Limited evidence for sympathetic neural overactivation in older patients with type 2 diabetes mellitus

Introduction: Mechanistic studies suggested that excess sympathetic activity promotes arterial hypertension while worsening insulin sensitivity. Older patients with type 2 diabetes are at particularly high cardiovascular and metabolic risk. However, data on sympathetic activity in this population is scarce. Methods: We studied 61 patients with type 2 diabetes mellitus (22 women, 60.9 ± 1.4 years; 39 men, 60.9 ± 1.4 years). They had to have diabetes for at least 2 years, a hemoglobin A1c of 6.5-10%, a body-mass-index of 20-40 kg/m2, and had to be treated with stable doses of metformin only. We recorded ECG, finger and brachial blood pressure, and muscle sympathetic nerve activity (MSNA). Results: MSNA was 37.5 ± 2.5 bursts/min in women and 39.0 ± 2.0 bursts/min in men (p = 0.55). MSNA expressed as burst incidence was 52.7 ± 2.0 bursts/100 beats in women and 59.2 ± 3.1 bursts/100 beats in men (p = 0.21). Five out of 39 men (12.8%) and two out of 22 women (9.1%) exhibited resting MSNA measurements above the 95th percentile for sex and age. In the pooled analysis, MSNA was not significantly correlated with systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, body composition, or HbA1c (r 2 0.26 for all). Discussion: We conclude that relatively few older patients with type 2 diabetes mellitus exhibit increased MSNA. The large interindividual variability in MSNA cannot be explained by gender, blood pressure, body mass index, or glycemic control

What scans we will read: imaging instrumentation trends in clinical oncology

Oncological diseases account for a significant portion of the burden on public healthcare systems with associated costs driven primarily by complex and long-lasting therapies. Through the visualization of patient-specific morphology and functional-molecular pathways, cancerous tissue can be detected and characterized non- invasively, so as to provide referring oncologists with essential information to support therapy management decisions. Following the onset of stand-alone anatomical and functional imaging, we witness a push towards integrating molecular image information through various methods, including anato-metabolic imaging (e.g., PET/ CT), advanced MRI, optical or ultrasound imaging. This perspective paper highlights a number of key technological and methodological advances in imaging instrumentation related to anatomical, functional, molecular medicine and hybrid imaging, that is understood as the hardware-based combination of complementary anatomical and molecular imaging. These include novel detector technologies for ionizing radiation used in CT and nuclear medicine imaging, and novel system developments in MRI and optical as well as opto-acoustic imaging. We will also highlight new data processing methods for improved non-invasive tissue characterization. Following a general introduction to the role of imaging in oncology patient management we introduce imaging methods with well-defined clinical applications and potential for clinical translation. For each modality, we report first on the status quo and point to perceived technological and methodological advances in a subsequent status go section. Considering the breadth and dynamics of these developments, this perspective ends with a critical reflection on where the authors, with the majority of them being imaging experts with a background in physics and engineering, believe imaging methods will be in a few years from now. Overall, methodological and technological medical imaging advances are geared towards increased image contrast, the derivation of reproducible quantitative parameters, an increase in volume sensitivity and a reduction in overall examination time. To ensure full translation to the clinic, this progress in technologies and instrumentation is complemented by progress in relevant acquisition and image-processing protocols and improved data analysis. To this end, we should accept diagnostic images as “data”, and – through the wider adoption of advanced analysis, including machine learning approaches and a “big data” concept – move to the next stage of non-invasive tumor phenotyping. The scans we will be reading in 10 years from now will likely be composed of highly diverse multi- dimensional data from multiple sources, which mandate the use of advanced and interactive visualization and analysis platforms powered by Artificial Intelligence (AI) for real-time data handling by cross-specialty clinical experts with a domain knowledge that will need to go beyond that of plain imaging

Investigation of the halo-artifact in 68Ga-PSMA-11-PET/MRI.

