Place de la scintigraphie osseuse dans la maladie de Paget

The clinical and laboratory signs, as well as the imaging and course of Paget's disease of bone, are now well known. This chronic and usually benign disease is characterized by excessive remodelling of bone tissue, associated with an increase, sometimes considerable, of osteoclast resorption and osteoblast formation activities. The bone scan is a fundamental examination to establish initial mapping of the localizations of the disease. This examination has a greater sensitivity than X-rays for the flat bones. Through three clinical cases, we present the bone scan aspect, the various localizations and the diagnosis difficulties of the disease, especially when a context of neoplasm is present.     

Apports de la tomodensitométrie cardiaque dans la maladie coronaire

With the improvement of spatial and temporal resolution of the latest generations of multislice CT scanners, cardiac CT will probably take a growing role in noninvasive coronary imaging. After a short technical review, this article presents the performances and considers the actual and potential role of cardiac CT in the evaluation of coronary artery disease.     

Trichopoliodystrophie,ou la maladie de Menkes.

Trichopoliodystrophy (also known as Menkes'' kinky or steely hair disease), a recessive sex-linked syndrome, is characterized by severely retarded mental and physical development, convulsions, a particular phenotype and abnormalities of the hair, bones and arteries. Very low levels of copper and ceruloplasmin in the serum confirm the diagnosis. This rare disorder is caused by an inborn error of copper metabolism whose nature is not yet clear. Recent hypotheses favour either an abnormality in the transport of copper across the cell membrane or increased affinity for copper of the intracellular binding protein. Because the metabolic abnormality is expressed autonomously and irregularly in various tissues, the distribution of copper within the body is disordered. Up to now none of the many forms of copper therapy has succeeded in modifying the fatal course of the disease in humans. This article presents a new case, the first in Canada, and a review of the other 69 cases described in the literature. The new case illustrates, in addition to the classic picture, less well known features, such as diverticula of the bladder mucosa and serosa, as well as cortical atrophy and malformed cerebral vessels demonstrated by computer-assisted tomography.     

La TEP-TDM dans la maladie de Hodgkin : expérience clermontoise

The aim of this study was to evaluate the standardized uptake value (SUV) of ¹⁸FDG in Hodgkin's disease according to various histopathologic parameters as well as the impact of the examination on stadification and follow-up. A total of 37 patients profited from a pretherapeutic PET-CT. Standardized uptake value was calculated a posteriori. This one is higher in mixed cellularity Hodgkin's disease compared to nodular sclerosing Hodgkin's disease. In addition, the examination involved a change of stage in 35% of the cases compared to the injected CT. The specificity of the PET-CT at the end of the treatment was 96% and its exactitude of 93%, both significantly higher than those found in CT.     

Tomographie par émission de positons au F-fluorodeoxyglucose dans la mise en évidence de la maladie veineuse thromboembolique

Purpose

Association of venous thromboembolism (VTE) and inflammation reported in the literature may allow the use of FDG PET/CT in the detection of thrombotic process. Published studies remain limited and contradictory. The aim was, therefore, to evaluate the performance of FDG PET/CT for the detection of VTE.

Patients and methods

Patients included in a prospective study evaluating FDG PET/CT for the detection of malignancy in patients with idiopathic VTE were analysed (MVTEP, PHRC 2008). PET/CT images were interpreted initially without and then retrospectively with knowledge of VTE locations.

Results

Hundred and fourteen patients were included in MVTEP study from March 13th 2009 to July 1st 2010. Forty-six patients (median age: 74 years [20-87], 27 males, 19 females) were analysed. No abnormal uptake was initially reported in pulmonary vessels. The retrospective analysis of pulmonary embolism locations did not demonstrate any significant difference in FDG uptake between embolic sites and controlateral vessels (P = 0.883). Initial analysis of lower limbs vessels demonstrated sensitivity and specificity of PET/CT for deep venous thrombosis (DVT) diagnosis of 15 and 99%. The metabolic activity of DVT was significantly higher than the activity of controlateral vessels (P < 0.005) but without showing any significant SUV threshold for DVT diagnosis.

Conclusion

In conclusion, there is insufficient evidence to suggest that FDG PET/CT could be accurate in detection of VTE. These results need to be completed in a larger study with shorter delay between VTE and FDG PET/CT.     

Imagerie moléculaire de la maladie de Parkinson : données actuelles

During the last years, knowledge and concepts concerning Parkinson's disease and other parkinsonian syndromes have progressed: a concept of network pathology with different clinical presentations and evolutions, involving several neurotransmission pathways succeeeded the single dopaminergic lesion concept. Imaging also changed with the development of MRI. In this context, the aim of this work is to bring up-to-date methodology and clinical contribution of dopaminergic neuron imaging. Nigrostriatal neuron imaging (dopamine transporter imaging) contributes to diagnosis of Parkinson's disease and Lewy body dementia. Dopamine receptor imaging mainly helps in differential diagnosis of parkinsonian syndromes (Parkinson's disease and Parkinson plus syndromes). The ongoing development of dopaminergic, cholinergic, serotoninergic tracers and the recent emergence of amyloid plaques and neurofibrillary tangles imaging open perspectives for molecular imaging and care of neurodegenerative diseases.     

L'angiographie et la maladie thrombo-embolique pulmonaire: Indications et contre-indications

Pulmonary angiographic studies were performed on 100 patients with suspected pulmonary embolic disease.In the majority, the contrast medium was injected through a catheter located in the outflow tract of the right ventricle or the pulmonary trunk.Pulmonary embolic disease should be suspected in the presence of the following unexplained symptoms or signs: (1) dyspnea, (2) thoracic pain, (3) hemoptysis, (4) left ventricular failure, (5) global ventricular failure, and (6) pulmonary function deterioration.Pulmonary angiography is a simple, specific and objective method by which to diagnose thromboembolic disease of the lung. Acute myocardial infarction and terminal illness were the only contraindications to the procedure.