Severely increased albuminuria in patients with type 2 diabetes mellitus is associated with increased subclinical atherosclerosis in femoral arteries with Na [18F]F activity as a proxy - The DETERMINE study.

BACKGROUND AND AIMS: Sodium [18F]fluoride (Na [18F]F) positron emission tomography imaging allows detailed visualization of early arterial micro-calcifications. This study aims to investigate atherosclerosis manifested by micro-calcification, macro-calcification, and aortic stiffness in patients with type 2 diabetes mellitus (T2DM) with and without albuminuria and severely decreased kidney function. METHODS: A cohort was stratified in four groups (N = 10 per group), based on KDIGO categories (G1-5 A1-3). G1-2A1 non-diabetic controls (median [IQR] estimated glomerular filtration rate (eGFR) in mL/min/1.73 m2 91 [81-104]), G1-2A1 with T2DM (eGFR 87 [84-93], and albumin-creatinin-ratio (ACR) in mg/mmol 0.35 [0.25-0.75]), G1-2A3 with T2DM (eGFR 85 [60-103], and ACR 74 [62-122], and G4A3 with T2DM (eGFR 19 [13-27] and ACR 131 [59-304]). RESULTS: Na [18F]F femoral artery grading score differed significantly in the groups with the highest Na [18F]F activity in A3 groups with T2DM (G1-2A3 with T2DM 228 [100-446] and G4A3 with T2DM 198 [113-578]) from the lowest groups of the G1-2A1 with T2DM (33 [0-93]) and in G1-2A1 non-diabetic controls (75 [0-200], p = 0.001). Aortic Na [18F]F activity and femoral artery computed tomography (CT)-assessed macro-calcification was increased in G4A3 with T2DM compared with G1-2A1 with T2DM (47.5 [33.8-73.8] vs. 17.5 [8.8-27.5] (p = 0.006) and 291 [170-511] vs. 12.2 [1.41-44.3] mg (p = 0.032), respectively). Carotid-femoral pulse wave velocity (PWV)-assessed aortic stiffness was significantly higher in both A3 groups with T2DM compared with G1-2A1 with T2DM (11.15 and 12.35 vs. 8.86 m/s, respectively (p = 0.009)). CONCLUSIONS: This study indicates that the presence of severely increased albuminuria in patients with T2DM is cross-sectionally associated with subclinical arterial disease in terms of micro-calcification and aortic stiffness. Additional decrease in kidney function was associated with advanced macro-calcifications.

Systematic assessment of coronary calcium detectability and quantification on four generations of CT reconstruction techniques: a patient and phantom study.

In computed tomography, coronary artery calcium (CAC) scores are influenced by image reconstruction. The effect of a newly introduced deep learning-based reconstruction (DLR) on CAC scoring in relation to other algorithms is unknown. The aim of this study was to evaluate the effect of four generations of image reconstruction techniques (filtered back projection (FBP), hybrid iterative reconstruction (HIR), model-based iterative reconstruction (MBIR), and DLR) on CAC detectability, quantification, and risk classification. First, CAC detectability was assessed with a dedicated static phantom containing 100 small calcifications varying in size and density. Second, CAC quantification was assessed with a dynamic coronary phantom with velocities equivalent to heart rates of 60-75 bpm. Both phantoms were scanned and reconstructed with four techniques. Last, scans of fifty patients were included and the Agatston calcium score was calculated for all four reconstruction techniques. FBP was used as a reference. In the phantom studies, all reconstruction techniques resulted in less detected small calcifications, up to 22%. No clinically relevant quantification changes occurred with different reconstruction techniques (less than 10%). In the patient study, the cardiovascular risk classification resulted, for all reconstruction techniques, in excellent agreement with the reference (κ = 0.96-0.97). However, MBIR resulted in significantly higher Agatston scores (61 (5.5-435.0) vs. 81.5 (9.25-435.0); p < 0.001) and 6% reclassification rate. In conclusion, HIR and DLR reconstructed scans resulted in similar Agatston scores with excellent agreement and low-risk reclassification rate compared with routine reconstructed scans (FBP). However, caution should be taken with low Agatston scores, as based on phantom study, detectability of small calcifications varies with the used reconstruction algorithm, especially with MBIR and DLR.