Category: Lab Tests and Imaging

Categories : Cardiovascular Disease Lab Tests and ImagingTags :

Spotting Blood Clots Before They Strike

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Thrombophilia. Credit: Scientific Animations CC4.0.

Researchers from the University of Tokyo have found a way to observe clotting activity in blood as it happens – without needing invasive procedures. Using a new type of microscope and artificial intelligence (AI), their study shows how platelet clumping can be tracked in patients with coronary artery disease (CAD), opening the door to safer, more personalised treatment.

“Platelets play a crucial role in heart disease, especially in CAD, because they are directly involved in forming blood clots,” explained Dr Kazutoshi Hirose, an assistant professor at the University of Tokyo Hospital and lead author of the study in Nature Communications. “To prevent dangerous clots, patients with CAD are often treated with antiplatelet drugs. However, it’s still challenging to accurately evaluate how well these drugs are working in each individual, which makes monitoring platelet activity an important goal for both doctors and researchers.”

That challenge pushed Hirose and his collaborators to develop a new system for monitoring platelets in motion, using a high-speed optical device and artificial intelligence.

“We used an advanced device called a frequency-division multiplexed (FDM) microscope, which works like a super high-speed camera that takes sharp pictures of blood cells in flow,” said co-author Yuqi Zhou, an assistant professor of chemistry at the University of Tokyo . “Just like traffic cameras capture every car on the road, our microscope captures thousands of images of blood cells in motion every second. We then use artificial intelligence to analyse those images. The AI can tell whether it’s looking at a single platelet (like one car), a clump of platelets (like a traffic jam), or even a white blood cell tagging along (like a police car caught in the jam).”

The research team applied this technique to blood samples from over 200 patients. Their images revealed that patients with acute coronary syndrome had more platelet aggregates than those with chronic symptoms – supporting the idea that this technology can track clotting risk in real time.

“Part of my scientific curiosity comes from the recent advances in high-speed imaging and artificial intelligence, which have opened up new ways to observe and analyse blood cells in motion,” said Keisuke Goda, a professor of chemistry at the University of Tokyo who led the research team. “AI can ‘see’ patterns beyond what the human eye can detect.”

One of the most important findings was that a simple blood drawn from the arm – rather than from the heart’s arteries – provided nearly the same information.

“Typically, if doctors want to understand what’s happening in the arteries, especially the coronary arteries, they need to do invasive procedures, like inserting a catheter through the wrist or groin to collect blood,” said Hirose. “What we found is that just taking a regular blood sample from a vein in the arm can still provide meaningful information about platelet activity in the arteries. That’s exciting because it makes the process much easier, safer and more convenient.”

The long-term hope is that this technology will help doctors better personalise heart disease treatment.

“Just like some people need more or less of a painkiller depending on their body, we found that people respond differently to antiplatelet drugs. In fact, some patients are affected by recurrent thrombosis and others are suffering from recurrences of bleeding events even on the same antiplatelet medications,” said Hirose. “Our technology can help doctors see how each individual’s platelets are behaving in real time. That means treatments could be adjusted to better match each person’s needs.”

“Our study shows that even something as small as a blood cell can tell a big story about your health,” Zhou added.

Source: University of Tokyo

Categories : Lab Tests and Imaging Neurodegenerative DiseasesTags :

Protein Clues in the Hunt for the Cause of Frontotemporal Dementia

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Photo by Bill Oxford on Unsplash

Dementia usually affects older people, so when it occurs in middle age, it can be hard to recognise. The most common form is frontotemporal dementia (FTD), which is often mistaken for depression, schizophrenia, or Parkinson’s disease before the correct diagnosis is reached.

Now, as part of an NIH-funded study, researchers at UC San Francisco have found some clues about how FTD develops that could lead to new diagnostics and get more patients into clinical trials. The findings appear in Nature Aging on May 16.

The team measured more than 4000 proteins found in spinal tap fluid from 116 FTD patients and compared them to those from 39 of their healthy relatives. All 116 patients had inherited forms of FTD, enabling researchers to study the disease in living people with confirmed diagnosis, something that isn’t possible in non-inherited FTD cases, which can only be confirmed after death.

The composition of the proteins that changed in FTD suggest that these patients have problems with RNA regulation along with defects that affect connections in their brains. These proteins, researchers think, could be the first specific markers for FTD that emerge as the disease develops in middle age.

