Introduction
Metabolic syndrome (MetS) is one of the most serious health conditions worldwide, which is associated with increased cardiocerebrovascular disease and all-cause mortality1. Although the definition of MetS is controversial and has been changed, its main components are central obesity, dyslipidemia, elevated arterial blood pressure, and dysregulated glucose homeostasis or insulin resistance2. The main factor of its pathophysiology is focused on central obesity, which is a marker of dysfunctional adipose tissues inducing insulin resistance and systemic inflammation, thus resulting in the final presentation of several diseases3. It is crucial to identify and assess the individuals prone to MetS for intervening with the pathologic course.
Interestingly, a unique population of obese individuals has been defined as “metabolically healthy, but obese (MHO)”; these individuals show a healthy metabolic profile despite having phenotypes of obesity4,5. Several studies have shown that mortality risk in MHO individuals is comparable to that of “metabolically unhealthy and obese (MUO)” individuals and that a significant portion of MHO eventually develop metabolic abnormalities6-10. Therefore, understanding and characterizing features that can enhance the aggravating effect of obesity to metabolic health is important.
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F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been the main tool for tumor imaging in oncology. However, due to the ability to represent the physiologic metabolic state of the entire body in vivo, there have been several attempts to use FDG PET/CT for non-tumor imaging biomarkers. For example, measuring the adipose tissue metabolism using FDG PET/CT has been attempted to represent the functional state of adipose tissues11-13. In addition, the metabolic activity of organs, such as blood pool, liver, and spleen, has been investigated with several other diseases related to systemic inflammation or metabolic state14,15. Among these, the blood pool activity has been considered as a reference organ which could be used to correct or normalize the metabolic activity across the oncologic imaging16. However, the blood pool activity could differ with metabolic states17. Therefore, instead of being a reference organ, the blood pool activity itself could be the possible parameter reflecting the metabolic status.
In this study, we investigated the metabolic activity of adipose tissue and blood pool using FDG PET/CT with parameters related to metabolic syndrome and obesity status to evaluate the possible imaging biomarkers for MetS.
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