Fixations extra-osseuses du Tc MDP dans le cas d’un cancer du sein métastatique à l’os

Aim

To report and discuss an unusual visceral uptake on bone scan in a case of breast cancer with bone metastases.

Patient and methods

A 40-year-old woman, with untreated bilateral breast cancer was referred to our department for a bone scan.

Results

The bone scan evidenced multiple metastases over the axial skeleton. Uncommonly, visceral uptake was noted associating diffuse bilateral lung uptake and intense myocardium, stomach and kidneys uptakes. Serum calcium level was high: 4.08 mmol/L (normal: 2.38–2.70 mmol/L).

Conclusion

The incidental observation of metastasic calcifications on bone scan is often related to severe hypercalcemia. Such pattern should alert the physician on the existence and the severity of calcium metabolism disturbances that had not been suggested before.     

Exploration des polyalgies par la scintigraphie osseuse planaire couplée à la TEMP-TDM

Polyalgia are a frequent indication of bone scintigraphy. The diagnostic process consists in seeking the characteristic data of a pathology, clinical, biological and radiological data integration, aspect, number and location of the lesions on planar bone scintigraphy and often, accurate location and morphological aspect of each lesion on the single photon emission computerized tomography guided by computerized tomography (SPECT/CT). The various pathologies responsible for polyalgia are arbitrarily classified according to their peripheral, axial or mixed predominance and are briefly described.     

Traitement de l’hyperthyroïdie par l’iode 131 : à propos de 280 cas

We report through this work the experience of nuclear medicine department at Ibn-Sina hospital (Rabat), in the treatment of hyperthyroidism with iodine-131. We retrospectively studied a cohort of 280 patients with hyperthyroidism, from several regions of Morocco between January 2001 and January 2010. A clinical examination and a serum assessment of TSHus, FT4 and FT3 have been made at baseline and at 3, 6, 12 and 24 months after radioiodine therapy. The activity of iodine-131 administered ranged from 296 to 740 MBq and depended on the pathology being treated, age, thyroid volume, intensity of clinical and biological hyperthyroidism and socioeconomic situation. Radioiodine therapy has often been proposed as a treatment for second or third intention, 71 patients were initially treated with iodine-131, while 209 patients had received iodine-131 after failure of medical treatment and/or recurrence after surgical treatment. Graves’ disease was the most common etiology (60%), followed by toxic adenoma (20%), and multinodular toxic goiter (13%). The therapeutic efficacy of a single dose of radioiodine evaluated after a 6-months follow-up was 92% in Graves’ disease, 98% in toxic adenomas and 97% in toxic multinodular goiter. No acute complication was observed. Taking into account our socioeconomic context, radioiodine therapy remains the preferred treatment of hyperthyroidism in our country with good value vs. price and excellent tolerance.     

La maladie d’Erdheim-Chester : à propos d’un cas

IntroductionErdheim-Chester disease (ECD) is a rare form of non-Langerhans histiocytosis of which prevalence is difficult to estimate. To date, 178 cases have been published. Its pathophysiology is still unknown. It is characterized by an infiltration of foamy histiocytes within several organs, mainly bone, retroperitoneum, lung, heart, brain and retro-orbital tissue.ObservationWe present the case of ECD in a 62-year-old woman with neurological symptoms, retro-orbital and osseous involvement. Diagnosis was made through an anatomopathological examination of the brain biopsy. A Tc^99m-HDP bone scan revealed a bilateral and symmetric increased uptake of diaphyses and metaphyses of the long bones and a focal increased uptake of the skull. The axial skeleton is spared. The evolution of this patient was marked by recurrences of cerebral localizations and by worsening of neurological deficits. The patient was treated by corticosteroids.Discussion and conclusionErdheim-Chester is a rare non-Langerhans histiocytosis showing characteristic radiological and histological features. Extraskeletal manifestations can occur in almost all organs, leading to a poor prognosis. The diagnosis requires biopsy with histologic confirmation of an extraosseous site. Because clinical bone symptoms can be mild or absent, bone scan may be valuable, as it discloses all sites of bone affected in one diagnostic procedure.     

