Tissue metabolism: fundamentals and advanced instrumental assessment

Tissue metabolism represents a complex, integrated system governing the energetic and plastic homeostasis of organs through the coordinated interaction of cellular biochemistry and systemic vascular supply. This review synthesises the fundamental concept of tissue metabolism, bridging various terminologies such as the microcirculatory-tissue system and perfusion-metabolic coupling, to emphasise its dual nature: intracellular metabolic pathways and substrate delivery via microcirculation. We detail the key stages of cellular energy metabolism (glycolysis, oxidative decarboxylation, the Krebs cycle, and oxidative phosphorylation), highlighting their plasticity and central role in health and disease. The critical importance of systemic support, particularly the function of the microcirculatory bed, is examined, including its regulatory rhythms. Further, we explore major pathological disruptions of tissue metabolism, including diabetes, mitochondrial dysfunction, neurodegenerative diseases, cancer metabolism (Warburg effect), ageing, and ischemia-hypoxia, underscoring the systemic consequences of metabolic imbalance. The second part provides a comprehensive overview of advanced instrumental methods for assessing tissue metabolism. A comparative analysis of radionuclide, magnetic resonance, mass spectrometry, optical, and other techniques is presented, outlining their physical principles, measured parameters, spatial-temporal resolutions, key advantages, limitations, and primary applications. This methodological survey demonstrates the powerful, multimodal toolkit available for non-invasive, high-resolution investigation of metabolic processes from the molecular to the organ level, offering critical insights for both fundamental research and clinical diagnostics.