Imagerie hybride (TEMP/TDM,TEP/TDM) et cancer différencié de la thyroïde

Differentiated thyroid cancer (DTC) is generally associated with a good prognosis. Local recurrences, mainly lymph-node involvement, account for 15–20% of cases and are surgically treated. Distant metastases, mostly in lungs and more rarely in bones, are present in 5% of patients. When iodine uptake is sufficient (in approximately 60% of patients), distant metastases can be destroyed by iterative activities of iodine 131. Serum thyroglobulin (Tg), which can be assessed either on hormonal treatment or on TSH stimulation is considered as the tumour marker in DTC. Functional (iodine 131 scintigraphy, FDG PET, bone scintigraphy) or anatomical (neck ultrasound, thoracic CT, bone MRI) imaging methods can be performed when Tg increases in order to show residual/recurrent disease. In recent years, new hybrid equipments integrating both a gamma camera and CT scan (SPECT/CT) have been commercialized while positron emission tomography cameras associated with CT (PET/CT) have been installed on the whole French territory. These equipments, which allow us to directly correlate functional and anatomical images, greatly improve the interpretation of planar scintigraphy or that of PET alone. Hybrid imaging enables us to precisely localize scintigraphic foci and most often, to immediately verify whether they correspond to tumour lesions. The aim of this article is to review the role of SPECT/CT and PET/CT in the management of patients with DTC in 2010.     

Associations between Stereotype Awareness,Childhood Trauma and Psychopathology: A Study in People with Psychosis,Their Siblings and Controls

IntroductionStereotype awareness—or an individual’s perception of the degree to which negative beliefs or stereotypes are held by the public—is an important factor mediating public stigma, self-stigma and their negative consequences. Research is required to assess how individuals become more sensitive to perceive stereotypes, pointing the way to therapeutic options to reduce its negative effects and increase stigma resilience. Because perception and interpretation can be guided by belief systems, and childhood trauma (CT) is reported to impact such beliefs, CT is explored in relation to stereotype awareness (SA) in persons with psychosis, their siblings and controls.MethodData from the GROUP project (Genetic Risk and Outcome of Psychosis) were analyzed. SA was measured by devaluation scales which assess a respondent’s perception of the degree to which stereotypes about people with mental illness and about their families are held by the public. CT was measured using the Childhood Trauma Questionnaire (short form).ResultsIn patients, symptoms of disorganization and emotional distress were associated with SA about people with mental illness. In siblings, schizotypal features were associated with both types of SA (more schizotypy = more SA). In both patients and siblings, CT was associated with both types of SA (more CT = more SA), independent of symptoms (patients) or schizotypy (siblings).ConclusionCT in people with psychosis and their siblings may sensitize to SA. Thus, CT may not only impact on risk for illness onset, it may also increase SA associated with mental illness, potentially interfering with the recovery process. CT-induced SA may indicate a heightened sensitivity to threat, which may also impact psychopathology.     

Metabolic and Receptor Imaging in Patients with Neuroendocrine Tumors: Comparison of Fludeoxyglucose-Positron Emission Tomography and Computed Tomography with Indium in 111 Pentetreotide

ObjectiveTo determine whether positron emission tomography/computed tomography (PET/CT) and indium In 111 pentetreotide, individually or collectively, predict the outcome of patients with neuroendocrine tumors (NETs).MethodsBetween July 31, 2002, and May 4, 2007, 29 patients with previously diagnosed NETs underwent both PET/CT and indium In 111 pentetreotide imaging at our institution. The images were evaluated for the presence of abnormalities. Clinical outcomes were classified as survival without major morbidities, survival with severe complications of disease, or death. Time to outcome was measured in months from the imaging date to outcome. Kaplan-Meier survival curves were calculated in which patient outcome was compared with results on PET/CT and indium In 111 pentetreotide imaging.ResultsOf the 29 patients, 9 had abnormalities on both PET/CT and indium In 111 pentetreotide imaging. Two patients had abnormal findings on PET/CT but normal findings on pentetreotide imaging. In 5 patients, findings were normal on PET/CT but abnormal on pentetreotide imaging. In 13 patients, normal findings were noted on both PET/CT and pentetreotide imaging. Kaplan-Meier analysis demonstrated a significant survival advantage for patients who had normal findings on PET/CT in comparison with abnormal PET/CT findings (P = .01). Patients with normal findings on indium In 111 pentetreotide imaging had a higher but insignificant survival advantage over those with abnormal results on pentetreotide imaging (P = .08).ConclusionFor evaluation of NETs, PET/CT and indium In 111 pentetreotide are complementary. Increased metabolic activity in tumor cells is reflected by abnormalities on PET/CT. Patients who had abnormal PET/CT findings had a generally poorer prognosis and a more rapid clinical deterioration than those with normal PET/CT findings. (Endocr Pract. 2009;15:521-527)     

