Diagnostic d’une fracture occulte isolée de la marge postérieure du tibia par la TEMP–TDM

We report the case of a 56-year-old woman, investigated for pains of the right ankle related to a traumatism of an unspecified mechanism. The radiographic assessment was negative. The ^99mTc-HDP 3-phase bone scintigraphy highlighted, on the blood pool and the delayed images, a located lesion on the right ankle. The single photon emission computerized tomography guided by computerized tomography (SPECT-CT) showed a focused uptake on the posterior margin of the right tibia and a sharp lucent line within the tomoscintigraphic spot of uptake. The diagnosis accepted was an isolated occult fracture of the posterior margin of the right tibia. The contribution of the ^99mTc-HDP 3-phase bone scintigraphy combined with the SPECT-CT in the diagnosis of the occult fractures is discussed.     

La procalcitonine : de la découverte à l’utilisation clinique

Since the early 1990's, procalcitonin (PCT) has been described as a marker of inflammation caused by bacterial infections, which is less affected by viral infections and inflammations with noninfectious origin. PCT levels indeed correlate with severity of the infection and can be used for prognostic assessment. More recently, numerous studies have investigated the biochemical and physiopathological features of this new acute phase protein and its usefulness in multiple pathological situations. Based on the results of retrospective or interventional studies, a number of medical teams now include PCT among other criteria of diagnostic, prognosis and therapeutical monitoring of bacterial infections. After recent agreements between Brahms and other companies, many clinical laboratories have become able to propose to physicians a rapid and sensitive assay for this marker.     

Détection automatique de micro-emboles cérébraux grâce à un nouveau détecteur de variance conditionnelle

The detection of precursor signs of cerebrovascular accidents is a problem of public health since cerebrovascular accidents correspond to the second leading cause of death worldwide. The transcranial Doppler system is used to detect micro-emboli signals. To date, the commercial devices used by clinician did not permit to detect all micro-emboli. New detectors are expected to reduce the false negative rate. We propose a novel detector based on the conditional variance. This detector outperforms the conventionnal detector by a factor 10. Consequently, it will allow a more efficient detection of precursor signs of cerebrovascular accidents and a reducing of the risk for patients.     

Apports de l’acquisition TDM couplée à la scintigraphie pulmonaire dans l’exploration d’une suspicion d’embolie pulmonaire

Pulmonary embolism is a frequent disease difficult to diagnose because of heterogeneous clinical presentation. Pulmonary embolism diagnosis requires additional examinations, which are guided by clinical probability scores. The ventilation/perfusion scintigraphy is a validated technic in pulmonary embolism diagnosis strategies, which represents one of its most important indications. In the past years, the technique of scintigraphy evolved with the appearance of hybrid cameras, allowing the realization of tomoscintigraphy coupled with computerised tomodensitometry (CT). One of the major interests of this technique is the possibility of considering alternative diagnosis in case of negative result of scintigraphy. The purpose of this article is to offer nuclear medicine physicians a review of the alternative diagnoses that can be found during pulmonary ventilation/perfusion tomoscintigraphy according to the underlying scintigraphic and morphological abnormalities. In this review, we will first on diseases responsible for: a mismatch (pathological perfusion and normal ventilation), an inverted mismatch (normal perfusion and pathological ventilation) and for associated disorders in ventilation and in perfusion patterns (identically abnormal perfusion and ventilation). The final part will address some specific CT features that can be encountered on a low dose CT centered on thorax.     

TOPASE-MED : comment repenser l’imagerie TEP grâce aux détecteurs semiconducteurs

This paper presents the main outcomes of the TOPASE-MED project, a feasibility study of a semiconductor-based PET imaging system, using CdTe as detection material. This project has followed three main goals: dimensioning a CdTe-based imager by simulation, developing technological bricks needed to build such a system and demonstrating experimentally the potential of the technology with a small scale mock-up.     

