Determinar el valor a-adido de los parámetros semicuantitativos en el análisis visual y estudiar los patrones del depósito cerebral de 18F-Florbetaben.Análisis retrospectivo de pacientes con deterioro cognitivo leve o demencia de origen incierto procedentes de un estudio multicentrico. Los PET con 18F-Florbetaben fueron interpretados de forma visual por dos observadores independientes, analizando las regiones “diana” con la finalidad de calcular el acuerdo interobservador. Se realizó análisis semicuantitativo de todas las regiones corticales con respecto a tres regiones de referencia para obtener índices de captación (SUVRs). Se analizó la capacidad de los SUVRs para predecir el resultado de la interpretación visual, la posibilidad de depósito preferencial del radiotrazador en algunas regiones “diana” así como las diferencias interhemisféricas.Se evaluaron 135 pacientes. En la valoración visual, 72 estudios se clasificaron como positivos. El acuerdo interobservador fue excelente. Todos los SUVRs fueron significativamente superiores en pacientes con PET positivos con respecto a los negativos. Las regiones corticales correspondientes al área prefrontal y al cingulado posterior mostraron la mejor correlación con la evaluación visual, seguidas por la valoración integrada cortical. Usando análisis de ROC, los SUVRs obtenidos en las mismas regiones “diana” mostraron la mejor capacidad diagnóstica.La información obtenida de las regiones “diana” parece ser de ayuda en la clasificación visual, basado en un depósito preferencial de amiloide, lo que permitiría el “machine learning”. El depósito de amiloide, aunque difuso en todas las regiones corticales, parece no ser uniforme ni simétrico.To assess the added value of semiquantitative parameters on the visual assessment and to study the patterns of 18F-Florbetaben brain deposition.Retrospective analysis of multicenter study performed in patients with mild cognitive impairment or dementia of uncertain origin. 18F-Florbetaben PET scans were visually interpreted by two experienced observers, analyzing target regions in order to calculate the interobserver agreement. Semiquantification of all cortical regions with respect to three reference regions was performed to obtain standardized uptake value ratios (SUVRs). The ability of SUVRs to predict the visual evaluation, the possibility of preferential radiotracer deposition in some target regions and interhemisphere differenceswere analyzed.135 patients were evaluated. In the visual assessment, 72 were classified as positive. Interobserver agreement was excellent. All SUVRs were significantly higher in positive PET scans than in negative ones. Prefrontal area and posterior cingulate were the cortical regions with the best correlations with the visual evaluation, followed by the composite region. Using ROC analysis, the SUVRs obtained in same target locations showed the best diagnostic performance.The derived information from target regions seems to help the visual classification, based on a preferential amyloid deposit, allowing machine learning. The amyloid deposit, although diffuse in all cortical regions, seems not to be uniform and symmetric.

Announcing ant delivering results to patients from nuclear medicine tests, and particularly with PET imaging, can vary profoundly from a department to another, even from a physician to another. French regulation regarding patients' information and access to their health data as well as the National Cancer Institute's (Institut national du cancer-INCa) most recent recommendations concerning cancer announcement ask all medical imaging specialists (nuclear medicine physicians and radiologists) to be more implicated in the announcement process. Moreover, and above all legal considerations, it is ethically difficult to refuse any kind of medical communication to a demanding patient and let that patient, sometimes alone, discover the results without any kind of medical comments from the specialist who wrote the report. Such heterogeneity is real and must therefore be understood and explored. The arguments given by physicians who do not give results or who are not implicated in cancer announcement are analyzed in a non-dogmatic fashion to find concrete answers to patients' legitimate expectancies. (C) 2020 Elsevier Masson SAS. All rights reserved.