Combined positron emission tomography (PET) and magnetic resonance imaging (MRI) targeting the prostate-specific membrane antigen (PSMA) with a 68Ga-labelled PSMA-analog (68Ga-PSMA-11) is discussed as a promising diagnostic method for patients with suspicion or history of prostate cancer. One potential drawback of this method are severe photopenic (halo-) artifacts surrounding the bladder and the kidneys in the scatter-corrected PET images, which have been reported to occur frequently in clinical practice. The goal of this work was to investigate the occurrence and impact of these artifacts and, secondly, to evaluate variants of the standard scatter correction method with regard to halo-artifact suppression.Experiments using a dedicated pelvis phantom were conducted to investigate whether the halo-artifact is modality-, tracer-, and/or concentration-dependent. Furthermore, 31 patients with history of prostate cancer were selected from an ongoing 68Ga-PSMA-11-PET/MRI study. For each patient, PET raw data were reconstructed employing six different variants of PET scatter correction: absolute scatter scaling, relative scatter scaling, and relative scatter scaling combined with prompt gamma correction, each of which was combined with a maximum scatter fraction (MaxSF) of MaxSF = 75% or MaxSF = 40%. Evaluation of the reconstructed images with regard to halo-artifact suppression was performed both quantitatively using statistical analysis and qualitatively by two independent readers.The phantom experiments did not reveal any modality-dependency (PET/MRI vs. PET/CT) or tracer-dependency (68Ga vs. 18F-FDG). Patient- and phantom-based data indicated that halo-artifacts derive from high organ-to-background activity ratios (OBR) between bladder/kidneys and surrounding soft tissue, with a positive correlation between OBR and halo size. Comparing different variants of scatter correction, reducing the maximum scatter fraction from the default value MaxSF = 75% to MaxSF = 40% was found to efficiently suppress halo-artifacts in both phantom and patient data. In 1 of 31 patients, reducing the maximum scatter fraction provided new PET-based information changing the patient's diagnosis.Halo-artifacts are particularly observed for 68Ga-PSMA-11-PET/MRI due to 1) the biodistribution of the PSMA-11-tracer resulting in large OBRs for bladder and kidneys and 2) inaccurate scatter correction methods currently used in clinical routine, which tend to overestimate the scatter contribution. If not compensated for, 68Ga-PSMA-11 uptake pathologies may be masked by halo-artifacts leading to false-negative diagnoses. Reducing the maximum scatter fraction was found to efficiently suppress halo-artifacts

Respiratory motion compensation for simultaneous PET/MR based on highly undersampled MR data.

Purpose Positron emission tomography (PET) of the thorax region is impaired by respiratory patient motion. To account for motion, the authors propose a new method for PET/magnetic resonance (MR) respiratory motion compensation (MoCo), which uses highly undersampled MR data with acquisition times as short as 1 min/bed.Methods The proposed PET/MR MoCo method (4D jMoCo PET) uses radial MR data to estimate the respiratory patient motion employing MR joint motion estimation and image reconstruction with temporal median filtering. Resulting motion vector fields are incorporated into the system matrix of the PET reconstruction. The proposed approach is evaluated for the thorax region utilizing a PET/MR simulation with 1 min MR acquisition time and simultaneous PET/MR measurements of six patients with MR acquisition times of 1 and 5 min and radial undersampling factors of 11.2 and 2.2, respectively. Reconstruction results are compared to 3D PET, 4D gated PET and a standard MoCo method (4D sMoCo PET), which performs iterative image reconstruction and motion estimation sequentially. Quantitative analysis comprises the parameters SUVmean, SUVmax, full width at half-maximum/lesion volume, contrast and signal-to-noise ratio.Results For simulated PET data, our quantitative analysis shows that the proposed 4D jMoCo PET approach with temporal filtering achieves the best quantification accuracy of all tested reconstruction methods with a mean absolute deviation of 2.3% when compared to the ground truth. For measured PET patient data, the mean absolute deviation of 4D jMoCo PET using a 1 min MR acquisition for motion estimation is 2.1% relative to the 5 min MR acquisition. This demonstrates a robust behavior even in case of strong undersampling at MR acquisition times as short as 1 min. In contrast, 4D sMoCo PET shows considerable reduction of quantification accuracy for the 1 min MR acquisition time. Relative to 3D PET, the proposed 4D jMoCo PET approach with temporal filtering yields an average increase of SUVmean, SUVmax, and contrast of 29.9% and 13.8% for simulated and measured PET data, respectively.Conclusions Employing artifact-robust motion estimation enables PET/MR respiratory MoCo with MR acquisition times as short as 1 min/bed improving PET image quality and quantification accuracy

Statistical results for halo-artifact reduction of the different scatter correction variants.

<p>Statistical results for halo-artifact reduction of the different scatter correction variants.</p

Results of the visual evaluation and inter-reader agreement.

<p>Results of the visual evaluation and inter-reader agreement.</p

Effect of the halo-artifact on lesion quantification.

<p>PET images of the pelvis phantom in coronal slice orientation for the lesion quantification experiment using absolute (A) and relative (B) scatter scaling. Without the bladder insert, both lesions can be clearly identified. With bladder insert, a severe halo-artifact is observed using the default MaxSF = 75%, masking one of the two lesions. Quantitative numbers corresponding to the reconstructions shown are given in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0183329#pone.0183329.t001" target="_blank">Table 1</a>. SF specifies the scatter fraction for each case.</p