PURPOSE:The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. SNMMI and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine.METHODS:The SNMMI and EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary, or sooner, if indicated.CONCLUSION:Each practice guideline, representing a policy statement by the SNMMI/EANM, has undergone a thorough consensus process in which it has been subjected to extensive review. The SNMMI and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by entities not providing these services is not authorized.

La tomografía por emisión de positrones con 18F-fluorodesoxiglucosa (18F-FDG) acoplada a la tomografía computarizada (18F-FDG PET-TC) ocupa, en lo que respecta a los cánceres ginecológicos y mamarios, un lugar destacado en el estudio inicial de extensión locorregional y metastásica. Esta técnica proporciona datos relevantes en caso de recidiva y puede ser útil para evaluar la respuesta terapéutica. En esta revisión de las publicaciones se resumen los datos más recientes respecto a la contribución de esta prueba de imagen en la exploración de los cánceres de mama, ovario, cuello y cuerpo del útero en la evaluación preterapéutica y el seguimiento de las pacientes. Las potencialidades y los límites en términos de detección y caracterización de los cánceres ginecológicos son motivo de discusión.

Purpose The aim of this study was to quantify the contribution of FDG PET to the diagnostic assessment of fever of unknown origin (FUO), taking into account the diagnostic limitations resulting from the composite nature of this entity. Methods The PubMed/MEDLINE database was searched from 2000 to September 2015. Original articles fulfilling the following criteria were included: (1) FUO as the initial diagnosis, (2) no immunosuppressed or nosocomial condition, (3) final diagnosis not based on PET, (4) a follow-up period specified, (5) adult population, and (6) availability of adapted data for calculation of odds ratios (ORs). ORs were computed for each study and then pooled using a random effects model. Stratification-based sensitivity analyses were finally performed using the following prespecified criteria: (a) study design, (b) PET device, (c) geographic area, and (d) follow-up period. Results A meta-analysis of the 14 included studies showed that normal PET findings led to an increase in the absolute final diagnostic rate of 36 % abnormal PET findings to an increase of 83 %, corresponding to a pooled OR of 8.94 (95 % CI 4.18 – 19.12, Z = 5.65; p < 0.00001). The design of the studies influenced the results (OR 2.92, 95 % CI 1.00 – 8.53 for prospective studies; OR 18,57, 95 % CI 7.57 – 45.59 for retrospective studies; p = 0.01), whereas devices (dedicated or hybrid), geographic area and follow-up period did not. Conclusion Abnormal PET findings are associated with a substantially increased final diagnostic rate in FUO. Consequently, FDG PET could be considered for inclusion in the first-line diagnostic work-up of FUO. Further randomized prospective studies with standardized FDG PET procedures are warranted to confirm this first-line position.

Afin qu’une nouvelle procédure d’imagerie diagnostique puisse être utilisée en routine clinique, il est nécessaire d’établir la concordance entre les résultats de cette nouvelle méthode et ceux donnés par la technique de référence. Cette étude évalue la qualité méthodologique et la pertinence des analyses statistiques dans un échantillon d’études en imagerie diagnostique récemment publiées. Nous avons effectué une revue systématique de la littérature dans Medline (via PubMed) pour huit journaux (4 en médecine nucléaire et 4 en radiologie) avec facteur d’impact élevé et publié depuis dix ans. Deux premières sélections (par mots clés puis par résumés) d’articles potentiellement pertinents ont été réalisées et suivies d’une analyse complète. Un formulaire standardisé d’extraction de données a été généré qui comprenait 29 items relatifs à la qualité de l’étude, et notamment sur les biais méthodologiques. Tous les articles sélectionnés ont été analysés par trois relecteurs indépendants (1 interne et 2 médecins expérimentés). Quatre-vingt articles ont été analysés en intégralité. Onze items analysés méritent d’être discutés. Plus de 90 % des articles avaient cinq éléments manquants : présence du mot « concordance » dans les « mots clés », mentionner si les évaluateurs appartiennent au même centre, « justification de la taille de l’échantillon », « notification des écarts au protocole » et « discussion de la pertinence clinique de l’interprétation ». Plus d’un tiers des articles étaient » des études rétrospectives », « sans détail du plan d’analyse statistique », « expériences des évaluateurs non décrites », « pas de respect de l’insu réel entre les évaluateurs » et « sans comparaison avec un gold standard ». plusieurs points pourraient être améliorés dans la présentation des résultats des études d’imagerie diagnostique afin d’assurer la fiabilité de leurs conclusions.

