We tested the hypothesis that reduced skin innervation in fibromyalgia syndrome is associated with specific CNS changes. This prospective case–control study included 43 women diagnosed with fibromyalgia syndrome and 40 healthy controls. We further compared the fibromyalgia subgroups with reduced (n = 21) and normal (n = 22) skin innervation. Brains were analysed for cortical volume, for white matter integrity, and for functional connectivity. Compared to controls, cortical thickness was decreased in regions of the frontal, temporal and parietal cortex in the fibromyalgia group as a whole, and decreased in the bilateral pericalcarine cortices in the fibromyalgia subgroup with reduced skin innervation. Diffusion tensor imaging revealed a significant increase in fractional anisotropy in the corona radiata, the corpus callosum, cingulum and fornix in patients with fibromyalgia compared to healthy controls and decreased FA in parts of the internal capsule and thalamic radiation in the subgroup with reduced skin innervation. Using resting-state fMRI, the fibromyalgia group as a whole showed functional hypoconnectivity between the right midfrontal gyrus and the posterior cerebellum and the right crus cerebellum, respectively. The subgroup with reduced skin innervation showed hyperconnectivity between the inferior frontal gyrus, the angular gyrus and the posterior parietal gyrus. Our results suggest that the subgroup of fibromyalgia patients with pronounced pathology in the peripheral nervous system shows alterations in morphology, structural and functional connectivity also at the level of the encephalon. We propose considering these subgroups when conducting clinical trials.

Aims: To estimate the long term cost effectiveness of treatment for amblyopia in 3 year old children. Methods: A cost utility analysis was performed using decision analysis including a Markov state transition model. Incremental costs and effects during the children’s remaining lifetime were estimated. The model took into account the costs and success rate of treatment as well as effects of unilateral and bilateral visual impairment caused by amblyopia and other eye diseases coming along later in life on quality of life (utility). Model parameter values were obtained from the literature, and from a survey of experts. For the utility of unilateral visual impairment a base value of 0.96 was assumed. Costs were estimated from a third party payer perspective for the year 2002 in Germany. Costs and effects were discounted at 3%. Uncertainty was assessed by univariate and probabilistic sensitivity analysis (Monte-Carlo simulation). Results: The incremental cost effectiveness ratio (ICER) of treatment was €2369 per quality adjusted life year (QALY). In univariate sensitivity analysis the ICER was most sensitive to uncertainty concerning the utility of unilateral visual impairment—for example, if this utility was 0.99, the ICER would be €9148/QALY. Monte-Carlo simulation yielded a 95% uncertainty interval for the ICER of €710/QALY to €38 696/QALY; the probability of an ICER smaller than €20 000/QALY was 95%. Conclusion: Treatment for amblyopia is likely to be very cost effective. Much of the uncertainty in results comes from the uncertainty regarding the effect of amblyopia on quality of life. In order to reduce this uncertainty the impact of amblyopia on utility should be investigated.

Magnetic Particle Imaging (MPI) is a promising tomographic technique for fast and sensitive visualization of superparamagnetic iron-oxide nanoparticles (SPIONs). Different types of MPI scanners have been presented in the past providing 2D as well as 3D data with different sizes of the field of view (FOV). With increasing FOVs, often the spatial resolution decreases. Traveling Wave MPI scanners provide the possibility to visualize the entire available FOV within the scanner at once with a good spatial resolution and a high temporal resolution. However, a more selective imaging process, such as scanning specific areas within the sample collecting more information, is of high interest. This can be performed by adjusting the sequences for signal acquisition, e.g., by modulation of the amplitude, to actively suppress signal generation in specific areas. Unfortunately, this method requires adaptation of the hardware. In this manuscript a novel approach for imaging specific areas within the FOV of a Traveling Wave MPI scanner is presented without specific hardware modifications. Furthermore, this technique offers the possibility to increase the resolution by up to 40 %, which reveals more details in this area, similar to a magnification effect.

Magnetic Particle Imaging (MPI) is a promising tomographic method to visualize the distribution of superparamagnetic materials in three-dimensions. For encoding, a strong gradient represented by a field free point (FFP) or a field free line (FFL) is steered rapidly through the field of view (FOV), acquiring the signal successively. Conventional MPI scanners only provide a single FFP or FFL to sample the entire scan volume, which limits the size of the FOV and/or the temporal resolution. The alternative scanner concept of Traveling Wave MPI (TWMPI) uses a dynamic linear gradient array (dLGA) for dynamic FFP generation along the symmetry axis. The TWMPI scanner is capable of creating multiple FFPs simultaneously, and usually care is taken to locate only a single FFP in the desired FOV. In this manuscript, the concept of parallel MPI utilizing multiple FFPs simultaneously is introduced. For that, conceptual simulations are presented followed by reconstruction approaches for visualization of parallel MPI signals. In addition, an initial parallel MPI experiment with simultaneous acquisition of signals from two FFPs inside the FOV of the same scanner using two receive chains is demonstrated. This allows scanning a doubled FOV within the same acquisition time without sacrificing resolution compared to the standard TWMPI scanner.