiovascular risk in patients with nonalcoholic fatty liver disease independent of nonalcoholic steatohepatitis.
        Clin Gastroenterol Hepatol. 2015; 13 (e1): 1513-1520
        • Yki-Jarvinen H.
        Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome.
        Lancet Diabetes Endocrinol. 2014; 2: 901-910
        • Brunt E.M.
        • Kleiner D.E.
        • Wilson L.A.
        • Belt P.
        • Neuschwander-Tetri B.A.
        • Network N.C.R.
        Nonalcoholic fatty liver disease (NAFLD) activity score and the histopathologic diagnosis in NAFLD: distinct clinicopathologic meanings.
        Hepatology. 2011; 53: 810-820
        • Cobbold J.F.
        • Patel D.
        • Taylor-Robinson S.D.
        Assessment of inflammation and fibrosis in non-alcoholic fatty liver disease by imaging-based techniques.
        J Gastroenterol Hepatol. 2012; 27: 1281-1292
        • Ma X.
        • Holalkere N.S.
        • Kambadakone R.A.
        • Mino-Kenudson M.
        • Hahn P.F.
        • Sahani D.V.
        Imaging-based quantification of hepatic fat: methods and clinical applications.
        Radiographics. 2009; 29: 1253-1277
        • Bohte A.E.
        • van Werven J.R.
        • Bipat S.
        • Stoker J.
        The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis.
        Eur Radiol. 2011; 21: 87-97
        • Idilman I.S.
        • Keskin O.
        • Celik A.
        • et al.
        A comparison of liver fat content as determined by magnetic resonance imaging-proton density fat fraction and MRS versus liver histology in non-alcoholic fatty liver disease.
        Acta Radiol. 2016; 57: 271-278
        • Livingstone R.S.
        • Begovatz P.
        • Kahl S.
        • et al.
        Initial clinical application of modified Dixon with flexible echo times: hepatic and pancreatic fat assessments in comparison with (1)H MRS.
        MAGMA. 2014; 27: 397-405
        • Schwenzer N.F.
        • Machann J.
        • Martirosian P.
        • et al.
        Quantification of pancreatic lipomatosis and liver steatosis by MRI: comparison of in/opposed-phase and spectral-spatial excitation techniques.
        Invest Radiol. 2008; 43: 330-337
        • Tang A.
        • Desai A.
        • Hamilton G.
        • et al.
        Accuracy of MR imaging-estimated proton density fat fraction for classification of dichotomized histologic steatosis grades in nonalcoholic fatty liver disease.
        Radiology. 2015; 274: 416-425
        • Permutt Z.
        • Le T.A.
        • Peterson M.R.
        • et al.
        Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease—MRI accurately quantifies hepatic steatosis in NAFLD.
        Aliment Pharmacol Ther. 2012; 36: 22-29
        • Middleton M.S.
        • Heba E.R.
        • Hooker C.A.
        • et al.
        Agreement between magnetic resonance imaging proton density fat fraction measurements and pathologist-assigned steatosis grades of liver biopsies from adults with nonalcoholic steatohepatitis.
        Gastroenterology. 2017; https://doi.org/10.1053/j.gastro.2017.06.005
        • Solga S.F.
        • Horska A.
        • Clark J.M.
        • Diehl A.M.
        Hepatic 31P magnetic resonance spectroscopy: a hepatologist's user guide.
        Liver Int. 2005; 25: 490-500
        • Sevastianova K.
        • Hakkarainen A.
        • Kotronen A.
        • et al.
        Nonalcoholic fatty liver disease: detection of elevated nicotinamide adenine dinucleotide phosphate with in vivo 3.0-T 31P MR spectroscopy with proton decoupling.
        Radiology. 2010; 256: 466-473
        • Abrigo J.M.
        • Shen J.
        • Wong V.W.
        • et al.
        Non-alcoholic fatty liver disease: spectral patterns observed from an in vivo phosphorus magnetic resonance spectroscopy study.