FTD is the most common form of dementia for people under 60. Because it occurs in younger people, it is often misdiagnosed as depression, early-onset Alzheimer’s, Parkinson’s, or a psychiatric condition. It takes an average of 3.6 years for patients to get an accurate diagnosis. There is no cure, and there are no treatments to slow or stop disease progression. It is distinct from Alzheimer’s in 3 major ways:

  • FTD features a gradual decline in behavior, language, or movement, but memory is intact.
  • It usually strikes younger people, between 45 and 65 years of age, and is less likely to strike after 65.
  • It’s less common, affecting 60 000 people in the U.S. (Alzheimer’s affects 6.7 million Americans).

“FTD affects people in the prime of their lives, stripping them of their independence,” said Rowan Saloner, PhD, professor in the UCSF Memory and Aging Center and corresponding author of the paper. “But there’s no definitive way to diagnose it in living patients, unlike other dementias like Alzheimer’s disease.”

“If we’re able to identify FTD early on, perhaps using some of the proteins we’ve identified, we can direct patients to the right resources, get them into the right therapeutic trials, and, ultimately, we hope, provide them with precision treatments.”

Source: University of California – San Francisco

Categories : Lab Tests and ImagingTags :

Medical Imaging Experts can Outsmart Optical Illusions

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Photo by Anna Shvets

Medical imaging experts are adept at solving common optical illusions, according to research from four UK universities, including the University of East Anglia. The correct analysis of medical images from scans, such as MRI, is critical for diagnosing cancer and many other conditions.

A new study published in Scientific Reports shows that people who do this professionally are also more accurate at judging the size of objects in common optical illusions.

In other words, medical imaging experts also literally see better in everyday life!

The research is also the first to show that people can be trained to do better at solving visual illusions, which was previously thought to be near-impossible.

Senior researcher Dr Martin Doherty, from UEA’s School of Psychology, said: “Optical illusions are designed to fool the brain. They can be a bit of fun, but they also help researchers shed light on how our brains works.

“We wanted to better understand whether people who are very experienced and skilled in visual recognition, do better at solving optical illusions.”

Participants were shown a series of visual illusions that made it hard to correctly judge the size of two similar objects – and asked to identify the larger one.

The object size differences varied, giving the research team an estimate of how much participants’ judgements were affected by the illusions.

They tested 44 radiographers and radiologists and compared their scores with a control group of 107 non-experts.

First author Dr Radoslaw Wincza, from the School of Medicine and Dentistry at University of Central Lancashire, said: “Many illusions are effective even if you know it is an illusion, and until now it was generally believed you could not train yourself to avoid the illusory effects.

“But this research suggests that training aimed at accurately perceiving objects in medical images has the effect of making experts less susceptible to visual illusions.

“This is the first time that it’s been shown that people can be trained to do better at solving visual illusions. And they could perhaps even be used for training medical image analysts in future.

“This is particularly important, given that 60 to 80 per cent of diagnostic errors are perceptual in nature,” he added.

Source: University of East Anglia

Categories : Lab Tests and Imaging Neurodegenerative DiseasesTags :

New Biomarker for Parkinson’s Disease Discovered in CSF

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A misfolded protein facilitates reliable diagnosis even in the early stages of Parkinson’s disease in body fluids.

Source: CC0

Parkinson’s disease is a neurodegenerative disorder that is usually diagnosed in its late stage on the basis of clinical symptoms, mainly motor disorders. By this point, however, the brain is already severely and irreparably damaged. Moreover, diagnosis is difficult and often incorrect because the disease takes many forms and symptoms overlap with other disorders.

Researchers from the PRODI Center for Protein Diagnostics at Ruhr University Bochum, Germany, and the biotech company betaSENSE have now discovered a biomarker in cerebrospinal fluid (CSF) that facilitates a reliable diagnosis at an early stage and can shed light on the progression of the disease and the effect of a therapy. They report their findings in the journal EMBO Molecular Medicine.