Reproductibilité en scintigraphie osseuse planaire,TEMP et TEMP/TDM du pied douloureux : importance d’une sémiologie standardisée

AimThe diagnostic benefit of bone single photon emission computed tomography/computed tomography (SPECT/CT) is currently being demonstrated. However, until now, reproducibility has been poorly investigated. Therefore, a study was undertaken to assess intra- and inter-reader reliability comparing bone planar views, SPECT and SPECT/CT.MethodsThe study was carried out on a cohort of 50 adults consecutively referred to two distinct Nuclear Medicine departments for clinical and radiological suspicion of a reflex sympathetic dystrophy (RSD) of the foot. Each set of planar views and SPECT/CT was independently re-read by two Nuclear Medicine physicians (one junior and one senior expert) in a blinded fashion. An array of bone scan and CT semiological criteria depicting RSD and main differential diagnoses was initially elaborated. Reliability was measured by percentage of agreement and computation of unweighted kappa.ResultsAmong the 50 patients, only four actually suffered from RSD. Among the 46 patients who did not suffer from RSD, 28 were affected by miscellaneous skeletal lesions. This is the reason why the study shifted from focusing on RSD to the etiologic diagnosis of a painful foot. Percentage of inter-reader agreement rose from 74% for planar scintigraphy and SPECT to 96% for SPECT/CT. This study showed reliability indices higher than in literature mainly due to the use of predefined detailed semiological criteria and to the learning effect of the junior physician at senior physician school.ConclusionBone SPECT/CT provides significantly stronger intra-reader and inter-reader agreement in comparison to planar images and stand-alone SPECT.     

Effets d’une exposition à la Vinclozoline et à la Génistéine de la gestation à l’âge adulte sur la fonction de reproduction du ratWistar mâle: protocole et résultats préliminaires

Current evidence indicates that endocrine disrupters (EDs) can induce adverse effects on the male reproductive tract in various mammalian species. Recent reports indicate deterioration in male reproductive health in several human populations, but the evidence for a causal link with endocrine disruption is still weak. In addition, the experimental conditions of most of the reportedin vivo studies are not representative of environmental exposures (for example, high doses, short-term exposure, a single ED) and the mechanisms by which EDs disrupt the reproductive system are poorly understood. The objective of the present study is to develop an animal model to assess the reproductive effects and study the putative cellular and molecular mechanisms involved after exposure to genistein (phytoestrogen) and vinclozolin (fungicide with a known antiandrogenic potential) alone or in combination. The study will be performed in male Wistar rats, with administration of low and high doses of the compounds from conception to adulthood and a subset of the males in each treatment group will be mated with unexposed females. We plan to assess the level of sperm production, histology of the reproductive organs, motility and morphometry of spermatozoa and hormone levels, as well as DNA fragmentation of spermatozoa and determination of the number of germ cells, Sertoli cells and the diameters of seminiferous tubules. Estrogen, androgen, progesterone and FSH receptors will be detected and quantified and the level of testicular apoptosis and several apoptosis pathways will be studied to determine the putative cellular and molecular mechanisms involved. The preliminary results confirmed the developmental effects previously reported for high doses of vinclozolin. More interestingly, they indicated a number of deleterious effects for male rats exposed to low dosages alone or mixtures of low and high dosages compared to controls and rats exposed to high dosages alone. For example, a number of developmental anomalies of the genitalia were observed and a significant decrease of sperm motility and motion and fertilizing ability were observed. These preliminary results provide evidence that chronic exposure to environmental levels of EDs or mixtures of EDs have a detrimental impact on the male reproductive tract. The next step involves assessment of the anatomical disorders and the study of some of the cellular and molecular mechanisms possibly involved.     

Découverte fortuite d’une masse mésentérique asymptomatique d’évolution rapide : rôle de la TEP/TDM au FDG dans la prise en charge du patient

The purpose of this case report is to illustrate the role of the FDG PET/CT in the diagnosis and management of an atypical form of follicular lymphoma of incidental discovery. We report the clinical case of a 75-year-old patient who was asymptomatic and followed annually by abdominopelvic ultrasonography due to a past history of renal infection. On ultrasonography was discovered incidentally a voluminous mesenteric mass of 23 cm, apparently invading the pancreas and encompassing the mesenteric vessels. FDG PET/CT allowed the characterization of the mass as most probably malignant, the staging of the disease, the elimination of the differential diagnosis of gastrointestinal stromal tumour, and the feasibility of a minimally invasive approach to obtain histologic evidence. A transduodenal fine-needle aspiration by ultrasonography-controlled endoscopy was then performed and resulted in cytological diagnosis of malignant non-Hodgkin's centro-follicular lymphoma, stage IV of Ann Arbor classification. Chemotherapy (R-CHOP rituximab) treatment was started.     

