Taux de fixation de la pointe du ventricule gauche et correction d’atténuation TEMP/TDM dans la scintigraphie myocardique de perfusion chez les patients non ischémiques

Introduction

Attenuation correction (AC) has been shown to improve the accuracy of myocardial perfusion single photon emission computed scintigraphy (SPECT). It often reveals a decrease in apical uptake in the AC of the left ventricular (LV) in non-ischemic patients. We aimed to identify the parameters that could affect the apical radiotracer uptake in non-ischemic patients.

Influence du positionnement du patient sur la survenue des artefacts et l’interprétation des images de perfusion myocardique obtenues à partir d’une caméra dédiée à semi-conducteurs CZT

Myocardial perfusion imaging (MPI) can be affected by physical artefacts, such as attenuation and Compton scatter, both related to patient's morphological characteristics and his/her position during acquisition. These positional artefacts have been largely studied with classical Anger cameras. Recently, a new generation of heart-dedicated cameras has emerged, using novel cadmium–zinc–telluride (CZT) semi-conductors, with different physical characteristics and geometrical distribution. Our study aimed to investigate, in this new generation camera, the relation between patient's positioning and the occurring of physical artefacts. Plus, we examined whether these artefacts were likely to affect the interpretation made with such images.Material and methodsIn this prospective study, we included 60 patients scheduled in our unit for MPI. All of them underwent both prone and supine acquisitions, after stress test as well as at rest.ResultsAt a global population level, we observed significantly more abnormalities in supine acquisitions in territories mainly vascularized by right coronary artery, and to a lesser extent, by circumflex artery, than observed in prone acquisitions. No scoring difference was observed, regardless of position, in Summed Stress Score, Summed Rest Score or Summed Difference Score. This observation remained the same whether on a global population level, or on a BMI- and perimeter-basis level.ConclusionPosition related physical artefacts, such as attenuation and Compton scattering, are similar to those previously described with Anger cameras. These artefacts do not affect the interpretation of myocardial scans significantly, provided that both images are acquired in the same anatomical position.     

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.     

Aspects cliniques, biologiques et thérapeutiques de la cryptorchidie diagnostiquée à l’âge adulte: analyse d’une série de 69 cas

Objective

To report the clinical, biological and therapeutic features of adult cryptorchidism and to determine whether orchidopexy at adulthood may improve male fertility.

Material and methods

We retrospectively studied the clinical pattern, biological and therapeutic features of 69 men aged of more than 18 years admitted for cryptorchidism at the urological department of Aristide-Le-Dantec teaching hospital between January 1999 and December 2007.

Results

The mean age of our patients was 31.04 ± 8.4 years. In the majority of cases, cryptorchidism was diagnosed in a context of infertility (38 cases), scrotum vacancy (21 cases) and testicular cancer (six cases). Cryptorchidism was unilateral in 69.5% and bilateral in 30.4% of cases. Semen analyses were done for 60 patients and showed azoospermia in 46.6%, oligozoospermia in 38.3% and a normal sperm count in 15% of cases. In all bilateral cryptorchidism cases, semen analyses showed azoospermia. At surgery, the undescended testis was found in 66 cases (95.6%) and orchidopexy was the most done surgical procedure. Seven patients (without testicular cancer) underwent unilateral orchiectomy and histology of specimens showed sertoli-cell-only syndrome with no spermatogenesis in all cases. The histological type of testicular cancer was seminoma (three cases) and embryonic carcinoma (three cases). In azoospermic men (28 cases) no induction of spermatogenesis was achieved after orchidopexy. In infertile patients, the improvement of sperm count was seen in three patients with unilateral cryptorchidism. Three patients with unilateral crytorchidism achieved pregnancy (pregnancy rate of 7.8%).

Conclusion

Orchidopexy for adult cryptorcidism had little impact in male fertility. Because of the risk of testicular cancer, orchidectomy was recommended as treatment of unilateral cryptorchidism. But with the recent development of TESE, orchidopexy appears as a reasonable treatment of adult cryptorchidism.     

Les lésions de l’urètre associées à une fracture des corps caverneux. A propos d’une série de 4 cas et revue de la littérature

Introduction

Urethral injury associated with corpora cavernosa fracture is a relatively uncommon form of urological trauma. Early diagnosis and immediate surgical repair are essential.

Patients and methods

Between January 1990 and December 2004, a total of 4 male patients with urethral injury associated with fracture of the corpora cavernosa were retrospectively studied from a series of 96 cases of penile fracture.

Results

The mean age of the patients was 36.5 years (range: 27–45 years). Urethral bleeding was noted in all patients. Immediate surgical repair via a penile circular subcoronal incision was performed in all cases. Two partial urethral injuries associated with a unilateral corpus cavernosum lesion were identified. In the other cases, total urethral injury was associated with bilateral rupture of the corpora cavernosa. The tunica albuginea defect was closed and the urethral laceration repaired over a urethral catheter. With a mean follow-up of 2.5 years, 2 short urethral strictures were observed and were managed non-operatively with good outcome.

Comments

Secondary urethral lesions associated with corpora cavernosa fracture most frequently affect young adults. In North African countries, forced self-manipulation of an erect penis is the most frequent cause, but the associated urethral lesion is usually related to vaginal intercourse. The diagnosis can generally be made on the basis of history and physical examination alone. Blood at the meatus or haematuria or voiding difficulties suggest associated trauma to the urethra [4]. Additional imaging examinations are rarely required. The standard treatment is prompt surgical exploration, evacuation of haematoma, and primary repair of the urethral and corpora cavernosa defects. Late complications after surgical repair are penile curvature and pain during coitus. They are usually attributable to a residual fibrotic area.

Conclusion

Urethral injury associated with corpora cavernosa fracture usually has typical signs. The mechanism of trauma is very suggestive. Early surgical treatment is the only guarantee of a satisfactory functional result.     

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.     

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.     

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.     

À propos d’une fixation de l’uncus du pancréas à la scintigraphie des récepteurs de la somatostatine

We report a case of increased Indium 111 pentetreotide (Octreoscan^®) uptake in the processus incinatus of pancreas. 68 Gallium somatostatin analog radiotracer uptake in the head of the pancreas is a common finding, however, this pitfall has never been described with Indium 111 pentetreotide SPECT.     

Apport de la TEP/TDM dans les cancers broncho-pulmonaires : étude d’une série de 35 cas

Lung cancer is one of the most common cancers in Morocco. Currently, PET/CT with FDG is described as the best suited imaging test to evaluate the initial extension of this type of cancer in it non-metastatic variety. Our study confirms the literature data, showing the superiority of PET/CT versus CT in the initial staging of lung non-small cell carcinoma.     

Le cystadénome des vésicules séminales : à propos d’un cas et revue de la littérature

The primitive tumors of seminal vesicles are rare. Almost one hundred cases were reported in the literature. This is most often benign tumours with cystadenomas, primary malignant tumours are too rare.We relate a new case of tumour of the left seminal vesicle with a 70 years aged patient discovered next to an acute retention of urine associated with a constipation. The diagnosis was confirmed by imaging (CT and IRM) that showed a large multi-cystic mass of the left seminal vesicle. The treatment was surgical (vesiculectomy) preceded by a suction drainage of the mass. The anatomopatholgic exam of surgical piece has reached to a cystadenoma of the left seminal vesicle. Throughout this observation, we discuss the different clinical, radiological, histological and therapeutic aspects of seminal vesicles tumours.     

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.