Parkinson’s disease – an unstoppable condition

Parkinson’s disease is characterised by the loss of dopaminergic nerve cells in the brain, typically leading to increasing motor impairments as the symptoms progress. Dopamine supplements can compensate for the loss and temporarily alleviate the symptoms. The misfolding of the key protein alpha-synuclein (αSyn) from α-helical structures to β-sheet-rich structures plays a crucial role in the development of Parkinson’s disease. “These misfoldings make the protein sticky, leading to the formation of larger complexes, so-called oligomers. The oligomers then produce long fibrillar filaments and cause the aggregation of these filaments into macroscopically large Lewy bodies in the brain,” explains Professor Klaus Gerwert, founding and managing director at PRODI and CEO of betaSENSE.

Advanced platform technology

In two independent clinical cohorts with a total of 134 participants, the Bochum-based researchers showed that, with a sensitivity and specificity of well over 90%, this misfolding of αSyn in body fluids is a viable biomarker for the diagnosis of Parkinson’s disease. The research was conducted using cerebrospinal fluid samples from patients at the Parkinson’s centres in Bochum (St. Josef Hospital, Professor Lars Tönges, Professor Ralf Gold) and Kassel (Paracelsus-Elena-Klinik, Dr. Sandrina Weber, Professor Brit Mollenhauer). The measurements were carried out using the patented iRS (immuno-infrared sensor) technology from betaSENSE GmbH.

betaSENSE has already successfully implemented the iRS technology for diagnosing Alzheimer’s disease. In this case, it was shown that the misfolding of the biomarker Aβ can indicate the risk of Alzheimer’s dementia at a later stage with high accuracy up to 17 years before clinical diagnosis. “We have now transferred this approach to Parkinson’s for the misfolding of αSyn,” stresses Klaus Gerwert.

Development of Parkinson’s drugs

In addition to diagnostic applications, the technology can also help to develop new active substances and prove their efficacy in clinical trials.

Source: Ruhr-University Bochum

Categories : Cancer Lab Tests and ImagingTags :

Preventing Unnecessary Pancreatic Cancer Surgery

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Pancreatic cancer. Credit: Scientific Animations CC BY-SA 4.0

Pancreatic cysts are fluid-filled sacs that can form in the pancreas. Some remain benign, while others have the potential to develop into pancreatic cancer. A recent study, which followed 257 patients in Japan for an average of five years, showed that the presence or absence of invasive nodules in pancreatic cysts is key to assessing whether these cysts are benign or cancerous.

The findings, published in the journal Annals of Surgery, may help patients diagnosed with a high risk of pancreatic cancer to avoid unnecessary surgery.

Pancreatic cancer is one of the most life-threatening and rapidly growing cancers. Pancreatic cysts, known as pancreatic intraductal papillary mucinous neoplasms (IPMNs), are gaining attention as one of the precursors of the cancer that can be identified by radiological imaging. In this context, patients diagnosed with pancreatic cysts are referred for further evaluation, and if they meet the criteria for being at particularly high risk of developing cancer, called high-risk stigmata, they are often recommended for surgery.

However, it was not clear whether all patients who met the criteria would need to undergo surgery. “In fact, among patients who underwent surgery, there were a number of cases where pathological examination results showed that their IPMNs were still benign and had not progressed to cancer,” explained Ryohei Kumano from Nagoya University, the first author of the study. “Pancreatic surgery is a significant burden for patients, so we wanted to find a more accurate way to diagnose whether their IPMNs are benign or cancerous in order to avoid unnecessary surgery.”

A research group consisting of Professor Hiroki Kawashima and Dr Kumano from Nagoya University Graduate School of Medicine, Professor Eizaburo Ohno from Fujita Health University, and their colleagues focused on the presence or absence of invasive nodules in 257 IPMN patients with high-risk stigmata. The researchers evaluated the prognosis of the patients with and without these nodules.

Invasive nodules, solid growths within cysts that have begun to invade surrounding tissues, are difficult to detect with a conventional method that uses a CAT scan. Therefore, the researchers instead used contrast-enhanced endoscopic ultrasound, which is thought to detect invasive nodules more accurately.

To track the prognosis of patients with and without invasive nodules between surgical and non-surgical groups, the researchers followed them for an average of about five years (ranging from 6 months to 24 years, depending on the patient).

The results showed that the presence or absence of invasive nodules had a significant impact on their survival. For patients with invasive nodules, undergoing surgery had a positive effect on improving their survival. On the other hand, most patients without invasive nodules had a favorable outcome even without surgery. 