Scintigraphie des parathyroïdes double isotope Tc-MIBI/I dans l’hyperparathyroïdisme primaire : comparaison entre un protocole d’acquisition planaire et une TEMP de soustraction couplée à la TDM

In patient with primary hyperparathyroidism, preoperative imaging first objective is to determine accurately and reliably position and anatomic localization of enlarged parathyroid gland in order to guide surgeon for gland removal and to permit minimally invasive surgery. Although subtraction planar scintigraphy is an efficient imaging to diagnose hyperfunctioning parathyroid, the lack of anatomical reference for this single imaging technique could be obviated by hybrid imaging. We compared, in 23 patients with primary hyperparathyroidism, a planar scan of neck and mediastinum associated with a cervical anterior pinhole scan to a subtraction (¹²³I/^99mTc-MIBI) SPECT scan of neck and mediastinum fused with CT. Surgical and histopathologic findings were used as the standard of truth. Subtraction SPECT/CT appeared to be more sensitive and specific than planar protocol to diagnose and to accurately localize pathologic parathyroid. Sensitivity was 76 and 56 %, specificity was 100 and 80 % for hybrid SPECT/CT and planar protocol respectively. SPECT protocol was typically more efficient to diagnose pathologic parathyroid derived from upper gland and for patient with concomitant nodular goiter.     

Découverte d’un site d’art rupestre en Cyrénaïque (Libye) : Kaf Tahr

In April 2009, a new rock art site was discovered in Libya. Kaf Tahr is situated in Cyrenaica, in the Djebel Akhdar (the “green mountain”). This new site with engravings displays several interests. Firstly, it is only the third rock art site discovered - or at least published - in Cyrenaica. Secondly, this rock shelter is the only one that had shown engravings belonging to at least two different chronological periods, the first one being very probably prehistoric, and the second, post-prehistoric. Finally, the engraving of a man (with a sword and a shield) and the engraving of a horse are the first discovered in the area. These two engravings could have been realized in the protohistoric period. This period is well-known in the Libyan Fezzan (“libyco-berberian period” or “horse period”) but it has never been defined in Cyrenaica. Owing to the lack of research, the long period separating the end of Prehistory from the beginning of the greek colonization is hitherto totally unknown. If these engravings would belong to this period, they would be the first elements attesting of a metal work and a horse domestication in Cyrenaica before the historic period.     

Dispersion du Genre Homo au sud d’Ibérie et au Maghreb. Nouvelles données à propos des fossiles VM-1960 et BL-0

In this article, there is a discussion about out-of-Africa models of Homo dispersal, considering new findings, specially a new site with Oldowan industry in Morocco (Ain-Beni-Mathar), found in 2005 by some of the authors (Gibert J, Gibert L, and El Hamouti). There is also a critical of the models of Homo dispersal only based on carrion consumption. We also discuss some objections about two human remains from Orce sites (VM-1960 and BL-0) based on morphometric data (that, in any case, move these remains away from genus Homo), on authority criteria and ad hoc hypothesis, ignoring the decisive anatomical data.     

Apport de la fusion d’images tomoscintigraphiques avec la tomodensitométrie X ou l’imagerie par résonance magnétique en pathologie osseuse : expérience du service de médecine nucléaire de Sfax

The aim of our study was to assess the contribution of image fusion of SPECT combined with computed tomography (SPECT-CT) or magnetic resonance imaging (SPECT-MRI) in our daily practice of bone scintigraphy. Seventeen patients underwent a SPECT image fusion, SPECT-CT or MRI in addition to conventional bone scintigraphy. These acquisitions are made separately with images stored in DICOM format. The fusion was operated after a manual coregistration of the images. Results show that in 35.29% of cases, the image fusion allowed to pinpoint the exact location of increased uptake seen on the whole body scan and/or on static images. In 35.29% of cases, the fusion has confirmed a diagnosis doubtful in planar imaging. In five patients, representing 29.41% of cases, the fusion has corrected a diagnosis. In one patient (5.88% of cases), the fusion has eliminated a false positive related to increased uptake visualized on the whole body scan. In two patients (11.11% of cases), the fusion has eliminated false negative of bone scan in one case and of MRI in the other case. Finally, in nine patients (50% of cases), the fusion has influenced the therapeutic management.     