TEMP/TDM et TEP/TDM en cardiologie : quel avenir ?

Over the recent years, clinical cardiology has witnessed a rapid evolution of multi-slice computed tomography (CT), starting with 4-slice CT developing into the current state of the heart 64-slice CT technology. This technology permits non-invasive visualization of the coronaries with high precision. CT coronary angiography will likely play an important role in the diagnosis of coronary artery disease. Because not all coronary stenoses detected by CT angiography are flow limiting, the stress myocardial perfusion imaging data complement the CT information. The integration of nuclear imaging (SPECT or PET) and CT data provides a potential opportunity to delineate the anatomic extent and the physiologic severity of coronary artery disease. The objective of this article is to provide a critical view of the relative strengths and weaknesses of myocardial perfusion imaging and CT coronary angiography, which we hope will help elucidate the potential role of these modalities in the diagnosis and management algorithms of patients with known or suspected coronary artery disease.     

CT检查中造影剂不良反应的预防、处理及对影像学检查的影响分析

目的：在CT等医学影像检查过程中,常需要应用造影剂。在造影剂的使用常常发生不良反应,掌握不良反应的发生率,减少或减轻患者的不良反应,能够使CT增强扫描顺利进行,提高检查安全性。方法：搜集我院2011年10月至2012年9月间的1500例CT造影增强检查患者,包括冠状动脉CT血管成像（冠脉CTA）、头部CT血管成像（头CTA）、肝脏增强、泌尿系三维成像（CTU）以及双下肢血管成像（双下肢CTA）,进行造影剂的不良反应类型、造影剂药物剂量、注射速度等统计分析,总结造成不良反应发生的因素及处理方法。结果：不良反应的类型包括发热、呕吐、荨麻疹、面色潮红、局部疼痛、流泪、血压下降、喉头水肿、休克等。使用非离子型造影剂出现不良反应者85例,占5．67％。其中轻度反应65例,占4．33％;中度反应16例,占1．06％;重度4例,占0．27％。结论：在CT增强扫描过程中,造影剂的用量及注射速度与不良反应的发生有相关性。cT检查过程总应该认真执行操作流程,密切观察病人情况,积极防治,正确处理,将造影剂不良反应降低到最低程度,使患者更加安全。     

CT 与X线诊断肠梗阻的临床价值探讨

目的：探讨腹部X 线与CT 扫描鉴别急性肠梗阻的准确性,为临床诊断提供参考。方法：选取2011年8 月-2013 年8 月我院 收治的66 例急性肠梗阻患者的临床资料进行回顾分析。所有患者均经手术活检或病理诊断证实为急性肠梗阻。术后患者均行腹 部X 线及CT扫描检查,对两种方法判断肠梗阻的发生、梗阻部位、类型及病因与手术病理结果进行比较,评价并分析两种检查 方法的准确率。结果：66 例肠梗阻患者中,X线检出率为89.39%,CT 检出率为95.45%。X 线诊断小肠梗阻准确率为72.10%,CT 为86.05%;X线诊断结肠梗阻准确率为69.57%,CT 为86.96%。X线诊断肿瘤准确率为69.57%,CT 为86.96%;X线诊断肠粘连 准确率为67.86%,CT 为82.14%;X 线诊断肠套叠准确率为60.00%,CT 为80.00%;X线诊断单纯性机械性肠梗阻准确率为78.72%,CT为82.98%;X线诊断绞窄性肠梗准确率为73.68%,CT 为78.95 %。CT 对肠梗阻部位、病因及类型的诊断准确率高于腹部X 线片,差异具有统计学意义(P<0.05)。结论：腹部X 线与CT 用于诊断急性肠梗阻具有较高的准确率,但CT 对于肠梗阻部位、梗阻类型及梗阻病因的诊断优于X线片。     