Endoscopic ultrasound (EUS) enables differentiation between non-invasive and invasive nodules within IPMN, providing crucial information for surgical decision making. (Credit: Ryohei Kumano) 

In this study, a total of 21 patients who did not have invasive nodules opted for clinical monitoring instead of surgery. Notably, their five-year survival rates were 84.7% for overall survival and 100% for disease-specific survival.

In addition, in patients at higher risk for surgery, such as the elderly, there was little difference in survival rates between patients who underwent surgery and those who did not, if they had no invasive nodules. “Avoiding surgery, especially in such patients, seems to be a reasonable treatment strategy, given the fact that pancreatic surgery is highly invasive, carries a high risk of complications, and requires a long recovery period,” Kumano said.  

“We expect that our findings will contribute to future clinical guidelines for IPMNs, leading to more accurate cancer diagnosis and optimised treatment selection.”

Source: Nagoya University

Categories : Lab Tests and ImagingTags :

Simpler Blood Glucose Monitoring to Delay or Prevent Onset of Diabetes

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The highs and lows of blood glucose aren’t just an energy rollercoaster; they could be a key to detecting diabetes risk early and spare a needle prick or two.

Researchers at the University of Tokyo have identified a simple, noninvasive method for assessing blood glucose regulation – an essential factor in diabetes risk. Their approach, based on continuous glucose monitoring (CGM) data, could improve early detection and risk assessment for diabetes without relying on blood samples and expensive or complex procedures.

The study is published in Communications Medicine.

Often called a “silent epidemic,” diabetes is an increasingly prevalent global health concern, with significant health and economic consequences. Early detection of impaired glucose regulation – an intermediate stage between normal blood glucose levels and diabetes – is essential for preventing or delaying the onset of Type 2 diabetes. Conventional diagnostic tools, however, often miss early signs because they rely on periodic blood samples rather than continuous monitoring.

“Traditional diabetes tests, while useful, do not capture the dynamic nature of glucose regulation under physiological conditions,” said Shinya Kuroda, a professor at the University of Tokyo’s Graduate School of Science and co-author of the current study.

To find a more practical alternative, the team turned to CGM, a wearable technology that continuously tracks glucose levels in real time, providing a clearer picture of blood glucose fluctuations in everyday life. Their goal was to identify a CGM-based method for estimating glucose handling capacity, which maintains stable levels, without invasive procedures.

The team analyzed 64 individuals without a prior diabetes diagnosis, using a CGM device, oral glucose tolerance tests (OGTT), and clamp tests that are used to assess insulin sensitivity and glucose metabolism. They then validated their findings with an independent dataset and mathematical simulations.

Their analysis showed that AC_Var, a measure of glucose-level fluctuations, strongly correlates with the disposition index, a well-established predictor of future diabetes risk. Moreover, the researchers’ model, which combines AC_Var with glucose standard deviation, outperformed traditional diabetes markers – such as fasting blood glucose, HbA1c and OGTT results – in predicting the disposition index.

“By analysing CGM data with our new algorithm, we identified individuals with impaired glycaemic control – even when standard diagnostic tests classified them as ‘normal,’” said Kuroda. “This means we can potentially detect issues much earlier, creating an opportunity for preventive interventions before diabetes is diagnosed.”

The team also showed that the method was more accurate than conventional diagnostic indicators in predicting diabetes complications such as coronary artery disease. To facilitate broader access to this approach, the research team has developed a web application that allows individuals and health care providers to easily calculate these CGM-based indices.

“Our ultimate goal is to provide a practical, accessible tool for widespread diabetes screening,” Kuroda said. “By enabling early detection of glucose regulation abnormalities, we hope to prevent or delay disease onset and reduce long-term complications.”

Source: University of Tokyo

Categories : Cancer Lab Tests and ImagingTags :

Cancer Risk from CT Scans up to Four Times Higher than Previous Estimates

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Computed tomography (CT) scans may account for 5% of all cancers annually, according to a new study out of UC San Francisco that cautions against overusing and overdosing CTs. For children, the greatest risk comes from scans of the head.

The danger is greatest for infants, followed by children and adolescents. But adults are also at risk, since they are the most likely to get scans. In the U.S., nearly 103 000 cancers are predicted to result from the 93 million CT scans that were performed in 2023 alone. This is 3 to 4 times more than previous assessments, the authors said.