        J Hepatol. 2014; 60: 809-815
        • Rosselli M.
        • Lotersztajn S.
        • Vizzutti F.
        • Arena U.
        • Pinzani M.
        • Marra F.
        The metabolic syndrome and chronic liver disease.
        Curr Pharm Des. 2014; 20: 5010-5024
        • Horowitz J.M.
        • Venkatesh S.K.
        • Ehman R.L.
        • et al.
        Evaluation of hepatic fibrosis: a review from the society of abdominal radiology disease focus panel.
        Abdom Radiol (NY). 2017; https://doi.org/10.1007/s00261-017-1211-7
        • Arena U.
        • Vizzutti F.
        • Abraldes J.G.
        • et al.
        Reliability of transient elastography for the diagnosis of advanced fibrosis in chronic hepatitis C.
        Gut. 2008; 57: 1288-1293
        • Millonig G.
        • Reimann F.M.
        • Friedrich S.
        • et al.
        Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis.
        Hepatology. 2008; 48: 1718-1723
        • Millonig G.
        • Friedrich S.
        • Adolf S.
        • et al.
        Liver stiffness is directly influenced by central venous pressure.
        J Hepatol. 2010; 52: 206-210
        • Tang A.
        • Cloutier G.
        • Szeverenyi N.M.
        • Sirlin C.B.
        Ultrasound elastography and MR elastography for assessing liver fibrosis: part 1, principles and techniques.
        AJR Am J Roentgenol. 2015; 205: 22-32
        • Venkatesh S.K.
        • Yin M.
        • Ehman R.L.
        Magnetic resonance elastography of liver: technique, analysis, and clinical applications.
        J Magn Reson Imaging. 2013; 37: 544-555
        • Motosugi U.
        • Ichikawa T.
        • Sano K.
        • et al.
        Magnetic resonance elastography of the liver: preliminary results and estimation of inter-rater reliability.
        Jpn J Radiol. 2010; 28: 623-627
        • Yin M.
        • Woollard J.
        • Wang X.
        • et al.
        Quantitative assessment of hepatic fibrosis in an animal model with magnetic resonance elastography.
        Magn Reson Med. 2007; 58: 346-353
        • Batheja M.
        • Vargas H.
        • Silva A.M.
        • et al.
        Magnetic resonance elastography (MRE) in assessing hepatic fibrosis: performance in a cohort of patients with histological data.
        Abdom Imaging. 2015; 40: 760-765
        • Wu W.C.
        • Wang C.Y.
        Association between non-alcoholic fatty pancreatic disease (NAFPD) and the metabolic syndrome: case-control retrospective study.
        Cardiovasc Diabetol. 2013; 12: 77
        • Katz D.S.
        • Hines J.
        • Math K.R.
        • Nardi P.M.
        • Mindelzun R.E.
        • Lane M.J.
        Using CT to reveal fat-containing abnormalities of the pancreas.
        AJR Am J Roentgenol. 1999; 172: 393-396
        • Pinnick K.E.
        • Collins S.C.
        • Londos C.
        • Gauguier D.
        • Clark A.
        • Fielding B.A.
        Pancreatic ectopic fat is characterized by adipocyte infiltration and altered lipid composition.
        Obesity (Silver Spring). 2008; 16: 522-530
        • Mathur A.
        • Marine M.
        • Lu D.
        • et al.
        Nonalcoholic fatty pancreas disease.
        HPB (Oxford). 2007; 9: 312-318
        • Cnop M.
        • Hannaert J.C.
        • Hoorens A.
        • Eizirik D.L.
        • Pipeleers D.G.
        Inverse relationship between cytotoxicity of free fatty acids in pancreatic islet cells and cellular triglyceride accumulation.
        Diabetes. 2001; 50: 1771-1777
        • Uygun A.
        • Kadayifci A.
        • Demirci H.
        • et al.
        The effect of fatty pancreas on serum glucose parameters in patients with nonalcoholic steatohepatitis.
        Eur J Intern Med. 2015; 26: 37-41
        • Catanzaro R.