Objectifs Les histiocytoses langerhansiennes (HL) et non langerhansiennes sont des maladies inflammatoires caracterisees par une infiltration tissulaire d’histiocytes. Les objectifs de l’etude etaient de caracteriser par TEP/TDM au 18 F-FDG sur le plan metabolique des sujets atteints d’histiocytose, ceci au moment du diagnostic puis dans le suivi therapeutique. Materiels et methodes Cent vingt-sept bilans initiaux et 457 de suivi ont ete compares a l’imagerie morphologique (TDM et IRM). La reponse metabolique au traitement (41 patients sous interferon-α, 13 sous vemurafenib et 7 sous infliximab) a ete estimee sur les fixations les plus intenses, par le rapport SUV max (initial–final)/initial. Resultats La sensibilite et la specificite de la TEP/TDM au 18 F-FDG par rapport a l’imagerie morphologique etaient comprises, respectivement, entre 33 a 100 % et entre 60 a 100 %, selon le type d’histiocytose et le site lesionnel analyse. Exprimee en pourcentage d’examens, la TEP/TDM au 18 F-FDG initiale comparativement a l’imagerie morphologique a identifie plus de lesions des os longs (93 % vs 86 %), pleuropulmonaires (43 % vs 33 %) et des sinus paranasaux (50 % vs 45 %). La TEP/TDM au 18 F-FDG de suivi a identifie 17 reponses metaboliques complete ou partielle sous interferon-α (RC + RP = 41 % ; mediane de suivi 24 mois), une reponse complete et 8 reponses partielles sous vemurafenib (RC + RP = 62 % ; mediane de suivi 12 mois), enfin une reponse partielle sous infliximab (mediane de suivi 15 mois). Conclusions Les resultats de cette large etude retrospective suggerent que la TEP/TDM au 18F-FDG permet de mieux caracteriser certaines localisations d’histiocytose et qu’elle se revele tres utile dans l’evaluation de la reponse metabolique de cette maladie aux traitements immunomodulateurs.

RADIOLOGIE ET IMAGERIE MEDICALE : Genito-urinaire - Gyneco-obstetricale - Mammaire - 34-106-A-10

Objectives. - Both Langerhans' cell histiocytosis (LCH) or non-LCH histiocytosis represent rare inflammatory diseases characterized by histiocytic infiltration. The objectives of this study were to evaluate F-18 FDG PET/CT contribution to the metabolic characterization of histiocytoses and to assess the metabolic response to different immunomodulatory treatments.Patients and methods. - One hundred and twenty-seven initial and 457 follow-up F-18 FDG PET/CT exams were compared with radiological (CT/MRI) findings. Metabolic responses to treatments (41 patients on IFN-alpha, 13 patients on vemurafenib and 7 patients on infliximab) were assessed by SUVmax (initial-final)/initial after measuring lesions with highest uptake.Results. - F-18 FDG PET/CT sensitivity and specificity varied with the organ and the histiocytosis subtype explored from 33 to 100% and from 60 to 100%. In comparison with CT/MRI and expressed in numbers of positive exams/number of total exams percentage, F-18 FDG PET/CT identified more long bone (93% vs 86%) and sinus (50% vs 45%) lesions. F-18 FDG PET/CT identified 17 metabolic responses (41%) on IFN-alpha (on 24 month median follow-up), one complete response and 8 (62%) partial responses on vemurafenib (12-month median follow-up), as well as a partial response on infliximab (on 15-month median follow-up).Conclusions. - The results of this large retrospective study suggest that whole-body F-18 FDG PET/CT is informative at diagnosis for characterizing several localizations for each histiocytosis subtype and for the evaluation of the metabolic response to various immunomodulatory treatments. (C) 2015 Elsevier Masson SAS. All rights reserved.

