Monitoring of liver glycogen synthesis in diabetic patients using carbon-13 MR spectroscopy

To investigate the relationship between liver glucose, glycogen, and plasma glucose in diabetic patients, in vivo liver carbon-13 magnetic resonance spectroscopy (¹³C MRS) with a clinical 3.0 T MR system was performed. Subjects were healthy male volunteers (n = 5) and male type-2 diabetic patients (n = 5). Pre- and during oral glucose tolerance tests (OGTT), ¹³C MR spectra without proton decoupling were acquired in a monitoring period of over 6 h, and in total seven spectra were obtained from each subject. For OGTT, 75 g of glucose, including 5 g of [1-¹³C]glucose, was administered. The MR signals of liver [1-¹³C]glucose and glycogen were detected and their time-course changes were assessed in comparison with the plasma data obtained at screening. The correlations between the fasting plasma glucose level and liver glycogen/glucose rate (Spearman: ρ = -0.68, p < 0.05, n = 10) and the fasting plasma glucose level and liver glycogen peak/fasting rate (Spearman: ρ = -0.67, p < 0.05, n = 10) indicated that ¹³C MRS can perform noninvasive measurement of glycogen storage/degradation ability in the liver individually and can assist in tailor-made therapy for diabetes. In conclusion, ¹³C MRS has a potential to become a powerful tool in diagnosing diabetes multilaterally.