        • Cuffari B.
        • Italia A.
        • Marotta F.
        Exploring the metabolic syndrome: nonalcoholic fatty pancreas disease.
        World J Gastroenterol. 2016; 22: 7660-7675
        • Lim S.
        • Bae J.H.
        • Chun E.J.
        • et al.
        Differences in pancreatic volume, fat content, and fat density measured by multidetector-row computed tomography according to the duration of diabetes.
        Acta Diabetol. 2014; 51: 739-748
        • Kim S.Y.
        • Kim H.
        • Cho J.Y.
        • et al.
        Quantitative assessment of pancreatic fat by using unenhanced CT: pathologic correlation and clinical implications.
        Radiology. 2014; 271: 104-112
        • Hu H.H.
        • Kim H.W.
        • Nayak K.S.
        • Goran M.I.
        Comparison of fat-water MRI and single-voxel MRS in the assessment of hepatic and pancreatic fat fractions in humans.
        Obesity (Silver Spring). 2010; 18: 841-847
        • Gaborit B.
        • Abdesselam I.
        • Kober F.
        • et al.
        Ectopic fat storage in the pancreas using 1H-MRS: importance of diabetic status and modulation with bariatric surgery-induced weight loss.
        Int J Obes (Lond). 2015; 39: 480-487
        • Jeong H.T.
        • Lee M.S.
        • Kim M.J.
        Quantitative analysis of pancreatic echogenicity on transabdominal sonography: correlations with metabolic syndrome.
        J Clin Ultrasound. 2015; 43: 98-108
        • Ng T.P.
        • Feng L.
        • Nyunt M.S.
        • et al.
        Metabolic syndrome and the risk of mild cognitive impairment and progression to dementia: follow-up of the Singapore longitudinal ageing study cohort.
        JAMA Neurol. 2016; 73: 456-463
        • Sarrafzadegan N.
        • Gharipour M.
        • Sadeghi M.
        • et al.
        Metabolic syndrome and the risk of ischemic stroke.
        J Stroke Cerebrovasc Dis. 2017; 26: 286-294
        • Cavalieri M.
        • Ropele S.
        • Petrovic K.
        • et al.
        Metabolic syndrome, brain magnetic resonance imaging, and cognition.
        Diabetes Care. 2010; 33: 2489-2495
        • Craft S.
        • Watson G.S.
        Insulin and neurodegenerative disease: shared and specific mechanisms.
        Lancet Neurol. 2004; 3: 169-178
        • Sala M.
        • de Roos A.
        • van den Berg A.
        • et al.
        Microstructural brain tissue damage in metabolic syndrome.
        Diabetes Care. 2014; 37: 493-500
        • Alfaro F.J.
        • Lioutas V.A.
        • Pimentel D.A.
        • et al.
        Cognitive decline in metabolic syndrome is linked to microstructural white matter abnormalities.
        J Neurol. 2016; 263: 2505-2514
        • Tambasco N.
        • Nigro P.
        • Romoli M.
        • Simoni S.
        • Parnetti L.
        • Calabresi P.
        Magnetization transfer MRI in dementia disorders, Huntington's disease and parkinsonism.
        J Neurol Sci. 2015; 353: 1-8
        • Segura B.
        • Jurado M.A.
        • Freixenet N.
        • Falcon C.
        • Junque C.
        • Arboix A.
        Microstructural white matter changes in metabolic syndrome: a diffusion tensor imaging study.
        Neurology. 2009; 73: 438-444
        • Shimoji K.
        • Abe O.
        • Uka T.
        • et al.
        White matter alteration in metabolic syndrome: diffusion tensor analysis.
        Diabetes Care. 2013; 36: 696-700
        • Shigaeff N.
        • Amaro E.
        • Franco F.G.M.
        • et al.
        Functional magnetic resonance imaging response as an early biomarker of cognitive decline in elderly patients with metabolic syndrome.
        Arch Gerontol Geriatr. 2017; 73: 1-7
        • Hirvonen J.
