The Role of Receptivity in Heidegger’s Kant Interpretation

Commentators on Heidegger’s late-1920s interpretation of Kant often argue that Heidegger reveals himself in this work to be a philosopher of receptivity: Heidegger gives pride of place to the passive aspects of human cognition, our “openness to the world,” over against activity, spontaneity, and understanding (Gordon, 2010, p.7). On this view, Heidegger’s contribution to the transcendental tradition is offering an “affective transcendentalism” (Engelland, 2017, p.223): in response to the central question of transcendental philosophy – What are the prior conditions that enable and structure our experience? – Heidegger emphasizes the prior affectivity that preconditions our experience. While Heidegger’s position, so construed, may appear an exciting strain of transcendental philosophy, it likewise seems to be a considerable departure from Kant. After all, Kant insisted that both spontaneity and receptivity are required for human cognition; this is often referred to as Kant’s “discursivity thesis”. In Kant’s well-known formulation connecting our passively receiving intuitions and actively organizing concepts, “thoughts without content are empty, and intuitions without concepts are blind” (A51/B75). Therefore, the idea that Heidegger defends a philosophy of receptivity in his interpretive works on Kant contributes to the common view that Heidegger is a bad interpreter of Kant. I challenge the claim that Heidegger defends a philosophy of receptivity in his interpretive works on Kant. This claim derives its plausibility from Heidegger’s opening discussion of intuition, where Heidegger does insist that “thinking is in the service of intuition.” While this discussion grants a kind of primacy to sensibility – in particular, our faculty of sensibility explains why human cognition is finite – I suggest that it does not compromise Kant’s discursivity thesis. Heidegger affirms, with Kant, that understanding and sensibility, two distinct capacities or faculties, are required for cognition. Further, I argue that Heidegger’s claim that sensibility plays a “leading role” in cognition is merely the beginning of Heidegger’s argument; it is not his main intervention. For Heidegger is concerned not with cognition, but with the source of cognition: the very constitution of the human being. And this source, Heidegger insists, is both receptive and spontaneous. Heidegger’s central thesis – that we must consider the imagination to be the fundamental cognitive faculty in Kant – rests crucially on the claim that the imagination is both receptive and spontaneous. Under the consensus reading of Heidegger’s interpretation of Kant, Heidegger is supposed to be a perfect foil to the Neo-Kantian interpretation of Kant: where the Neo-Kantians privilege spontaneity, Heidegger privileges receptivity. While Heidegger is certainly critical of the Neo-Kantian prioritization of spontaneity, I argue that we must rethink Heidegger’s relationship to the Neo-Kantian view. Heidegger’s main thesis in the Kant interpretation – that the imagination, a faculty that is both spontaneous or receptive, is the “common root” of sensibility and understanding – answers a question that Heidegger takes up from the Marburg Neo-Kantians: what is the origin that unifies the faculties of sensibility and understanding? While the Neo-Kantians insist on an origin in the spontaneous faculty of understanding, Heidegger suggests instead that the origin is the receptive and spontaneous faculty of imagination. Where the Neo-Kantians overemphasize spontaneity, Heidegger restores balance. Ultimately, Heidegger does not prioritize receptivity in his reading of Kant; rather, Heidegger offers a transcendental philosophy that inquires more deeply into the unified receptivity and spontaneity that characterizes the human being.

CO2-based C-arm computed tomography (CACT) of the pelvic arteries: feasibility and diagnostic performance in comparison to CO2-angiography in patients with peripheral arterial disease