CT检查中造影剂不良反应的预防、处理及对影像学检查 的影响分析

目的：在CT 等医学影像检查过程中,常需要应用造影剂。在造影剂的使用常常发生不良反应,掌握不良反应的发生率,减少 或减轻患者的不良反应,能够使CT 增强扫描顺利进行,提高检查安全性。方法：搜集我院2011 年10 月至2012 年9 月间的1500 例CT 造影增强检查患者,包括冠状动脉CT 血管成像（冠脉CTA）、头部CT 血管成像（头CTA）、肝脏增强、泌尿系三维成像 （CTU）以及双下肢血管成像（双下肢CTA）,进行造影剂的不良反应类型、造影剂药物剂量、注射速度等统计分析,总结造成不良 反应发生的因素及处理方法。结果：不良反应的类型包括发热、呕吐、荨麻疹、面色潮红、局部疼痛、流泪、血压下降、喉头水肿、休 克等。使用非离子型造影剂出现不良反应者85 例,占5.67 %。其中轻度反应65 例,占4. 33%;中度反应16 例,占1.06%;重度4 例,占0. 27 %。结论：在CT 增强扫描过程中,造影剂的用量及注射速度与不良反应的发生有相关性。ＣＴ 检查过程总应该认真 执行操作流程,密切观察病人情况,积极防治,正确处理,将造影剂不良反应降低到最低程度,使患者更加安全。     

Impact of 68Ga-PSMA PET/CT in the treatment of prostate cancer: Initial experience in Spain

AimTo evaluate whether positron-emission tomography/computed tomography with ⁶⁸Ga-PSMA (⁶⁸Ga-PSMA PET/CT) influences the therapeutic management of patients with primary or recurrent prostate cancer (PCa).BackgroundAlthough ⁶⁸Ga-PSMA PET/CT is one of the best options for staging or restaging patients with PCa, its availability is still very limited in Spain. The present study reports the results of the first group of patients in Spain who underwent ⁶⁸Ga-PSMA PET/CT imaging.Materials and methodsAll patients (n = 27) with a histological diagnosis of PCa who underwent ⁶⁸Ga-PSMA PET/CT prior to the definitive treatment decision at the only centre with this technology in Spain during 2017–2018 were included. Two nuclear medicine physicians and a radiologist reviewed the imaging studies. The clinical impact was assessed from a theoretical perspective, based on the treatment that would have been applied if no data from the ⁶⁸Ga-PSMA PET/CT were available.ResultsMost patients (n = 26; 96%) had persistent disease or biochemical recurrence after radical prostatectomy, radiotherapy, or combined treatment. One patient underwent ⁶⁸Ga-PSMA PET/CT imaging to stage high-risk PCa. Overall, ⁶⁸Ga-PSMA PET/CT was positive in 19 patients (70.4%). In 68.75% of these patients, none of the other imaging tests—MRI, CT, or bone scans—performed prior to the ⁶⁸Ga-PSMA PET/CT were able to detect the presence of cancerous lesions. Overall, the findings of the ⁶⁸Ga-PSMA PET/CT led to a modification of the therapeutic approach in 62.96% of the patients in the study.Conclusions⁶⁸Ga-PSMA PET/CT alters the therapeutic approach in a substantial proportion of patients with PCa.     

