Abstract
In this issue of Diabetologia, Alavi and Werner (https://doi.org/10.1007/s00125-018-4676-1) criticise the attempts to use positron emission tomography (PET) for in vivo imaging of pancreatic beta cells, which they consider as ‘futile’. In support of this strong statement, they point out the limitations of PET imaging, which they believe render beta cell mass impossible to estimate using this method. In our view, the Alavi and Werner presentation of the technical limitations of PET imaging does not reflect the current state of the art, which leads them to questionable conclusions towards the feasibility of beta cell imaging using this approach. Here, we put forward arguments in favour of continuing the development of innovative technologies enabling in vivo imaging of pancreatic beta cells and concisely present the current state of the art regarding putative technical limitations of PET imaging. Indeed, far from being a ‘futile’ effort, we demonstrate that beta cell imaging is now closer than ever to becoming a long-awaited clinical reality.
Highlights
5 JDRF, New York, NY, USA 6 Clinical and Experimental Endocrinology, University of Leuven, Leuven, Belgium 7 Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden 8 Division of Endocrinology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium. In their commentary on the clinical study published by Cline and colleagues [1, 2], Alavi and Werner criticise the use of positron emission tomography (PET) for the imaging of pancreatic beta cells and put forward the argument that imaging of native beta cells is not technically feasible using this approach
In no way did we suggest that beta cell imaging by PET is not feasible
The current development of innovative technology to further improve the performance of clinical PET scanners, namely innovative detector technology and optimised system geometries, is expected to improve image quality in the near future, with spatial resolutions as low as 1–2 mm [6]
Summary
In their commentary on the clinical study published by Cline and colleagues [1, 2], Alavi and Werner criticise the use of positron emission tomography (PET) for the imaging of pancreatic beta cells and put forward the argument that imaging of native beta cells is not technically feasible using this approach. Alavi and Werner imply that beta cell imaging is a matter of identifying and counting objects that are smaller than voxel size [2], which would be impossible when faced with poor spatial resolution This argument may be true in oncology, where identification of small objects such as, for example, peritoneal tumour deposits or small lymph node metastases, is the aim of imaging. When stating that ‘efforts to image targets that are dispersed within high background activity sites will fail’ [2], Alavi and Werner do not take into account the concept of chemical resolution based on beta cell-specific tracers with high uptake in beta cells and low uptake in the exocrine pancreas [8]. PET imaging has been demonstrated to provide sufficient quantitative data to allow reliable diagnosis and individualised therapeutic interventions with excellent results [12]
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