Scintigraphie de perfusion cérébrale positionnelle : résultats physiologiques et applications cliniques

To assess the impact of standing on brain perfusion, 125 brain perfusion scans in the upright and supine position were performed, including 108 patients. Perfusion values were compared using a relative quantitative approach and a segmentation of vascular territories with the help of an atlas of brain perfusion. We found a change in the distribution of the perfusion in favor of the vertebro-basilar system in the upright position. We discuss the case of a patient whose symptoms could be explained with the help of the comparison of brain perfusion scans in the upright and supine position. Atheromatous and post-dissection stenosis and their influence on perfusion are also discussed.     

Scintigraphie cérébrale de perfusion et troubles cognitifs d’origine vasculaire

The vascular cognitive impairment (VCI) is a heterogeneous group of various etiologies, which share a presumed vascular cause. Although the age is the most important risk factor, the cardiovascular risk factors are also involved. A relatively high proportion of these cognitive disorders could be prevented or delayed. Only the treatment of arterial hypertension is recognized as a factor in preventing vascular dementia. MRI is the examination of choice for the investigation of cerebral vascular pathology. However, this morphological imaging is insufficient and does not provide useful functional information. Perfusion brain SPECT is not widely used in the exploration of VCI. Strategies for screening VCI are not standardized and long-term studies are needed to establish the better prevention of cognitive vascular disorders. This article aims to summarize the possible benefit of cerebral perfusion SPECT in the exploration of VCI.     

Distribution physiologique cérébrale et corps entier du 18F-DPA-714 en TEP/TDM

ObjectiveTo investigate the physiological biodistribution of N,N-diethyl-2-(2 – (4 – (2-fluoroethoxy) phenyl) -5,7-dimethylpyrazolo [1,5] pyrimidin-3-yl) acetamide labeled with fluorine 18 (¹⁸F-DPA-714) in humans, by PET/CT in the brain and the whole body. The DPA-714 is a ligand of the translocator protein (Translocator Protein kDa or TSPO), protein overexpressed by microglia in case of neuroinflammation.Materials and methodsDynamic PET/CT brain acquisitions were performed in six healthy volunteers for 90 minutes after intravenous injection of ¹⁸F-DPA-714. Brain biodistribution of ¹⁸F-DPA-714 was assessed visually and using regions of interest (ROI), according to MNI AAL guidelines in order to obtain the activity/time curves for each brain region predefined. One of the subjects was also included whole body PET/CT acquisitions 1 hour after injection of ¹⁸F-DPA-714, allowing visual analysis and semi-quantitative distribution of the tracer, by definition of ROI and SUVs max computation.ResultsThe maximum brain uptake of ¹⁸F-DPA-714 was visualized at 3.5 minutes after injection, gray matter, mostly thalamic. This peak was followed by two elimination phases: an initial rapid phase (3.5 to 35 minutes) and a slower phase until the end of recording. Uptake of ¹⁸F-DPA-714 was generally consistent across brain structures analyzed. The whole body images show significant activity in the gallbladder, spine and salivary glands under the jaw, in accordance with previous published studies using other radioligands for TSPO.ConclusionThis very preliminary study confirms that the brain biodistribution of ¹⁸F-DPA-714 makes it an interesting marker of neuroinflammation. This work allows to recommend a PET protocol acquisition. However, it now seems necessary to implement these findings in patients referred for brain conditions.     

Effets de l’âge et du genre sur la perfusion cérébrale régionale étudiée par deux méthodes d’analyse statistique voxel-par-voxel

Fully automated analysis programs have been applied more and more to aid for the reading of regional cerebral blood flow SPECT study. They are increasingly based on the comparison of the patient study with a normal database. In this study, we evaluate the ability of Three-Dimensional Stereotactic Surface Projection (3D-SSP) to isolate effects of age and gender in a previously studied normal population. The results were also compared with those obtained using Statistical Parametric Mapping (SPM99).MethodsEighty-nine ^99mTc-ECD-SPECT studies performed in carefully screened healthy volunteers (46 females, 43 males; age 20–81 years) were analysed using 3D-SSP. A multivariate analysis based on the general linear model was performed with regions as intrasubject factor, gender as intersubject factor and age as covariate.ResultsBoth age and gender had a significant interaction effect with regional tracer uptake. An age-related decline (p < 0.001) was found in the anterior cingulate gyrus, left frontal association cortex and left insula. Bilateral occipital association and left primary visual cortical uptake showed a significant relative increase with age (p < 0.001). Concerning the gender effect, women showed higher uptake (p < 0.01) in the parietal and right sensorimotor cortices. An age by gender interaction (p < 0.01) was only found in the left medial frontal cortex. The results were consistent with those obtained with SPM99.Conclusion3D-SSP analysis of normal rCBF variability is consistent with the literature and other automated voxel-based techniques, which highlight the effects of both age and gender.     