Métastase rénale d’un carcinome vésiculaire de la thyroïde révélée par le balayage du corps entier à l’iode 131

Distant metastasis of differentiated thyroid carcinoma generally affect lung and/or bone tissue. Renal metastasis from thyroid carcinoma is extremely rare. We report a case of renal metastasis from a follicular thyroid carcinoma in a 55-year-old man, occuring 11 years after total thyroidectomy, fortuitously discovered on a whole body scan carried out after 131-iodine therapy for neck recurrence of disease. Salient features of our clinical case are the fortuitous mode of discovery the unilateral localization of metastases and especially the long time interval which separates its detection from that of the primitive tumour. This case report exemplifies the useful role of the whole body scan carried out after 131-iodine therapy better adapted to reveal often undetectable occult metastases with low dose, but also to ensure a regular and protracted follow-up of patients treated for differentiated thyroid carcinoma.     

Apport de l’imagerie hybride TEMP/TDM dans la détection des ganglions sentinelles : à propos de 32 cas

Objectives

Retrospective evaluation of the SPECT/CT role in the Sentinel Lymph Node identification.

Patients and methods

Thirty-two patients underwent a lymphoscintigraphy with SPECT/CT imaging. Those patients presented several cancer types (16 melanoma, one squamous cell carcinoma, three breast cancers, eight vulvar cancers, three cervical cancers).

Results

The scintigraphic detection rate was 81% with planar imaging while this rate was 89% with SPECT/CT. The SPECT/CT provided an additional quantitative information in 66% cases. Moreover, the quality of the interpretation was better in two different conditions (planar interpretation followed by routine and blinded SPECT/CT interpretation) with SPECT/CT. In our study, the false negative rate is 4.5%.

Conclusions

SPECT/CT provides quantitative and qualitative informations in the sentinel lymph node detection. Therefore, it can be a valuable tool for the surgeon to find and harvest the sentinel lymph node especially where the lymphatic drainage pattern can be unusual or hard to predict (cervical or trunk localisation). It's a new tool for preoperative detection and it can decrease the false negative rate.     

Ndindan : synthèse archéologique d’un site datant de trois millénaires à Yaoundé (Cameroun)

This text is a synthesis of the results from the archaeological study of Ndindan site (Ndedama in Ewondo language) (3°54’N; 11°30’E), located north-west of Yaoundé urban area, on the Mont-Febe eastern side. An overview of the historical of prehistoric research in Yaoundé is given. It then tackles the study of the archaeological materials and supplies the radiocarbon datings of the site. A reconstitution of ancient population and of the paleoeconomy on the regional scale is at last made.     

Le travail des matières d’origine dure animale dans le Magdalénien Morave : l’exemple des aiguilles à chas

Needles made from hard animal tissues are a stereotyped artefact; they have been found in six caves of the Moravian Karst / Czech Republic (Pekárna, ?itného, K?lna, Bý?í skála, Verun?ina, K?í?ova) containing Magdalenian layers. The paper deals with the technology of the production of these objects on the example of the Pekárna cave that has provided a lot of these artefacts in various degrees of wear, fragments, exploitation matrices and uncompleted needles. By the mean of spatial analysis we try to reconstitute the original context in the cave and insert the concerned artefact into the frame of the exploitation, treatment and utilisation of hard animal tissues by Magdalenian hunters in Moravia.     

Plaidoyer pour un outillage lithique de l’Âge du fer : le cas des maillets à gorge de l’Ouest de la France

The attention is turned here to one kind of tools, characterized by a special morphology: the grooved hammer-stones. They are known in Europe and all over the world in various cultures, as Neolithic or Bronze Age remains and generally linked to extraction or mining activity; but, the discovery of several of these tools in western France, within pre-roman archaeological contexts, especially in sites devoted to marine salt production, leads us to a discussion on dating and the function of such tools, and feeds a more general reflexion about the existence of a specialised lithic set of tools during the Iron Age.     

Apport de l’imagerie hybride TEMP-TDM dans le suivi d’un cancer différencié de la thyroïde