Intérêt de la TEP/TDM dans le diagnostic de la carcinose péritonéale : à propos d’une observation

PET/CT is a significant examination recognized in the detection of tumors and their metastases. Through a rare case of peritoneal carcinomatosis complicating an endometrial carcinoma, the authors discuss utility of FDG-PET/CT in the diagnosis and follow-up of this disease.     

Intérêt d’une semi-quantification et d’une analyse statistique automatique pour l’interprétation de la tomoscintigraphie cérébrale de perfusion dans la maladie d’Alzheimer

IntroductionAs the visual interpretation of the brain perfusion SPECT for the diagnosis of Alzheimer's disease might be difficult, it is wished to benefit from techniques allowing to improve the diagnostic accuracy especially for the inexperienced readers.Materials and methodsThree readers retrospectively interpreted 77 ^99mTc-ECD SPECT studies within the context of suspected neurodegenerative disease. The probability of Alzheimer's disease was quoted from 1 to 5, and the optimum sensitivity and specificity values were determined from ROC curves. The readers also attributed a hypoperfusion score to 13 brain regions; a diagnosis was obtained from this semi-quantification using a simple logic rule. The SPECT scans were also analyzed using the Planet Neuro software and a diagnosis was reached from a threshold for 2 of the 90 analyzed regions. The gold standard was established by a comprehensive neurological evaluation with at least 5 years of follow-up.ResultsThe sensitivities and specificities of the three readers were 50 %, 56 %, 28 % and 76 %, 83 % and 90 %, respectively. Using the semi-quantification they were 50 %, 67 %, 61 % and 54 %, 85 %, 69 %. The results of two readers were more in agreement. Using the automatic quantification, sensitivity was 78 % and specificity 81 %.ConclusionThe semi-quantification seems to ameliorate the results of and the agreement between certain readers. However, the automatic quantification seems to be the only way of assisting all of the readers to improve their diagnostic performances.     

Enjeux,défis,opportunités et stratégie durable d’implantation de l’imagerie hybride TEMP/TDM dans un pays à ressources médicales limitées,la Côte d’Ivoire

From HO Anger's analogic gamma camera to digital camera, developed countries are at the time of hybrid cameras SPECT/CT and PET/CT. Sub-Saharan black Africa in the image of Côte d’Ivoire, a country with limited medical resources shows an important delay in the evolution of the health system in general and particularly in medical imaging equipment. The purpose of this paper was to approach the issues, challenges and sustainable strategy for the implementation of hybrid imaging SPECT/CT in a developing country where the rate of morbidity and mortality remains high due to infectious but also cancer diseases because of the inadequacy of the health technical platform. To address these challenges, Côte d’Ivoire like many countries in sub-Saharan Africa with limited medical resources must design, test and develop clinical strategies adapted to developing countries. Health authorities of this country must develop a policy for sustainable financing of medical imaging, including the training of the adequate health personnel according to a model of corporate leadership. In this perspective, Côte d’Ivoire must have a SPECT/CT instead of a simple gamma camera. This would allow to optimize its diagnostic health system in oncology, bone and joint disease and in many other medical disciplines. And especially since the SPECT/CT is a high-performance device that has largely demonstrated its diagnostic efficiency and that can be used as SPECT alone or as isolated CT. In addition, this country should take over digital imaging in the context of cooperation with some countries of Africa and Europe ahead in the field of modern medical imaging, seeking assistance from international organizations (IAEA, RAD-AID, WHO,…). Finally this country should implement methods of assessment, types of performance indicators to guide planning for future projects of its system.