Place de l’imagerie dans l’évaluation de l’efficacité des traitements dans le cancer du sein

This paper describes, from the current literature, the role of various imaging methods to assess the response to therapy in breast cancer. Two different clinical situations are considered: neoadjuvant chemotherapy of locally advanced breast cancer and the metastastic breast cancer. Significant clinical data are available for three criteria: the volume of the tumour, the uptake of fluorodeoxyglucose using PET and the perfusion of the tumor evaluated either by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) or by PET using ¹⁵O water. ¹⁸F FDG PET allows prediction of the response after one or two cycles of neoadjuvant chemotherapy. New approaches will offer opportunities to refine the role of imaging in monitoring the response to chemotherapy. PET using thymidine as biomarker is promising in assessing the tissular proliferation. Estrogen analogs could be used to predict hormonally responsive breast cancer. Many other approaches, although less developed, might offer new insights in the response to therapy of breast cancer like magnetic resonance spectroscopy or optical imaging of hemoglobin oxygenation. Imaging also offers potential of monitoring the down-regulation of specialized receptors of the cell membrane in response to treatment: the most studied receptor in preclinical model has been the human epidermal growth factor receptor type 2 (HER2). Integrin, a family of cell adhesion receptor, is also an important target for imaging. Apoptosis, multidrug resistance and hypoxia can also be studied using appropriate biomarkers. To allow reliable multicenter trials of new drugs, these different imaging approaches still require an improved standardization of image acquisition and processing.     

Apport de l’IRM dans l’imagerie pelvienne : aspect normal et pathologique

The pelvic MRI allows a better morphological analysis of the uterus (cervix and body) and ovaries compared to CT scan either before or after injection. MRI is the modality of choice for preoperative staging and follow-up of cervical and endometrial tumors. MRI assessed tumor response, detect recurrences. MRI also allows better characterization of ovaries lesions.     

Intérêt de l’imagerie hybride TEMP-TDM dans l’exploration des infections

Single-Photon Emission Computed Tomography-Computerized Tomography (SPECT-CT) is a new hybrid technique which offers new diagnostical capabilities in daily nuclear medicine practice. This technique not only allows to acquire fusioned anatomic and functional images in the same time, but also, it increases sensitivity and accuracy of SPECT thanks to attenuation and scattering corrections got from transmission data. Until now, SPECT-CT data have been mainly obtained in oncology and cardiology, but now, many authors use it in many scan studies and particularly for infectious diseases. In inflammatory bowel diseases, SPECT-CT seems to increase diagnostical performances and to modify management of many patients. In suspected vascular sepsis, SPECT-CT could increase sensitivity of white blood cell scintigraphy but also its specificity thanks to spatial resolution of CT. In osteoarticular sepsis, SPECT-CT has the advantage to distinguish osteomyelitis from soft tissue infection and to guide biopsies. Nevertheless, in the light of PET-CT works, SPECT-CT development will probably modify nuclear medicine practice and many studies have to be conducted to highlight consensual procedure guidelines.     

Apport de l’IRM cardiaque à l’exploration des cardiopathies ischémiques

This article presents the current and future possibilities of the cardiac magnetic resonance imaging (MRI) in the ischemic heart disease. It is not an emergency technique, but is becoming an element of decision for an acute myocardial infarction. It makes it possible to visualize the extent of the myocardial lesions in post acute infarction, to appreciate functional recovery and to uncover a nonsymptomatic coronary stenosis or of atypical clinical presentation. The visualization of the coronary arteries in MRI is realizable, but remains experimentation field. The cardiac MRI place is to be defined by each medical team according to their diagram of ischemic heart disease follow-up.     

Apport de l’exploration cytogénétique et ultrastructurale dans le pronostic de fertilité des sujets globozoospermiques

Globozoospermia is a severe form of teratozoospermia characterized by round-headed sperms with absence or presence of a rudimentary acrosome. The objective of this study is to analyze sperm from six patients with globozoospermia syndrome and report the results of 11 intracytoplasmic sperm injection (ICSI) attempts. The investigation of these issues was carried out by studying the sperm aneuploidy rate by fluorescent in situ hybridization (sperm-FISH) for chromosomes X, Yand 18. The rate of DNA fragmentation was studied by using the terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) technique and a detailed ultrastructural morphology study of the sperm using transmission electron microscopy. Eleven ICSI attempts were performed in patients with low fertilization rate, (9.37%) and pregnancy did not occur. This study confirmed the variability of sperm phenotypes observed in this syndrome and the low fertilization rates after IVF-ICSI regardless of the phenotype.     

Apport de l’échographie dans le bilan d’une infécondité masculine

Recent technical progress in ultrasound, particularly with respect to high-frequency linear probes and transrectal probes, now enables a very detailed morphological approach to the scrotal, prostate and surrounding structures, such as the seminal vesicles, the vas deferens and the ejaculatory ducts. For almost 20 years, in close collaboration with Male Sterility Center of Toulouse, we have carried out such examinations as part of infertility testing procedures, and we set out below the results of our experience. After a short anatomical reminder, we shall begin with an echographical study of the scrotum, followed by the prostate and its adjoining structures, pursuant to a transrectal examination. In the course of these two examinations, we shall consider the various pathologies that we have encountered, which have tended to be secretory with respect to the scrotum, and excretory in the prostate area, in order to determine the usefulness and importance of echographical examinations in male infertility.     