        • Virtanen K.A.
        • Nummenmaa L.
        • et al.
        Effects of insulin on brain glucose metabolism in impaired glucose tolerance.
        Diabetes. 2011; 60: 443-447
        • Heiss W.D.
        • Rosenberg G.A.
        • Thiel A.
        • Berlot R.
        • de Reuck J.
        Neuroimaging in vascular cognitive impairment: a state-of-the-art review.
        BMC Med. 2016; 14: 174
        • Lin F.
        • Lo R.Y.
        • Cole D.
        • et al.
        Longitudinal effects of metabolic syndrome on Alzheimer and vascular related brain pathology.
        Dement Geriatr Cogn Dis Extra. 2014; 4: 184-194
        • Bonifacio G.
        • Zamboni G.
        Brain imaging in dementia.
        Postgrad Med J. 2016; 92: 333-340
        • Grundy S.M.
        • Cleeman J.I.
        • Daniels S.R.
        • et al.
        Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.
        Circulation. 2005; 112: 2735-2752
        • Tuttolomondo A.
        • Pecoraro R.
        • Di Raimondo D.
        • et al.
        Immune-inflammatory markers and arterial stiffness indexes in subjects with acute ischemic stroke with and without metabolic syndrome.
        Diabetol Metab Syndr. 2014; 6: 28
        • Kilburg C.
        • Scott McNally J.
        • de Havenon A.
        • Taussky P.
        • Kalani M.Y.
        • Park M.S.
        Advanced imaging in acute ischemic stroke.
        Neurosurg Focus. 2017; 42: E10
        • Giannopoulos S.
        • Boden-Albala B.
        • Choi J.H.
        • et al.
        Metabolic syndrome and cerebral vasomotor reactivity.
        Eur J Neurol. 2010; 17: 1457-1462
        • D'Andrea A.
        • Conte M.
        • Cavallaro M.
        • et al.
        Transcranial Doppler ultrasonography: from methodology to major clinical applications.
        World J Cardiol. 2016; 8: 383-400
        • Bassi N.
        • Karagodin I.
        • Wang S.
        • et al.
        Lifestyle modification for metabolic syndrome: a systematic review.
        Am J Med. 2014; 127: e1-10
        • Miller M.
        • DiNicolantonio J.J.
        • Can M.
        • Grice R.
        • Damoulakis A.
        • Serebruany V.L.
        The effects of ezetimibe/simvastatin versus simvastatin monotherapy on platelet and inflammatory biomarkers in patients with metabolic syndrome.
        Cardiology. 2013; 125: 74-77
        • Reyes-Soffer G.
        • Rondon-Clavo C.
        • Ginsberg H.N.
        Combination therapy with statin and fibrate in patients with dyslipidemia associated with insulin resistance, metabolic syndrome and type 2 diabetes mellitus.
        Expert Opin Pharmacother. 2011; 12: 1429-1438
        • Rodriguez R.
        • Viscarra J.A.
        • Minas J.N.
        • Nakano D.
        • Nishiyama A.
        • Ortiz R.M.
        Angiotensin receptor blockade increases pancreatic insulin secretion and decreases glucose intolerance during glucose supplementation in a model of metabolic syndrome.
        Endocrinology. 2012; 153: 1684-1695
        • Zreikat H.H.
        • Harpe S.E.
        • Slattum P.W.
        • Mays D.P.
        • Essah P.A.
        • Cheang K.I.
        Effect of renin-angiotensin system inhibition on cardiovascular events in older hypertensive patients with metabolic syndrome.
        Metabolism. 2014; 63: 392-399
        • Samson S.L.
        • Garber A.J.
        Metabolic syndrome.
        Endocrinol Metab Clin North Am. 2014; 43: 1-23
        • Shuai X.
        • Tao K.
        • Mori M.
        • Kanda T.
        Bariatric surgery for metabolic syndrome in obesity.
        Metab Syndr Relat Disord. 2015; 13: 149-160