In the management of patients with differentiated thyroid cancer (DTC), abnormalities detected on planar whole body scan and ¹³¹I-SPECT are difficult to interpret because of a lack of anatomical landmarks and limited specificity. Integrated ¹³¹I-SPECT-CT imaging has an additional value for characterization of equivocal tracer uptake seen on planar imaging as well as for precise localization. We illustrate through an observation the incremental diagnostic value of ¹³¹I-SPECT-CT images in the diagnosis of a cervical lymph node mimicking a physiological uptake on planar views. A 35-year-old Tunisian female was followed for papillary thyroid carcinoma, for which she underwent total thyroidectomy and iratherapy. Three years after a complete remission, the thyroglobulin (Tg) level on TSH stimulation increased. Diagnostic planar images with ¹³¹I did not disclose any obvious pathological foci. Furthermore, we noticed an increased ¹³¹I-uptake in the left sub-mandibulary area, which suggested a salivary physiological activity. SPECT-CT of the neck and chest were then performed with a Symbia T camera. Fused images demonstrate that this activity corresponds to a cervical lymph node closely adjacent to sub-mandibulary gland. Management of the patient was then changed. In selected patients with DTC, hybrid imaging should be used as a complementary to planar imaging in terms of diagnostic accuracy, because of superior focus localization and additional anatomic information derived from the CT component. Integrated SPECT-CT is then a useful tool, especially in cases of unclear diagnoses, precising anatomical localization of areas of increased ¹³¹I-uptake and distinguishing malignant lesions from normal physiological uptakes. This is particularly important in an oncologic center, as ours, where we don’t yet have a positron emission tomography (PET) camera is not yet available.     

Tumeurs mammaires bilatérales chez une jeune femme : pensez à réaliser une TEP/TDM au FDG. À propos d’un cas de discordance entre l’imagerie sénologique et la TEP/TDM

This case report shows the potential role of FDG (18F) PET/CT in characterization of breasts tumors in a young female without any risk factor of malignancy.     

La flore probable : un mode d’expression des gradients écologiques en France

The application of the criterion of fidelity of plants to plants over four millions botanical observations in France is considered to characterize the ecology of 215,000 phytosociological surveys. Among those discriminant plants, some are missing of the surveys, but they can have a certain probability of occurrence: these plants are called “probable plants” and they represent the “probable flora” of a territory. The study of their geographical distribution shows ecological gradients of flora across France in a better way than only considering the botanical observations. In fact, this method mitigates the discontinuities of taxa observations whose absence may be due to historical and/or anthropogenic factors.     

Fixation extraosseuse du radiotraceur lors de la réalisation d’une scintigraphie du squelette chez un patient atteint de bêta-thalassémie : à propos d’un cas

Red blood cell transfusion, main therapeutic modality of beta-thalassemia, leads to iron overload which may perturb several metabolic ways. The aim of this paper is to illustrate the uptake abnormalities observed on bone scan of thalassemic patients and to discuss mechanisms of extraosseous accumulation of the radiopharmaceutical in this pathology. We report a 16-year-old child suffering from beta-thalassemia major undergoing transfusion therapy. A bone scan was indicated to look for osseous infection. This study revealed a little skeletal uptake and abnormal liver, splenic and renal accumulation. A repeat bone scan, performed three weeks later showed a better skeletal uptake which enabled the discovery of focal abnormalities and made the diagnostic easier. The effect of iron overload on radiopharmaceuticals's uptake in bone scan is known since 1975. Dissociation of ^99mTc from the carrier ligand due to the presence of iron excess seems the most plausible hypothesis. Free ^99mTc can be bound to other tissular substrates which can explain extraosseous uptake. The normally available pool for bone is reduced and then the skeletal uptake decreased. This report limits considerably the sensitivity of the bone scan. A well-led iron chelation and eventually the use of diuretic drug may guarantee a better quality of bone scan images.     

Relecture d’un modèle architectural du III millénaire provençal : l’Habitation n 1 du Collet-Redon à La Couronne (Martigues, Bouches-du-Rhône)

The open-air site of Collet-Redon (Martigues, Bouches-du-Rhône) was discovered in the 1940s, and excavated by M. Escalon de Fonton until the beginning of 1980s. Those pioneering works gave up important series of artefacts and domestic structures of Late Neolithic and Bronze Age that permit to define a new Neolithic culture: the Couronnien group. The importance of this establishment, as a reference in research on Late Neolithic period in South of France, is particularly based on built remains revealed in a sector called “Habitation no. 1”. Quantity and quality of architectural structures allowed M. Escalon de Fonton to describe a Neolithic domestic unit, which became a model for interpreting other regional sites. Since 1999, various studies of artefacts and structures, coupled with an excavation, have been engaged in order to discuss first interpretations. The purpose of this article is to present our results concerning architectural remains of “Habitation no. 1” sector. Study of ancient publications and new observations on structures permit us to suggest a revision of the plan proposed for this third millenary construction.