CT与X线诊断肠梗阻的临床价值探讨

目的：探讨腹部X线与CT扫描鉴别急性肠梗阻的准确性,为临床诊断提供参考。方法：选取2011年8月-2013年8月我院收治的66例急性肠梗阻患者的临床资料进行回顾分析。所有患者均经手术活检或病理诊断证实为急性肠梗阻。术后患者均行腹部X线及CT扫描检查,对两种方法判断肠梗阻的发生、梗阻部位、类型及病因与手术病理结果进行比较,评价并分析两种检查方法的准确率。结果：66例肠梗阻患者中,X线检出率为89．39％,CT检出率为95．45％。X线诊断小肠梗阻准确率为72．10％,CT为86．05％;X线诊断结肠梗阻准确率为69．57％,CT为86．96％。X线诊断肿瘤准确率为69．57％,CT为86．96％;X线诊断肠粘连准确率为67．86％,CT为82．14％;X线诊断肠套叠准确率为60．00％,CT为80．00％;X线诊断单纯性机械性肠梗阻准确率为78．72％,CT为82．98％;X线诊断绞窄性肠梗准确率为73．68％,CT为78．95％。CT对肠梗阻部位、病因及类型的诊断准确率高于腹部X线片,差异具有统计学意义（P〈0．05）。结论：腹部X线与CT用于诊断急性肠梗阻具有较高的准确率,但CT对于肠梗阻部位、梗阻类型及梗阻病因的诊断优于X线片。     

Susceptibility Weighted Imaging: A New Tool in the Diagnosis of Prostate Cancer and Detection of Prostatic Calcification

Background

Susceptibility weighted imaging (SWI) is a new MRI technique which has been proved very useful in the diagnosis of brain diseases, but few study was performed on its value in prostatic diseases. The aim of the present study was to investigate the value of SWI in distinguishing prostate cancer from benign prostatic hyperplasia and detecting prostatic calcification.

Methodology/Principal Findings

23 patients with prostate cancer and 53 patients with benign prostatic hyperplasia proved by prostate biopsy were scanned on a 3.0T MR and a 16-row CT scanner. High-resolution SWI, conventional MRI and CT were performed on all patients. The MRI and CT findings, especially SWI, were analyzed and compared. The analyses revealed that 19 out of 23 patients with prostate cancer presented hemorrhage within tumor area on SWI. However, in 53 patients with benign prostatic hyperplasia, hemorrhage was detected only in 1 patient in prostate by SWI. When comparing SWI, conventional MRI and CT in detecting prostate cancer hemorrhage, out of the 19 patients with prostate cancer who had prostatic hemorrhage detected by SWI, the prostatic hemorrhage was detected in only 7 patients by using conventional MRI, and none was detected by CT. In addition, CT demonstrated calcifications in 22 patients which were all detected by SWI whereas only 3 were detected by conventional MRI. Compared to CT, SWI showed 100% in the diagnostic sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) in detecting calcifications in prostate but conventional MRI demonstrated 13.6% in sensitivity, 100% in specificity, 75% in accuracy, 100% in PPV and 74% in NPV.

Conclusions

More apparent prostate hemorrhages were detected on SWI than on conventional MRI or CT. SWI may provide valuable information for the differential diagnosis between prostate cancer and prostatic hyperplasia. Filtered phase images can identify prostatic calcifications as well as CT.     

Clinical implication of coronary tortuosity in patients with coronary artery disease

BackgroundCoronary tortuosity (CT) is a common coronary angiography finding. The exact pathogenesis, clinical implication and long-term prognosis of CT are not fully understood. The purpose of this study is to investigate the clinical characteristics of CT in patients with suspected coronary artery disease(CAD) in a Chinese population.MethodsA total of 1010 consecutive patients underwent coronary angiography with complaints of chest pain or related symptoms were included in the present study (544 male, mean age: 64±11 years). CT was defined by the finding of ≥3 bends (defined as ≥45° change in vessel direction) along main trunk of at least one artery in systole and in diastole. Patients with or without CAD were further divided into CT-positive and CT-negative groups, all patients were followed up for the incidence of major adverse cardiovascular events (MACE) for 2 to 4 years.ResultsThe prevalence of CT was 39.1% in this patient cohort and incidence of CT was significantly higher in female patients than that in male patients (OR = 2.603, 95%CI 1.897, 3.607, P<0.001). CT was positively correlated with essential hypertension (OR = 1.533, 95%CI 1.131, 2.076, P = 0.006) and negatively correlated with CAD (OR = 0.755, 95%CI 0.574, 0.994, P = 0.045). MACE during follow up was similar between CAD patients with or without CT.ConclusionsCT is more often seen in females and positively correlated with hypertension and negatively correlated with coronary atherosclerosis.     