“CT can save lives, but its potential harms are often overlooked,” said first author Rebecca Smith-Bindman, MD, a UCSF radiologist and professor of epidemiology and biostatistics and obstetrics, gynaecology and reproductive sciences.

“Given the large volume of CT use in the United States, many cancers could occur in the future if current practices don’t change,” said Smith-Bindman.

“Our estimates put CT on par with other significant risk factors, such as alcohol consumption and excess body weight,” she said. “Reducing the number of scans and reducing doses per scan would save lives.”

Benefits and potential dangers

CT is both indispensable and widely used to detect tumours and diagnose many illnesses. Since 2007, the number of annual CT exams has surged by 30% in the U.S. But the ionising radiation dose from CT is a known cancer risk.

To assess the public health impact of current CT use, the study estimates the total number of lifetime cancers associated with radiation exposure in relation to the number and type of CT scans performed in 2023.

“Our approach used more accurate and individualised CT dose and utilisation data than prior studies, allowing us to produce more precise estimates of the number of radiation-induced cancers,” said co-author Diana Miglioretti, PhD, a breast cancer researcher and division chief of biostatistics at UC Davis. “These updated estimates suggest the excess risks – particularly among the youngest children – are higher than previously recognised.”

Researchers analysed 93 million exams from 61.5 million patients in the U.S. The number of scans increased with age, peaking in adults between 60 to 69 years old. Children accounted for 4.2% of the scans. The researchers excluded testing in the last year of a patient’s life because it was unlikely to lead to cancer.

Future cancers from radiation exposure

Adults 50 to 59 had the highest number of projected cancers: 10 400 cases for women, 9300 for men. The most common adult cancers were lung, colon, leukaemia, bladder and breast. The most frequently projected cancers in children were thyroid, lung and breast.

The largest number of cancers in adults would come from CTs of the abdomen and pelvis, while in children they came from CTs of the head. Projected cancer risks were highest among those who underwent CT when they were under 1 year old. They were 10 times more likely to get cancer compared to others in the study.

The researchers said some CT scans are unlikely to help patients, and are overused, such as those for upper respiratory infections or for headaches without concerning signs or symptoms. They said patients could lower their risk by getting fewer of these scans or by getting lower dose scans.

“There is currently unacceptable variation in the doses used for CT, with some patients receiving excessive doses,” Smith-Bindman said.

Co-author Malini Mahendra, MD, a UCSF assistant professor of Pediatric Critical Care, said it was important that families understand the risk of developing cancer from paediatric scans.

“Few patients and their families are counselled about the risk associated with CT examinations,” she said. “We hope our study’s findings will help clinicians better quantify and communicate these cancer risks, allowing for more informed conversations when weighing the benefits and risks of CT exams.”

Source: University of California – San Francisco

Categories : Healthcare Politics and Regulations Lab Tests and ImagingTags :

SAHPRA Joins the Medical Device Single Audit Programme

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Photo by Jo McNamara

The South African Health Products Regulatory Authority (SAHPRA) has joined the Medical Device Single Audit Programme (MDSAP), an international audit programme of medicines and medical device regulators aimed at improving efficiencies in the regulation of medical device manufacturers by engaging in work sharing and collaboration. SAHPRA joins MDSAP as an affiliate member, which expands its ability to monitor the manufacturing of medical devices beyond South Africa’s borders.

The MDSAP membership will result in the improved regulation of medical devices and in-vitro diagnostics (IVDs) as it increases SAHPRA regulatory reach and ensures that SAHPRA can leverage the resources of other regulators that participate in the MDSAP to both audit and monitor adherence to quality standards by medical device manufacturers in several countries globally.

“SAHPRA’s admission into MDSAP signals progress in our strategy to ensure the efficient application of our own resources and those of our peers globally in safeguarding the quality, efficacy and safety of medical devices and in-vitro diagnostics (IVDs) used by the South African public,” says Dr Boitumelo Semete-Makokotlela, SAHPRA Chief Executive Officer.

Dr Semete-Makokotlela says that the admission to MDSAP adds to individual agreements for both monitoring and regulatory reliance that SAHPRA already has in place with several regulators the world over, and would thus improve SAHPRA’s quality assurance abilities and has the potential to increase turnaround times in reviewing and approving key medical devices manufactured elsewhere in the world.

Categories : Lab Tests and Imaging Neurodegenerative DiseasesTags :

Could a Blood Test Rule out Future Dementia Risk?

