1. To review the etiology and complications of metabolic syndrome 2. To understand the role of multimodality imaging in metabolic syndrome 3. To illustrate the utility of imaging in diagnosis of metabolic syndrome and assessment of target organ injury

• METABOLIC SYNDROME- Definition and criteria • CAUSES AND RISK FACTORS • ROLE OF IMAGING - Diagnosis, target organ injury assessment, biomarkers for novel therapy • MODALITIES- CT, MRI (including MR spectroscopy, Elastography, PET/MRI), nuclear medicine, Ultrasound, DXA • FAT ASSESSMENT - Subcutaneous abdominal fat - Visceral abdominal fat- US (thickness, fat index), CT (inc single slice CT ) MRI (FSE, chemical shift, fat selective), DXA - Parenchymal fat- MRS - Fat around organs- Eg. Pericardiac fat (echo, CT/MRI) - Fat around vessels- CT, MRI, 1H-MRS • INSULIN RESISTANCE - Intramyocellular lipid in skeletal muscle biopsy, 1H- MRS - Glucose metabolism using 18F-FDG PET, dynamic triple-tracer PET with 15O-H20, 11C-3-0-methylglucose, and 18F-FDG • TARGET ORGAN INJURY - Vessels- Atherosclerosis, elevated arterial stiffness- Doppler, CT, MRI - Cardiac- Dilation/hypertrophy, diastolic dysfunction, impaired strain, coronary atherosclerosis, ischemic heart disease- Echo, CT, MRI, Nuclear perfusion - Liver- Nonalcoholic fatty liver, cirrhosis- Ultrasound, CT, !H- MRS, Dixon MRI, 31P- MRS, MRI, MR Elastography, US elastography - Pancreas- Fatty disease- US, CT, MR, 1HMRS - Kidney- Chronic renal disease, renal stone- Ultrasound, CT, MRI, 99mTc-DTPA, dynamic CE- MRI, ASL-MRI, DWI, BOLD-MRI - Brain- Cognitive impairment, dementia, stroke- MRI, DTI, MTI, 18F-FDG PET • ALGORITHMIC APPROACH for diagnosis and target organ injury assessment