La rémission dite « incertaine » selon Cheson, fondée sur des critères morphologiques, atteste des limites de la tomodensitométrie (TDM) dans la caractérisation des masses résiduelles (MR). Le but de ce travail est de rechercher pour chacun des paramètres quantitatifs mesurables sur les images TEP-TDM [Standardizd Uptake Value (SUV) et diamètres des MR], une valeur seuil discriminante qui pourrait permettre de diagnostiquer une maladie résiduelle. Nous avons inclus 19 patients atteints d’un lymphome malin hodgkinien (LH) ou non (LNH) ayant bénéficié d’une TEP-TDM en fin de traitement au CHU de Montpellier et présentant une ou plusieurs MR. Nous avons mesuré pour chaque MR les SUVmax, SUVmoy, SUVmin et les diamètres petit et grand axe, puis nous avons suivi les patients afin de rechercher un lien avec le statut de la maladie à cinq mois. Seuls les SUVmax, SUVmoy et le diamètre petit axe (DPA) sont prédictifs du statut de la maladie à cinq mois. Une valeur seuil de SUVmax supérieure ou égale à 4 est en faveur d’une maladie résiduelle avec une spécificité de 90–100 %. La spécificité est de 92 % pour un DPA supérieur ou égal à 11,5mm. Lorsqu’on compare deux à deux le SUV ou le DPA pris séparément avec la combinaison « SUV–DPA », les courbes ROC (Receiver operating characteristic) montrent une tendance à la supériorité de la combinaison « morphofonctionnelle ». Cependant, il n’y a pas de différence significative entre chacun de ces tests (p>0,05). Une étude complémentaire mettant en jeu un effectif suffisant est donc nécessaire pour confirmer ces résultats préliminaires pour lesquels la combinaison du SUV avec le DPA semble être plus performante dans la caractérisation des MR que le SUV seul, faisant de la TEP-TDM l’examen de choix dans l’évaluation des patients atteints d’un lymphome en fin de traitement.

AIMS:To assess the association between abnormal stress myocardial perfusion imaging (MPI) and cardiac events (CE) in asymptomatic patients with diabetes and with > or = 1 additional risk factor. Predictors of abnormal stress MPI were also evaluated. METHODS:Four hundred and forty-seven consecutive patients who underwent stress MPI were prospectively followed for 2.1 [0.5-4.1] years for the subsequent occurrence of hard CE (myocardial infarction and sudden or coronary death) and soft CE (unstable angina and ischaemic heart failure requiring hospitalization). Re-vascularization procedures performed as a result of the screening protocol were not included in the analysis. RESULTS:Follow-up was successful in 419 of 447 patients (94%), of whom 71 had abnormal MPI at baseline. Medical therapy was intensified in all subjects and especially in those with abnormal MPI. Twenty-three patients with abnormal MPI underwent a re-vascularization procedure. CEs occurred in 14 patients, including six of 71 patients (8.5%) with abnormal MPI and eight of 348 patients (2.3%) with normal MPI (P < 0.005). Only two patients developed a hard CE and 12 a soft CE. In multivariate analysis, abnormal MPI was the strongest predictor for CEs [odds ratio (OR) (95% CI) = 5.6 (1.7-18.5)]. Low-density lipoprotein cholesterol > or = 3.35 mmol/l [OR (95% CI) = 7.3; 1.5-34.7] and age > median [OR (95% CI) = 6.0 (1.2-28.6)] were additional independent predictors for CE. The independent predictors for abnormal MPI were male gender, plasma triglycerides > or = 1.70 mmol/l, creatinine clearance < 60 ml/min and HbA1c > 8%, with male gender the strongest [OR (95% CI) = 4.0 (1.8-8.8)]. CONCLUSIONS:Asymptomatic patients with diabetes in this study had a very low hard cardiac event rate over an intermediate period. This could be explained by the effects of intervention or by the low event rate in the background population. Randomized studies of cardiac heart disease screening are required in asymptomatic subjects with diabetes to determine the effectiveness of this intervention.