Intraoperative computer tomography control within the scope of maxillofacial traumatology using a mobile scanner]

Advances in intra-operative imaging and the development of new minimally invasive techniques are having an ever greater impact on modern surgery. Mobile CT scanners in the operating room is a new technique that permits image-guided surgery, and helps minimize postoperative complications. We report on our initial experience with intraoperative CT scanning during surgery on patients suffering lateral midface trauma. A mobile CT unit, the Tomoscan M (Philips, Utrecht, Netherlands) set up in the operating room, was evaluated in 6 patients with zygomatic bone fractures. The patients were placed on the CT scanner table, which is detachable from the gantry. The unit is powered by batteries charged from an ordinary ring mains supply via a conventional plug. The CT images obtained were of good quality in all cases. No technical problems were observed during surgery. Using repeat CT scans, the procedure also permits accurate intraoperative monitoring of the anatomical repositioning of the bone fragments, and accurate implantation. No intraoperative or early postoperative complications were observed. This new technical aid ensures highly accurate reduction of the bone fragments, and minimizes the need for reoperation. High-quality intraoperative imaging with surgical navigation increase surgical outcome, and expand the spectrum of minimally invasive surgery.     

Apport de la TEP/TDM au 18F-FDG dans le suivi des endocardites infectieuses sur prothèses valvulaires non opérées

Introduction

Prosthetic valve endocarditis is a diagnostic and therapeutic challenge; ¹⁸F-FDG PET/CT has seen increasing use and has been incorporated in the latest ESC endocarditis guidelines. Follow-up by PET/CT has never been studied. The aim was to study the use of PET/CT to help predicting recurrences after full antibiotic treatment.

Effects of immunotherapy and chemotherapy on immunocompetence. A study of patients with acute myeloblastic leukemia in remission

Summary The immunocompetence of 33 patients with acute myeloblastic leukemia in remission and treated with cytostatics (CT) was studied. In addition to cytostatics some of the patients were given immunotherapy (CT+IT).In an attempt to demonstrate immunization against allogeneic leukemic blast cells (or their extracts) or immunostimulation after immunotherapy or, alternatively, immunodepression after maintenance chemotherapy without immunotherapy, delayed hypersensitivity tests and lymphocyte stimulation tests were performed. In most cases PHA seemed to be a stronger stimulator than allogeneic lymphocytes and these seemed to be stronger than allogeneic blasts, although no difference was statisically significant.No significant differences were found in vitro or in vivo between the reactions of CT and CT+IT patients or their lymphocytes to allogeneic myeloblasts or to allogeneic lymphocytes. However, numerically, in vitro and in vivo CT+IT patients reacted more to myeloblasts, CT patients more to lymphocytes. This could suggest antigens on leukemic myeloblasts that are not found on lymphocytes. With present methods we could demonstrate neither immunodepression in patients given only chemotherapy nor nonspecific immunostimulation after immunotherapy. There was no significant difference between the two treatment groups in lymphocyte reactivity against PHA and allogeneic lymphocytes. Nor was the lymphocyte reactivity different from that in a group of healthy persons.Decreasing lymphocyte reactivity to PHA and allogeneic lymphocytes seemed to herald relapse.     

Carcinoma of unknown primary in the head and neck: The evaluation of the effectiveness of 18F-FDG-PET/CT,own experience

AimThe aim of the present study was to estimate the clinical effectiveness of ¹⁸F-FDG-PET/CT in the detection of the primary tumor in patients with histologically proven squamous cell carcinoma cervical lymph nodes metastasis from an unknown primary.Background¹⁸F-fluorodeoxyglucose positron emission tomography combined with CT (¹⁸F-FDG-PET/CT) is believed to be very helpful in localization of primary tumor in CUP Syndrome patients.Material and method41 patients referred to Poznan Medical University Department of Head and Neck Surgery from January 2010 to December 2013 with CUP Syndrome were included in the study. All patients presented fine-needle biopsy proven squamous cell carcinoma metastasis of the upper-, or mid neck lymph nodes. The final results were obtained from the histopathologic reports of tissue samples from anatomical regions suspected for primary tumor, additional imaging exams as well as clinical follow-up data.ResultsThe ¹⁸F-FDG-PET/CT successfully detected primary tumor in 7 out of 41 patients (17%). In two more cases the primary tumor was indicated in the lung. 24 of 41 patients (58.5%) analyzed in our study remained without evidence of a primary tumor. In 4 cases (9.75%) we did not reveal any pathology within the localizations indicated by PET/CT on panendoscopy. In 4 cases we obtained histological confirmation of neoplasm on panendoscopy despite the negative results of PET/CT examinations.ConclusionWe may suppose a relatively high usefulness of ¹⁸F-FDG-PET/CT in the diagnosis process of CUP Syndrome patients. High NPV may indicate patients with no symptoms of primary tumor, which allows to avoid extensive resection or extra imaging.     