PURPOSE:To evaluate if measurement of split renal function ( SRF split renal function ) with dynamic contrast material-enhanced ( DCE dynamic contrast enhanced ) magnetic resonance (MR) urography is equivalent to that with renal scintigraphy ( RS renal scintigraphy ) in patients suspected of having chronic urinary obstruction.MATERIALS AND METHODS:The study protocol was approved by the institutional ethics committee of the coordinating center on behalf of all participating centers. Informed consent was obtained from all adult patients or both parents of children. This prospective, comparative study included 369 pediatric and adult patients from 14 university hospitals who were suspected of having chronic or intermittent urinary obstruction, and data from 295 patients with complete data were used for analysis. SRF split renal function was measured by using the area under the curve and the Patlak-Rutland methods, including successive review by a senior and an expert reviewer and measurement of intra- and interobserver agreement for each technique. An equivalence test for mean SRF split renal function was conducted with an α of 5%.RESULTS:Reproducibility was substantial to almost perfect for both methods. Equivalence of DCE dynamic contrast enhanced MR urography and RS renal scintigraphy for measurement of SRF split renal function was shown in patients with moderately dilated kidneys (P < .001 with the Patlak-Rutland method). However, in severely dilated kidneys, the mean SRF split renal function measurement was underestimated by 4% when DCE dynamic contrast enhanced MR urography was used compared with that when RS renal scintigraphy was used. Age and type of MR imaging device had no significant effect.CONCLUSION:For moderately dilated kidneys, equivalence of DCE dynamic contrast enhanced MR urography to RS renal scintigraphy was shown, with a standard deviation of approximately 12% between the techniques, making substitution of DCE dynamic contrast enhanced MR urography for RS renal scintigraphy acceptable. For severely dilated kidneys, a mean underestimation of SRF split renal function of 4% should be expected with DCE dynamic contrast enhanced MR urography, making substitution questionable.

Introduction. - The nuclear medicine physician is a member of a team responsible for the safe and correct implementation of radioactivity-based procedures. To ensure the consistent provision of high-quality services, sufficient education and training are necessary. The aim of this study was to provide a structured description of the present status of the education and training framework in 12 EANM member or affiliated member countries.Materials and methods. - The acquisition of data describing national education and training systems was based on a questionnaire prepared by the authors. It comprised 19 questiOns related to education and training, the different professional levels, the presence or not of a national register and its characteristics, and finally of other miscellaneous professional issues.Results. - In the majority of cases, being an accredited nuclear medicine physician is required to practice nuclear medicine. The specialty duration ranges from 4 to 6 years (or 5 to 7 years for dual accreditation). Successful completion of the specialty requires satisfaction of time-related as well as other threshold criteria. A national register is available in the majority of the countries. There can be a register renewal mechanism, based on a Continuing Professional Development system.Discussion. - In conclusion, a common policy is generally followed in the countries evaluated, notwithstanding the presence of a few noted differences. Certain suggestions have been made, including the proposed threshold criteria for successful specialty completion, standardization of radiology-related training, the adoption of Continuing Professional Development systems and national registers' renewal mechanisms. (C) 2014 Elsevier Masson SAS. All rights reserved.

Although renovascular disease remains defined as a stenosis of the main renal artery or its proximal branches (renal artery stenosis [RAS]), its clinical overview has changed dramatically over the last 15-20 years and its management is more controversial than ever before. The clinical problems, not only diagnosis and treatment but also the relative contribution of different pathophysiological mechanisms involved in the progression of kidney disease, have shifted dramatically. This presentation aims to emphasize the paradigm change revisiting the (recent) past focused on renovascular hypertension (RVH) to the current context of preservation or recovery of threatened renal function in patients with progressive atherosclerotic renovascular disease until its last stage of irreversible "ischemic nephropathy." In the past, the foreground was occupied by RVH, a very rare disease, where the activation of the renin-angiotensin-aldosterone system (RAAS) was supposed to play the major, if not only, role in RVH issues. The retrospective RVH diagnosis was established either on the improvement or, more rarely, on the cure of hypertension after revascularization by, most often, a percutaneous transluminal renal angioplasty with or without a stent placement. At this time, captoptril radionuclide renography was an efficient diagnostic tool, because it was a functional (angiotensin-converting enzyme inhibition), noninvasive test aiming to evidence both the RAAS activation and the lateralization (or asymmetry) of renin secretion by the kidney affected by a "hemodynamically significant" RAS. At present, even if captoptril radionuclide renography could be looked upon as the most efficient (and cost effective in selected high-risk patients) noninvasive, functional test to predict the improvement of hypertension after RAS correction, its clinical usefulness is questioned as the randomized, prospective trials failed to demonstrate any significant benefits (either on blood pressure control or on renal function protection) of the revascularization over current antihypertensive therapy. Today many patients with RVH remain undetected for years because they are treated successfully and at low expense with these new blockers of RAAS. In addition to its well-known role in hemodynamics, angiotensin II promotes activations of profibrogenic and inflammatory factors and cells and stimulates reactive oxygen species generation. The "atherosclerotic milieu" itself plays a role in the loss of renal microvessels and defective angiogenesis. After an "adaptative" phase, ischemia eventually develops and induces hypoxia, the substratum of ischemic nephropathy. Because blood oxygen level-dependent MRI may provide an index of oxygen content in vivo, it may be useful to predict renal function outcome after percutaneous transluminal renal angioplasty. New PET tracers, dedicated to assess RAAS receptors, inflammatory cell infiltrates, angiogenesis, and apoptose, would be tested in this context of atherosclerotic renovascular disease.