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Researchers at Karolinska Institutet have demonstrated how specific biomarkers in the blood can predict the development of dementia up to 10 years before diagnosis with high accuracy, among older adults living independently in the community.

A new study, published in Nature Medicine, has investigated the potential of specific biomarkers such as tau217, Neurofilament Light (NfL), and Glial Fibrillary Acidic Protein (GFAP) to predict the occurrence of dementia, including Alzheimer’s disease, up to ten years before an actual diagnosis in cognitively healthy older adults living in the community. 

Blood samples from more than two thousand

Previous research has suggested that these biomarkers could be useful in early dementia diagnostics, but most studies involved individuals who have already sought medical care for cognitive issues, due to cognitive concerns or cognitive symptoms, such as memory difficulties. 

A larger, community-based study, was necessary to determine the predictive value of biomarkers in the general population.

Led by researchers from the Aging Research Center of Karolinska Institutet in collaboration with SciLifeLab and KTH Royal Institute of Technology in Stockholm, the study analysed blood biomarkers in more than 2100 adults aged 60+, who were followed over time to determine if they developed dementia.

At a follow-up ten years later, 17% of participants had developed dementia. The accuracy of the biomarkers used in the study was found to be up to 83%.

“This is an encouraging result, especially considering the 10-year predictive window between testing and diagnosis. It shows that it is possible to reliably identify individuals who develop dementia and those who will remain healthy,” says Giulia Grande, assistant professor at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and first author of the study.

Promising biomarkers

“Our findings imply that if an individual has low levels of these biomarkers, their risk of developing dementia over the next decade is minimal”, explains Davide Vetrano, associate professor at the same department and the study’s senior author. “This information could offer reassurance to individuals worried about their cognitive health, as it potentially rules out the future development of dementia.”

However, the researchers also observed that these biomarkers had low positive predictive values, meaning elevated biomarker levels alone could not reliably identify individuals who would surely develop dementia within the next ten years. Therefore, the study authors advise against widespread use of these biomarkers as screening tools in the population at this stage.

“These biomarkers are promising, but they are currently not suitable as standalone screening tests to identify dementia risk in the general population,” says Davide Vetrano. 

The researchers also noted that a combination of the three most relevant biomarkers – p-tau217 with NfL or GFAP – could improve predictive accuracy.

“Further research is needed to determine how these biomarkers can be effectively used in real-world settings, especially for elderly living in the community or in primary health care services,” says Grande.

“We need to move a step further and see whether the combination of these biomarkers with other clinical, biological or functional information could improve the possibility of these biomarkers to be used as screening tools for the general population”, Grande continues.

The study was mainly funded by the Swedish Research Council, The Swedish Brain Foundation and The Strategic Research Area in Epidemiology and Biostatistics at Karolinska Institutet. The researchers declare that there are no conflicts of interest.

Source: Karolinska Institutet

Categories : Lab Tests and Imaging Metabolic DisordersTags :

Radiology’s Role in the Diagnosis and Management of Diabetic Complications

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SCP -Using modern CT technology, radiologists can search for narrowed arteries in various parts of the body, including the neck and brain. This process is called CT angiography.

Radiology provides crucial insights into the complications caused by diabetes, allowing for timely diagnosis, effective management and monitoring of disease progression. Early detection of these complications can significantly improve patient outcome and quality of life.

What is diabetes?

Diabetes is known as a ‘silent killer’ because it is quite often asymptomatic at the onset. Diabetes, a major lifestyle disorder, has become one of the most dangerous and common diseases in the world. It is a chronic disease that causes high blood sugar levels and occurs when the body doesn’t produce enough insulin or use insulin properly.

Types of diabetes

  • Type 1 diabetes: The body’s immune system destroys the cells that produce insulin
  • Type 2 diabetes: The body doesn’t produce enough insulin or the body’s cells don’t react to insulin as they should
  • Gestational diabetes: Sometimes occurs during pregnancy when the placenta releases hormones that cause insulin resistance. This tampers with the expectant mom’s blood sugar level, changing the amount of glucose in the blood

Around 4.2 million people in South Africa have diabetes – 90% of whom have type 2 diabetes, a lifestyle disease exacerbated by dietary factors, coupled with too little physical activity and high levels of obesity.

Dr Jean de Villiers, senior partner and radiologist at SCP Radiology, discusses the imaging techniques used to identify and manage complications of diabetes.