Application of Endobronchial Ultrasonography for the Preoperative Detecting Recurrent Laryngeal Nerve Lymph Node Metastasis of Esophageal Cancer

Background

The preoperative detection of recurrent laryngeal nerve lymph node (RLN LN) metastasis provides important information for the treatment of esophageal cancer. We investigated the possibility of applying endobronchial ultrasonography (EBUS) with conventional preoperative endoscopic ultrasonography (EUS) and computerized tomography (CT) examination to evaluate RLN LN metastasis in patients with esophageal cancer.

Methods

A total of 115 patients with advanced thoracic esophageal cancer underwent EBUS examinations. Patients also underwent EUS and CT imaging as reference diagnostic methods. Positron emission tomography /computed tomography (PET/CT) was also introduced in partial patients as reference method. The preoperative evaluation of RLN LN metastasis was compared with the surgical and pathological staging in 94 patients who underwent radical surgery.

Results

The sensitivities of the preoperative evaluations of RLN LN metastasis by EBUS, EUS and CT were 67.6%, 32.4% and 29.4%, respectively. The sensitivity of EBUS was significantly different from that of EUS or CT, especially in the detection of right RLN LNs. In addition, according to the extra data from reference method, PET/CT was not superior to EBUS or EUS in detecting RLN LN metastasis. Among all 115 patients, 21 patients who were diagnosed with tracheal invasions by EUS or EBUS avoided radical surgery. Another 94 patients who were diagnosed as negative for tracheobronchial tree invasion by EUS and EBUS had no positive findings in radical surgery.

Conclusions

EBUS can enhance the preoperative sensitivity of the detection of RLN LN metastasis in cases of thoracic esophageal cancer and is a useful complementary examination to conventional preoperative EUS and CT, which can alert thoracic surgeons to the possibility of a greater range of preoperative lymph node dissection. EBUS may also indicate tracheal invasion in cases of esophageal stricture.     

18F-fluoro-deoxy-glucose focal uptake in very small pulmonary nodules: fact or artifact? Case reports

ABSTRACT: BACKGROUND: F-fluoro-deoxy-glucose (18F-FDG) positron emission tomography integrated/combined with computed tomography (PET-CT) provides the best diagnostic results in the metabolic characterization of undetermined solid pulmonary nodules. The diagnostic performance of 18F-FDG is similar for nodules measuring at least 1 cm and for larger masses, but few data exist for nodules smaller than 1 cm. CASE PRESENTATION: We report five cases of oncologic patients showing focal lung 18F-FDG uptake on PET-CT in nodules smaller than 1 cm. We also discuss the most common causes of 18F-FDG false-positive and false-negative results in the pulmonary parenchyma. In patient 1, contrast-enhanced CT performed 10 days before PET-CT did not show any abnormality in the site of uptake; in patient 2, high-resolution CT performed 1 month after PET showed a bronchiole filled with dense material interpreted as a mucoid impaction; in patient 3, contrast-enhanced CT performed 15 days before PET-CT did not identify any nodules; in patients 4 and 5, contrast-enhanced CT revealed a nodule smaller than 1 cm which could not be characterized. The 18F-FDG uptake at follow-up confirmed the malignant nature of pulmonary nodules smaller than 1 cm which were undetectable, misinterpreted, not recognized or undetermined at contrast-enhanced CT. CONCLUSION: In all five oncologic patients, 18F-FDG was able to metabolically characterize as malignant those nodules smaller than 1 cm, underlining that: 18F-FDG uptake is not only a function of tumor size but it is strongly related to the tumor biology; functional alterations may precede morphologic abnormalities. In the oncologic population, especially in higher-risk patients, PET can be performed even when the nodules are smaller than 1 cm, because it might give an earlier characterization and, sometimes, could guide in the identification of alterations missed on CT.     