Proposer un état de l’art sur les modalités d’exploration d’imagerie moderne des tumeurs de la voie excrétrice urinaire supérieure (TVES).Une revue de la littérature sur Medline a été réalisée en considérant l’ensemble des articles répertoriés jusqu’en 2014 et en utilisant différentes combinaisons des mots clés suivant : carcinome urothélial ; voie excrétrice supérieure ; uretère ; bassinet ; scanner ; IRM ; échographie ; urographie.L’imagerie occupe un rôle prépondérant dans le bilan diagnostique, d’extension et de suivi des tumeurs des voies excrétrices supérieures (TVES). Le couple échographie/urographie intraveineuse a laissé la place à l’uro-scanner et à l’uro-IRM, qui peuvent aussi être combinés dans certains cas. Cette revue de la littérature présente les techniques d’exploration actuelle et leurs principaux protocoles (notamment l’intérêt de l’injection de furosémide), détaille les techniques d’interprétation des examens sériés pour rechercher les TVES ou en faire le diagnostic différentiel, et leurs performances respectives. Enfin, la place de l’imagerie en fonction du contexte dans lequel se présente le patient est discutée. La combinaison et la fusion de différentes modalités (TDM, IRM…) pour un même objectif est mise en valeur et présentée comme l’évolution probable de l’imagerie des TVES.L’uro-TDM est devenu l’examen de référence pour le bilan et la caractérisation des TVES.To propose a state of the art regarding imaging techniques for the diagnosis and work-up of upper tract urothelial carcinoma (UTUC).A systematic review of the scientific literature was performed in the Medline database (PubMed) until 2014 using different associations of the following keywords: urothelial carcinomas; upper urinary tract; ureter; renal pelvis; CT scan; MRI; ultrasound; urography.Imaging has a prominent role in the diagnosis, extension and follow-up assessment of upper tract urothelial cancers (UTUC). The couple ultrasound/intravenous urography made way for the multidetector computed tomography urography (MDCTU) and for the magnetic resonance imaging urography (MRU), which can also be combined in some cases. This review of the literature presents available techniques for the exploration of the upper urinary tract, the main protocols (in particular the interest of furosemide addition), details the interpretation techniques for searching UTUC on serial imaging, as well as the main differential diagnoses, and their accuracy. Finally, the role of imaging, according to patient's context is discussed. The combination or fusion of different modalities (CT, MR…) for the same objective is highlighted and presented as the likely evolution of UTUC imaging.MDCTU is nowadays the gold standard imaging modality for the diagnosis of UTUC.

The mission of nuclear medicine (NM) is the use of unsealed radioactive substances for diagnosis and therapy. For training in the “use of artificial radionuclides in medicine”, a Certificate (Attestation d’etudes relatives aux applications a la medecine des radioelements artificiels) and a Licence (CES: Certificat d’Etudes Speciales relatives aux applications en medecine) were created in 1962 and 1973, respectively. Until 1988, holders of this Certificate and later the CES were recognized as NM specialists. During a transition period from 1988 to 2000, a primary (DES) or a secondary supplementary (DESC) specialty degree was awarded. NM was recognized as an exclusive medical specialty in 2000 (DES: Diplome d’Etudes Speciales de medecine nucleaire). NM is a “full” specialty with an exclusive practice. However, after a specific and well-defined procedure (i.e. 2-year minimum theoretical and practical training and after passing an examination) some physicians (an average of two a year) from other specialties (endocrinology, cardiology, internal medicine...) may become NM specialists. As in France a physician can be certified for only one specialty, these “secondary” NM physicians are no longer allowed (“certified”) to practise in their initial specialty by the National Health Authority.

We report the case of a 36-year old patient, referred for parathyroid imaging in a context of hyperparathyroidism. He had a history of congenital bilateral renal hypoplasia treated by four successive transplantations, the last one in July 2011. In 1990, a total parathyroidectomy with autologous parathyroid tissue graft in the right forearm has been performed for secondary hyperparathyroidism. However, hypocalcaemia persisted (2.78 mmol/L), associated with high levels of PTH (1329 pg/mL), even after the last renal transplantation. Neck ultrasound and parathyroid scintigraphy images did not show any cervical or thoracic ectopic parathyroid tissue, while right forearm incidences revealed a high uptake focus corresponding to the autonomisation of the parathyroid transplanted tissue. A brief review of the literature evaluating the benefits of this type of intervention is presented. (c) 2013 Elsevier Masson SAS. All rights reserved.