Purpose: This study sought to determine whether 133Xe-radiospirometry (XRS) successfully selects patients able to undergo lung resection without postoperative respiratory complications and whether perfusion lung scintigraphy (PLS) is likely to provide a similar selection of patients for certain tumour stages. Methods: Two hundred and eighty-four patients with resectable lung cancer underwent preoperative assessment of postoperative forced expiratory volume in 1 s (FEV1) by XRS and PLS. Correlations, Bland and Altman analysis and contingency tables were used to analyse the difference between the two predictive techniques. Results: One hundred and sixty patients underwent lung resection on the basis of XRS preoperative testing only. None of them developed respiratory insufficiency. Despite a close correlation, the limits of agreement between predicted FEV1 by XRS and PLS exceeded ±0.3 l/s. For tumour stages T1Nx and T2N0, PLS underestimated postoperative FEV1 whereas it overestimated this parameter for stage III. Conclusion: XRS accurately selects patients able to undergo lung resection without postoperative pulmonary insufficiency. The agreement between XRS and PLS is unacceptable. When only PLS is available, higher thresholds for patients with stage III cancers and lower thresholds for those with stage I cancers should be used to decide on operability.

L'analyse histologique des ganglions lymphatiques preleves lors du curage cervical des cancers de la cavite buccale et de l'oropharynx apporte une information pronostique majeure. Les techniques d'immuno histo chimie ou de biologie moleculaire permettent d'ameliorer la sensibilite de detection en permettant la mise en evidence d'un envahissement micro metastatique. Toutefois, compte tenu du grand nombre de ganglions preleves lors du curage cervical, une analyse histologique exhaustive de ceux-ci est difficilement realisable. Le ciblage de l'etude anatomo pathologique des pieces du curage est donc souhaitable. Le but de cette etude est d'etablir la faisabilite de la detection isotopique per operatoire du ganglion sentinelle (GS) dans cette indication. A ce jour, 13 patients presentant un cancer de la cavite buccale ou de l'oropharynx au stade T1 pN0 ont ete inclus dans cette etude. Le GS a ete recherche au bloc operatoire. L'exerese selective de celui-ci a precede le curage ganglionnaire. Les resultats histologiques ont ensuite ete confrontes. Le GS a pu etre identifie dans 92% des cas. Dans un cas, l'analyse immuno histo chimique du GS a permis de mettre en evidence un envahissement micro metastatique alors que l'analyse classique de celui-ci est restee negative. L'analyse preliminaire des resultats de notre etude atteste de la faisabilite de la detection isotopique du GS en cancerologie ORL et autorise la recherche systematique d'un envahissement micrometastatique. La poursuite de cette etude permettra de confirmer cette observation sur une plus grande population et d'etudier la signification pronostique du stade micro metastatique.

This study sought to investigate whether the presence of right ventricular systolic dysfunction with pre-existing left ventricular systolic dysfunction is associated with higher plasma brain natriuretic peptide (BNP) levels, compared with patients with isolated left ventricular dysfunction. Eighty-five patients referred for evaluation of isotopic ventricular function were prospectively included in the study. Left (LVEF) and right (RVEF) ventricular ejection fractions were evaluated by gated blood pool scintigraphy and compared with plasma BNP levels. BNP correlated negatively with LVEF, except in patients with ischaemic heart disease (P=0.09) and in patients with LVEF<40% (P=0.11). In contrast, BNP levels correlated negatively with RVEF for all subgroups. Among patients with RVEF<40%, no significant BNP difference was found between patients with or without additional left ventricular systolic dysfunction (P=0.51). Among patients with LVEF<40%, plasma BNP levels were significantly higher in patients with RVEF<40% than in patients with RVEF>/=40% (P=0.004) whereas age, renal function, clinical findings, ventricular volumes, LVEF or medication were not significantly different. In conclusion, an important increase in BNP levels in patients with left ventricular systolic dysfunction should be considered by cardiologists as an indication of high risk of right ventricular dysfunction and should justify further investigation.