Background Patients with substantially impaired kidney function and peripheral arterial disease (PAD) underwent comparative CO2-based depiction of the pelvic arteries (PAs). Purpose To evaluate the feasibility and diagnostic performance of CO2-based C-arm computed tomography (CACT) and compare its depiction of PAs with CO2-digital subtraction angiography (DSA). Material and Methods Fifteen patients (10 men, mean age 70 ± 11 years) with PAD received CO2-DSA and CO2-CACT of the PAs, depicted from the aorta to femoral arteries. These were divided into nine segments (135 in total) and graded by two independent readers for image quality (IQ; 1 = sufficient, 2 = minimal impairments, 3 = insufficient, 4 = outside field of view) and subsequent stenosis grading (SG; grade 1: normal to grade 4: occlusion), under exclusion of all segments with insufficient IQ. Inter-observer and inter-modality agreement calculation and subsequent consensus reading were performed and correlated to a standard of reference (StOR), representing a modality consensus. Results Of 135 segments, 117 showed sufficient IQ, excluding 18 segments (10 CACT, 8 DSA). Inter-observer agreement for IQ and consecutive SG demonstrated good to excellent agreement: IQDSA: κ = 0.83, IQCACT: κ = 0.76; StenosisDSA: κ = 0.71, StenosisCACT: κ = 0.84. Inter-modality agreement for SG lay at κ = 0.76 and κ = 0.65, respectively. More stenoses could be detected by CACT, and analysis of pooled consensus values of SG in CACTcons versus StOR showed an excellent agreement (κ = 0.96) that proved considerably higher than the moderate agreement between consensus values in DSAcons versus StOR (κ = 0.43). Conclusion CO2-CACT proved feasible, and has the potential to optimize angiographic work-up of PAD in patients with contraindications for other contrast media.

Impact of Tracer Retention Levels on Visual Analysis of Cerebral [18f]- Florbetaben pet Images

Background: To compare visual and semi-quantitative analysis of brain [18F]Florbetaben PET images in Mild Cognitive Impairment (MCI) patients and relate this finding to the degree of ß-amyloid burden. Methods: A sample of 71 amnestic MCI patients (age 74 ± 7.3 years, Mini Mental State Examination 24.2 ± 5.3) underwent cerebral [18F]Florbetaben PET/CT. Images were visually scored as positive or negative independently by three certified readers blinded to clinical and neuropsychological assessment. Amyloid positivity was also assessed by semiquantitative approach by means of a previously published threshold (SUVr ≥ 1.3). Fleiss kappa coefficient was used to compare visual analysis (after consensus among readers) and semi-quantitative analysis. Statistical significance was taken at P<0.05. Results: After the consensus reading, 43/71 (60.6%) patients were considered positive. Cases that were interpreted as visually positive had higher SUVr than visually negative patients (1.48 ± 0.19 vs 1.11 ± 0.09) (P<0.05). Agreement between visual analysis and semi-quantitative analysis was excellent (k=0.86, P<0.05). Disagreement occurred in 7/71 patients (9.9%) (6 false positives and 1 false negative). Agreement between the two analyses was 90.0% (18/20) for SUVr < 1.1, 83% (24/29) for SUVr between 1.1 and 1.5, and 100% (22/22) for SUVr > 1.5 indicating lowest agreement for the group with intermediate amyloid burden. Conclusion: Inter-rater agreement of visual analysis of amyloid PET images is high. Agreement between visual analysis and SUVr semi-quantitative analysis decreases in the range of 1.1<SUVr <=1.5, where the clinical scenario is more challenging.

Abstract 131: Feasibility and Efficacy of Central Blinded Video Rankin Scale Outcome Assessments in a Randomized Clinical Trial

Introduction: In randomized clinical trials, central adjudication is frequently used for study outcomes. However, stroke trials have historically used site-derived Rankin scale assessments as primary outcome. Hypothesis: A central adjudication of Rankin scale assessment is at least as accurate as site-derived assessment. Methods: We studied acute stroke survivors from the RESILIENT study, where primary outcome was the consensus Rankin scale rating of two blinded central adjudicators who independently watched video recordings of a 90-day post-stroke structured patient and/or family interview. We compared agreement rates (weighted kappa statistics) between both central adjudicators with that between the blinded site investigator and the consensus reading between central adjudicators. Results: Trial randomized 221 patients to thrombectomy or medical treatment alone. At 90 days, 161 (73%) survived and 142/161 (88%) had quality video recordings for central adjudicators. Median (interquartile range) Rankin scores were similarly 3 (2-4) for each central rater and for the site investigators. Agreement rates between central adjudicators was 79.6% (kappa=0.94, p<0.001), while agreement between site investigator and consensus rating from central adjudicators was 76.8% (kappa=0.92, p<0.001). Conclusions: Central blinded Rankin scale outcome assessment is feasible and is at least as good as site investigator assessments. For open-label trials with blinded clinical outcome assessment, central adjudication of video-recorded interviews provides safer blinding and accountability.