La stimulation électrique pallidale dans le traitement des mouvements anormaux : l’expérience montpelliéraine dans l’utilisation de l’imagerie fonctionnelle comme critères de sélection des patients

Magnetic resonance anatomical imaging gives to the practician an important set of criteria for selecting patients with dystonic and dyskinetic syndromes who can get benefice from a treatment by electrical deep brain stimulation. However, anatomical anomalies seen on MRI, whatever their number and morphological extension, do not reflect the effective (residual) functional activity of the corresponding structures. We describe, in this short report, the way how, in our experience, functional imaging techniques used for measuring cerebral perfusion and neurotransmission in Single Photon Emission Computerized Tomography (SPECT), cerebral metabolism in Positron Emission Tomography (PET) and motor neuroactivations in functional Magnetic Resonance Imaging (fMRI) are capable of progressively fulfil this deficiency.     

Le mammouth dans l’art paléolithique

The mammoth, an emblematic animal of the Prehistory, possesses an important place in the depictions made by prehistoric artists, both in parietal art (cave art) and in mobile art. Its image is known from the Aurignacian, at the beginning of the Upper Palaeolithic, until the end of the Last Ice Age, the Magdalenian. However, its geographical and chronological distribution is dissimilar. Mammoth depictions are generally more frequent during the Aurignacian where this animal is found engraved and painted in the Chauvet cave for example and carved from ivory in several cave sites of the Swabian Jura. The Magdalenian cave of Rouffignac and its 160 representations constitute a notable exception. From a formal point of view, the representations of mammoth are elaborated in a rather constant way, like the characteristic cephalic contour and the typical back of the animal, at least as it could be seen in nature. The representations are often even limited to a cursive line with a double curvature that expresses the pachyderm. On the other hand some drawings show intimate details. Sometimes the tusks of the mammoths are not indicated, but certain stylistic features, such as the ventral arch, are relatively reliable chronological markers. Finally, one cannot ignore the ethological or seasonal expressions that sometimes link the mammoths to each other, in a row or in confrontation. This animal obviously inspired the artists of the prehistory who created various portraits of the mammoth.     

Apport de la scintigraphie rénale avec test au captopril dans l’exploration de l’hypertension artérielle rénovasculaire : à propos d’un cas

IntroductionDynamic renal scintigraphy with ^99mTc-DTPA and captopril test is a non-invasive functional method for the diagnosis of renovascular hypertension. It allows differentiating between hypertension induced by renal arterial stenosis from primary arterial hypertension with an incidental stenosis.Case reportA 14-year-old girl, without previous medical history, developed a severe arterial hypertension with cephalgias and ears buzzing. Auscultation revealed a murmur in the left lumbar pit. Renal angiography objectified a stenosis of the infrarenal aorta due to a circumferential parietal thickening associated to renal arteries stenosis more marked in the left side. Dynamic renal scintigraphy after administration of captopril highlighted a marked collapse of the rate of tracer uptake exceeding 40% on the left side with an increase in the time of collecting on the right side testifying a frankly positive test prevailing on the left. A transluminal angioplasty of the left renal artery and a revascularisation surgery on the right side were carried out. The evolution was marked by an improvement of blood pressure figures.DiscussionDynamic renal scintigraphy using ^99mTc-DTPA with captopril test constitutes a non-invasive process with a low dosimetry for the patients. Its principal goal is to affirm the role of renovascular stenosis in the origin of arterial hypertension and to determine which hypertensive patients with renal arterial stenosis can be treated successfully by surgical or endoscopic revascularisation of the kidney.     

Place du scanner dans l’imagerie de l’hyperparathyroïdie primaire

Primary hyperparathyroidism is a biological diagnosis. The reference treatment is surgery. When minimally invasive surgery is considered, it is recommended to perform a cervical ultrasound and a scintigraphic examination to localize the hypertrophied parathyroid glands. The multiphasic scanner (4D CT) is a very effective examination to detect and locate precisely the parathyroid adenomas. The study of densities makes it possible to differentiate the adenoma from the thyroid and the lymph nodes that are the differential diagnoses. Without injection, the adenoma is more hypodense than the thyroid with a threshold set at 75 UH. On the early phase after injection, the adenoma appears very hypervascularized with a density > 114 UH. The ganglion appears hypovascularized with a density < 114 UH. In the late phase, there is a decrease in the density within the adenoma, while density within the ganglion increases. The parathyroid scan is indicated in case of negativity or discordance of the couple ultrasound scintigraphy. It is also strongly recommended, in case of persistence or recurrence of hyperparathyroidism after surgery, as well as to better study a parathyroid ectopy.     

Apport de l’iode 131 dans le traitement de l’adénome thyroïdien toxique

IntroductionToxic thyroid adenoma is an evolutive condition requiring radical treatment. The purpose of this study is to evaluate the contribution of 131 in the treatment of toxic thyroid adenoma.Patients and methodsThis is a retrospective study of patients treated with iodine 131 for toxic thyroid adenoma. The diagnosis of toxic adenoma is confirmed by scintigraphy and/or ultrasound. Data collected were age, sex, previous treatments, pre treatment hormonal status, radioiodine activity received and post therapy hormonal status.Results and conclusionWe have 45 women to seven men with a sex ratio of 6.42. Mean age of our patients is 53 years. Mean age for women at time of treatment is 57.33 years and 52.85 years for men. 98.07% of our patients treated with iodine 131 gained euthyroidism or became hypothyroid vs. 1.92% in whom hyperthyroidism persisted. These results are comparable to literature. Moroccan patients socioeconomic status pleads for an expansion of use of radioiodine in toxic thyroid adenoma due to its favourable cost/effectiveness ratio.