Impact clinique et thérapeutique de l’acquisition corps entier en TEP/TDM au 18F-FDG chez les patients suivis pour mélanome malin

ObjectiveTo assess the added benefit of scanning lower limbs in addition to usual whole-body PET/CT scan in patients with no known or suspected primary or metastatic melanoma involving the lower limbs.Materials and methodsThis is a retrospective study of 133 consecutive patients (189 FDG PET/CT) who underwent FDG PET/CT for staging of melanoma at different time points in the course of disease from October 2005 to July 2009 at Brest University Hospital. Reports of whole-body PET/CT scans including lower limbs were reviewed. PET/CT abnormalities on the lower extremities were tabulated by location and correlated with pathology, other imaging studies and at least a 6-month clinical follow-up.ResultsAmong the 189 consecutive PET/CT scans performed in 133 patients, 34 scans in 29 patients highlighted abnormal FDG uptakes considered as equivocal or suggestive of malignancy on lower limbs. In 29 cases, uptakes were located both on lower limbs and on the rest of the body (lung, liver, mediastinal and sub-diaphragmatic lymph nodes, adrenal glands, bone) corresponding to disseminated disease. In five cases, PET/CT uptakes were located only on lower limbs; each pathological uptake corresponded to benign lesions. Lower limbs findings never impacted clinical and therapeutic decision.ConclusionLower limbs additional PET/CT acquisition appears to offer poor additional benefit with no unexpected solitary lesion detected and routine skull base to upper thigh images may be sufficient for this subset of patients.     

Management of necrotizing pancreatitis.

A comprehensive management plan is presented for patients with severe acute pancreatitis. These patients may have pancreatic or peripancreatic necrosis or pancreatic fluid collections. Multiple organ failure often develops in patients with severe pancreatitis. We therefore recommend that all patients with acute pancreatitis be evaluated for pancreatic anatomy and function. If a patient is seriously ill, a computed tomographic (CT) scan with vascular enhancement should be done. Meanwhile, vigorous fluid replacement is necessary using Swan-Ganz monitoring. Patients with necrosis do not need surgical intervention unless the clinical course or CT scan-guided aspiration shows infection. The objective of an operation should be to remove all infected tissue and fluid. A preoperative CT scan with vascular enhancement should be used as a guide during the operation to ensure that all foci of infected necrosis or fluid are eliminated. We have found that open packing and irrigation with sodium oxychlorosene are helpful in patients with extensive necrosis or those who become infected early after the onset of symptoms. In all, 40% to 50% of patients treated by closed drainage will require reoperation because of incomplete debridement. Persistent sepsis is an indication for reoperation.     

Value of computed tomography in patients with stroke: Oxfordshire Community Stroke Project.

The usefulness of computed tomography (CT) was assessed in 325 consecutive patients with a "clinically definite first stroke" from a community stroke register. CT detected five "non-stroke" lesions (two cerebral gliomas, one cerebral metastasis, and two subdural haematomas), a frequency of 1.5%. Five patients were identified with cerebellar haemorrhage, but only one survived long enough to have a CT scan. CT was useful in excluding intracranial haemorrhage as the cause of the stroke in four patients receiving anticoagulants and seven receiving antiplatelet treatment; it showed intracranial haemorrhage in one patient taking aspirin. Forty six patients were in atrial fibrillation at the time of their stroke; four had intracranial haemorrhages and three had haemorrhagic cerebral infarcts. Nineteen patients with presumed ischaemic minor stroke were considered suitable for carotid endarterectomy; CT showed small haemorrhages in two. The CT scan provides very useful information in a minority (up to 28%) of patients with first stroke, who can be selected on quite simple criteria: (a) doubt (usually because of an inadequate history) whether the patient has stroke or a treatable intracranial lesion; (b) the possibility of cerebellar haemorrhage or infarction; (c) the exclusion of intracranial haemorrhage in patients who either are already taking or likely to need antihaemostatic drugs or are being considered for carotid endarterectomy; (d) if the patient deteriorates in a fashion atypical of stroke.