FDG and FCH PET/CT of Multiple Myeloma at Various Clinical Situations: Lesion Detection, Proposal for a Patient-Based "Summ" Score and Reproducibility of Scoring

Introduction: In a previous pilot study, PET/CT performed for suspected relapsing or progressive multiple myeloma (MM) revealed more lesions with FCH than with FDG. We then launched a prospective comparison of FDG and FCH PET/CT in MM at initial staging, restaging and during therapeutic follow-up. The IMPeTUs scoring system was proposed in 2016 by Nanni et al. to summarize the results of FDG PET/CT. However, the IMPeTUs scoring system is not designed to reflect by one single patient-based score the extent of the disease, as determined on radiotracer uptake. To compare the performance of those two PET radiotracers, we set a single patient-based score, derived from the IMPeTUs approach, and we applied it to the comparison of FDG and FCH PET/CT at various clinical situations of MM. Aim: To compare (1) the reproducibility of reading and scoring of FDG and FCH PET/CT in initial staging, restaging and therapeutic follow-up of MM, (2) the correlation between the scores on FDG or on FCH PET/CT and serum concentration of M-protein, a quantitative criterion reflecting the secretory activity of MM, recommended at diagnosis and as a part of evaluation of therapeutic response. Patients and methods: FDG and FCH PET/CT were performed in 105 patients (20 at initial staging, 37 at relapse and 48 during follow-up).The FDG and FCH PET/CTs were read in a random order with a wash out period by two experienced readers blinded to any patient's clinical data. They scored according to IMPeTUs scoring system, evaluating the number and intensity of foci of radiotracer uptake in 5 sites (spine, skull, extraspinal, visceral and nodal), the presence of diffuse axial and/or appendicular bone marrow uptake, of PET-positive lytic lesions, or of fractures. According to the number of visible foci in each site, the site-score was: 1: 0 focus, 2: 1-3 foci, 3: 4-10 foci or 4: >10 lesions. In case of diffuse bone marrow uptake by the axial or appendicular skeleton, the site-score 4 was attributed to the corresponding site, to integrate this pattern in one single score per site. A "SUMM" score, theoretically ranging from 5 to 20, was obtained by summing up the site-scores of the 5 sites. The kappa coefficient was calculated to evaluate the inter-reader agreement in determining the SUMM score.A consensus reading was finally performed, to solve discordances in scoring between the two readers. The paired Wilcoxon test was used to compare the consensual SUMM scores of PET/CT with FDG and FCH; the correlation coefficient between the consensual SUMM scores and M-protein level was calculated. Results:Before final consensus, the inter-reader agreement in determining the SUMM score was better with FCH (Kappa=0.90; CI=0.85-0.95) than with FDG (Kappa=0.75; CI=0.64-0.86). The analysis was then continued on the data of consensus reading. FCH showed more foci in 28 patients (4 at initial staging, 13 at relapse, 11 during follow up) and FDG in 14 patients (3 at initial staging, 4 at relapse, 7 during follow up). The SUMM score was significantly greater with FCH than with FDG (p=0.0027).M-protein was present in the serum of 95/105 patients. The correlation with serum M-protein level was significantly >0 for both SUMM scores, but loose for FDG (r=0.3, p=0.0029) and stronger for FCH (r=0.7, p<0.001), the difference being significant (p=0.0001).Among 8 patients without M-protein detected in their serum, a negative PET/CT with FDG (SUMM FDG=5) but positive with FCH (SUMM FCH>5) was observed in 2 patients (1 referred for evaluation of relapsing MM and in one referred during therapeutic follow-up of MM). Conclusion: A patient-based "SUMM" score is proposed to characterize the extension and the number of foci on PET/CT imaging of MM. Using this SUMM score, a better inter-reader reproducibility, lesion detectability and correlation with serum M-protein was observed for FCH than for FDG, confirming FCH as a potential tracer in MM deserving further research. Disclosures Garderet: Celgene: Consultancy; Amgen: Consultancy; Takeda: Consultancy.