Rôle des androgènes dans la motivation sexuelle masculine: approche par la neuroanatomie cérébrale fonctionnelle

The central nervous system plays a crucial role in all of the successive stages of sexual behaviour, particularly for the processing of external stimuli. One important step consists of the evaluation of these stimuli and the assessment of their potential reward value, which will determine the development of the sexual response. These different stages involve complex cognitive processes interacting with emotional and physiological components. Androgens, and particularly testosterone, are closely related to the regulation of sexual behaviour. Many of the various effects of testosterone on sexual behaviour have been thought to result from its effects on the central nervous system. Several studies have demonstrated that a minimum concentration of plasma testosterone is necessary to maintain a normal level of sexual desire in human males. Consequently, in normal men, acute and profound androgen deficiency induced by an experimental pharmacological treatment results in decreased sexual desire and fantasies. This reduced sexual desire is also one of the major symptoms observed in male hypogonadism. Conversely, in hypogonadal men, androgen substitution therapy results in increased sexual interest and activity. Over recent years, the development of brain functional imaging techniques (Positron Emission Tomography, functional Magnetic Resonance Imaging) has demonstrated the brain regions participating in a neural network that controls and regulates sexual arousal. We have proposed a four component neurobehavioural model, comprising cognitive (e.g. orbitofrontal cortex), motivational (e.g. anterior cingulate gyrus), emotional (e.g. somatosensory cortex, insula) and physiological (e.g. hypothalamus) processes, to describe this cerebral control of sexual motivation in human males. This network comprises activating and inhibiting structures that interact with each other. As testosterone can modulate sexual desire via its action on cerebral function, we decided to perform a brain imaging study in hypogonadal patients (both when they were untreated and when they received hormone replacement therapy), to obtain e better understanding of the specificity of these brain regions in sexual arousal processes. This study could also help describe the brain regions via which testosterone acts to modulate sexual behaviour.     

Le diagnostic et le suivi thérapeutique des tumeurs cérébrales intra-parenchymateuses par l’imagerie par résonance magnétique multimodale

The multimodal magnetic resonance imaging (MMRI) has an important role in cancer care. This non-invasive and non-ionizing technique provides vital information for the diagnosis and answers to various questions of clinicians before, during and after treatment. The MMRI can specify the localization expanding process; it allows establishing the differential diagnosis of a brain tumor and a circumscribed lesion of another type, to approach the diagnosis of the tumor lesion nature as well as establishing the histological grade of glial tumor in view of lesion monitoring after treatment. The multimodal magnetic resonance imaging has a major contribution to the management progress of the brain tumors. Thus, this paper reviews the value of these MRI modalities in the diagnosis, management and therapy of brain tumors.     

Le sujet cérébral: une esquisse historique et conceptuelle

Since the middle of the 20th century, numerous discourses and practices, both within and outside scientific and philosophical disciplines, have manifested the development of the notion of the human being as acerebral subject. The brain appears to be the only organ of the body that we need, and that has to be exclusively ours, in order for each individual to be himself or herself. Sincepersonhood is the quality or condition of being an individual person,brainhood is thus the quality or condition of being a brain. This property defines the cerebral subject. The anthropology ofbrainhood may seem a natural consequence of progress in the neurosciences. However, it is rooted in 17th-century developments in the philosophies of matter and personal identity. The neurosciences confirm and reinforce this perspective. The author outlines the historical narrative concerning the development of the cerebral subject as well as some contemporary issues arising from the neurosciences.     

Pièges et artéfacts en imagerie TEP/TDM : intérêts des post-traitements

In PET imaging, quantification of the acquired data can be achieved by using a series of correction techniques to minimize the effects inherent in the imaging process of emission tomography. Quantitative images can be reconstructed after correcting the detected emission data for the presence of random and scattered coincidences, attenuation effects, effects associated with the variable detectors sensitivity, effects related to the geometry of the device and the effects of dead-time. All these effects are well accounted for in the PET imaging market. However, other effects can degrade the quality of the PET images, such as the finite spatial resolution generating partial volume effects, or the patient movements including respiratory and cardiac physiological movements. In the thoracic field, the effects of respiratory motion on PET images are characterized by a loss of detection sensitivity due to the associated blur. Several methods have been developed to correct for these effects, but still without a wide acceptance in clinical routine. These research areas are therefore still very active.