Department of Radiology, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA.
Diabetes Technol Ther. 2013 May;15(5):351-61. doi: 10.1089/dia.2013.0039. Epub 2013 Apr 15.
Quantifying body fat is currently an area of active research. Recent studies have shown that the quantity and location of fat in different compartments have varying clinical significance. This information can now be obtained from computed tomography (CT) or magnetic resonance (MR), and it can inform clinical decision making for patient management. Diabetes patients with insulin resistance and hyperinsulinemia have nonalcoholic fatty liver disease (NAFLD) ranging from steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis, typically diagnosed by liver biopsy or serum markers. There is now an emerging role of noninvasive imaging tests such as MR imaging or MR spectroscopy or elastography, which can provide quantitative information and have potential to avoid biopsy. Obese patients with diabetes are also at risk for cardiovascular disease and cancer. There is an emerging role for imaging in early detection of not only structural but also functional abnormalities of myocardium at a subclinical stage. Screening for cancer is currently recommended only for breast, colon, prostate, and cervix. Given wider availability and advances in imaging techniques such as positron emission tomography/CT (faster scans with higher resolution and less ionizing radiation) and better understanding of molecular biology and risk-stratification, more and more cancers are being detected in early stages with better clinical outcomes. Concerns related to cost, overdiagnosis, and unnecessary interventions must be addressed before population-based screening for other cancers is recommended. Based on ongoing imaging research, it is expected that it will be possible to provide more precise measurement of body fat and detect cardiovascular disease and cancers earlier in their course.
目前，定量体脂是一个活跃的研究领域。最近的研究表明，不同部位脂肪的数量和位置具有不同的临床意义。这些信息现在可以从计算机断层扫描（CT）或磁共振（MR）中获得，并为患者管理的临床决策提供信息。患有胰岛素抵抗和高胰岛素血症的糖尿病患者患有非酒精性脂肪性肝病（NAFLD），从脂肪变性到非酒精性脂肪性肝炎（NASH）和肝硬化不等，通常通过肝活检或血清标志物诊断。现在，MR 成像、MR 光谱或弹性成像等非侵入性成像测试具有新兴作用，这些测试可以提供定量信息，并有可能避免活检。肥胖的糖尿病患者也有患心血管疾病和癌症的风险。成像在早期检测心肌结构和功能异常方面具有新兴作用，不仅可以在亚临床阶段检测到，还可以在亚临床阶段检测到。目前仅推荐对乳腺癌、结肠癌、前列腺癌和宫颈癌进行癌症筛查。鉴于成像技术（如正电子发射断层扫描/CT（更快的扫描速度、更高的分辨率和更少的电离辐射））的广泛应用和进步，以及对分子生物学和风险分层的更好理解，越来越多的癌症在早期被发现，临床结果更好。在推荐对其他癌症进行基于人群的筛查之前，必须解决与成本、过度诊断和不必要的干预相关的问题。基于正在进行的成像研究，预计将有可能更精确地测量体脂，并在其发病早期更早地发现心血管疾病和癌症。