Multicenter prospective evaluation of the express view reading mode for small-bowel capsule endoscopy studies

Background Reducing the reading time of capsule endoscopy films is of high priority for gastroenterologists. We report a prospective multicenter evaluation of an “express view” reading mode (Intromedic capsule system). Methods Eighty-three patients with obscure gastrointestinal bleeding were prospectively included in 10 centers. All patients underwent small-bowel capsule endoscopy (Intromedic, Seoul, Republic of Korea). Films were read in standard mode, then a second reading was performed in express view mode at a second center. For each lesion, the precise location, nature, and relevance were collected. A consensus reading and review were done by three experts, and considered to be the gold standard. Results The mean reading time of capsule films was 39.7 minutes (11 – 180 minutes) and 19.7 minutes (4 – 40 minutes) by standard and express view mode, respectively (P < 1 × 10 – 4). The consensus review identified a significant lesion in 44/83 patients (53.0 %). Standard reading and express view reading had a 93.3 % and 82.2 % sensitivity, respectively (NS). Consensus review identified 70 significant images from which standard reading and express view reading detected 58 (82.9 %) and 55 (78.6 %), respectively. The informatics algorithm detected 66/70 images (94.3 %) thus missing four small-bowel angiodysplasia. Conclusion The express view algorithm allows an important shortening of Intromedic capsule film reading time with a high sensitivity.

How to train radiology residents to diagnose pulmonary embolism using a dedicated MRI protocol

Background In recent years, magnetic resonance imaging (MRI) has been suggested as an alternative to computed tomography angiography (CTA) to diagnose pulmonary embolism (PE). In previous studies, only senior radiologists have been evaluated as reviewers. Purpose To investigate if radiology residents can be trained to review MRI regarding PE and to determine the learning curve effects. Material and Methods Four residents independently went through a training program consisting of 70 participants that had undergone steady-state free precession MRI. The individuals were randomized into ten training sessions. For each exam, the review time and presence or absence of embolus was recorded. After completing each session, the residents received feedback on diagnostic accuracy compared to a consensus reading by two specialists. The residents were also presented with the corresponding CTA. Results The review time was nearly halved ( P = 0.0002) during the training program. Comparing the first three sessions with the last three sessions for all residents, the review time decreased from 5:22 min to 2:51 min. The inter-reader agreement improved for all residents during the training program reaching a clinically acceptable level after seven sessions. Conclusion Our study suggests that radiology residents can be trained to independently review MRI investigations regarding PE within a short training program. Similar training programs could be more extensively used as effective teaching method for residents.

Differentiation between papillary renal cell carcinoma and fat-poor angiomyolipoma: a preliminary study assessing detection of intratumoral hemorrhage with chemical shift MRI and T2*-weighted gradient echo

Background Recent literature suggests that intratumoral hemorrhage detection may be helpful in differentiating papillary renal cell carcinoma (pRCC) from fat-poor angiomyolipoma (fpAML). Purpose To determine whether intratumoral hemorrhage detected using chemical shift magnetic resonance imaging (MRI) and T2*-weighted (T2*W) gradient echo (GRE) can be used to differentiate pRCC from fpAML. Material and Methods This retrospective study included 42 patients with pRCC (n = 28) and fpAML (n = 14) who underwent MRI followed by surgery. Two blinded radiologists independently assessed the presence of intratumoral hemorrhage using chemical shift MRI (decrease in signal intensity from opposed- to in-phase) and T2*W GRE (“blooming”). Consensus reading was determined for discrepant cases. MRI findings were compared using Chi-square test. Inter-observer agreement was assessed using kappa statistics. Results Inter-observer agreement was substantial for both sequences ( k = 0.622 and 0.793, P < 0.001). For chemical shift MRI, the prevalence of intratumoral hemorrhage was significantly greater in pRCC than in fpAML (71.4% versus 28.6%, P = 0.019 for reader 1; 64.3% versus 14.3%, P = 0.003 for reader 2; and 75% versus 21.4%, P = 0.002 for the consensus). T2*W GRE showed a similar tendency (46.4% versus 14.3%, P = 0.049 for both readers; and 50% versus 14.3%, P = 0.042 for the consensus). Using the consensus reading, sensitivity and specificity of determining pRCC were 75% and 78.6% for chemical shift MRI and 50% and 85.7% for T2*W GRE. Conclusion The prevalence of intratumoral hemorrhage identified from chemical shift MRI or T2*W GRE was significantly different between pRCC and fpAML. These hemorrhage-sensitive MRI sequences may be used as an adjunctive tool for discriminating between the two entities.