Cardiovascular Disease: People with diabetes are at higher risk of developing heart disease and other cardiovascular problems. Imaging techniques such as CT angiography can be used to assess the heart’s blood vessels and detect issues such as atherosclerosis, coronary artery narrowing or blockage of the arteries. CT angiography is also used for the neck, arm and leg arteries, as well as the arteries to the gut.

Stroke: Diabetes increases the risk of stroke by damaging blood vessels through high blood sugar levels, leading to the formation of fatty deposits and clots within the arteries. This can increase the chance of clot formation and block blood flow to the brain and cause a stroke. Imaging techniques such as MRI, CT scans, and ultrasound may be able to detect these fatty deposits in the arteries. The deposits are generally seen as areas of narrowing in the involved arteries or calcification of the walls of the arteries.

Blood vessel damage: Chronic high blood sugar levels can directly damage the lining of blood vessels, making them more susceptible to inflammation and clot formation. Essentially, the excess glucose in the blood weakens and stiffens the blood vessel walls, making them more prone to blockages. CT or MRI scans can be critical in identifying and assessing strokes, transient ischemic attacks (TIAs) or other cerebrovascular issues in diabetic patients.

High blood pressure association: People with diabetes often also have high blood pressure, which can exacerbate the damage to blood vessels and increases stroke risk.  A CT of the coronary arteries is used to visualise blockages in the coronary blood vessels and assess the severity of atherosclerosis in diabetic patients. This helps in planning for interventions like stent placement or bypass surgery.

Kidney disease: Diabetes affects your kidneys by potentially damaging the blood vessels within the kidneys due to high blood sugar levels. This can lead to impaired kidney function, causing the kidneys to leak protein into the urine and eventually progressing to chronic kidney disease if left uncontrolled. This condition is often referred to as ‘diabetic nephropathy.’

Diabetic nephropathy can lead to kidney damage and radiology plays a role in assessing kidney size, structure and function. Renal ultrasound can help assess kidney size and detect signs of chronic kidney disease (CKD). In advanced cases, a CT scan or MRI can be used to further evaluate the kidneys for the presence of complications such as renal artery stenosis or renal scarring.

Diabetic neuropathy: Diabetic neuropathy is a complication of diabetes where high blood sugar levels damage nerves throughout the body.  Most commonly affected are the nerves in the legs and feet, leading to symptoms like numbness, tingling, pain and sometimes muscle weakness.  It can also impact internal organs, depending on which nerves are affected and is considered a serious diabetes complication that can affect up to 50% of diabetics.

While radiology is not typically used for direct diagnosis of diabetic neuropathy, it can help rule out other causes of neuropathy. MRI and CT scans can assess for structural issues, such as spinal problems or other nerve impingements that may be contributing to symptoms.

Infections: Diabetic patients have a higher susceptibility to infections due to impaired immune response.

Diabetic foot ulcers and infections: Over time, high blood sugar levels damage nerves, blood vessels and skin in the feet. Damaged nerves can cause loss of feeling in the feet, while damaged blood vessels slow blood flow to the feet, preventing the healing of injuries.

Imaging techniques like CT, MRI and ultrasound are useful for detecting and monitoring bone and soft tissue infections. These can be critical for determining the appropriate course of antibiotic treatment or surgical intervention. X-rays, CT and MRI can be used to assess for infection in diabetic foot, such as ulcers, osteomyelitis or abscesses that may progress to amputation if left untreated.

Liver disease: Non-alcoholic fatty liver disease (NAFLD) is commonly seen in diabetic patients. Ultrasound is the primary tool for detecting fatty liver, while CT and MRI may offer further details on liver fat content or cirrhosis. Regular monitoring through imaging can help prevent more severe liver damage.

Osteoporosis: Long-term diabetes, especially type 1, can increase the risk of osteoporosis due to lower bone density. A DEXA scan helps assess bone mineral density (BMD), aiding in the early detection of osteoporosis and providing information on fracture risk.

‘As with any lifestyle disease, prevention is best. However, second to this is early detection and timely diagnosis, effective management and monitoring of the disease,’ says Dr de Villiers. ‘In the case of diabetes, we work with physicians and patients to detect possible complications early enough to help improve medical care, monitor treatment response and ultimately, improve quality of life.’