Évaluation de l’apport de la TEMP/TDM basse dose et de la valeur ajoutée d’une acquisition « diagnostique » centrée chez les patients présentant un foyer isolé suspect ou indéterminé sur la scintigraphie osseuse (SO).Soixante patients ont bénéficié de façon prospective d’acquisitions TEMP/TDM basse dose (30 mAs, épaisseur de coupe de 3 mm), puis « diagnostique » (100 mAs, épaisseur de 1,25 mm) centrée sur le foyer. Le premier observateur a successivement examiné la SO, puis l’acquisition basse dose, puis celle centrée. Une double lecture en aveugle a été réalisée par un second observateur.La SO a permis d’identifier des foyers isolés de nature indéterminée ou suspecte chez 38 et 22 patients. Les acquisitions TEMP/TDM basse dose ont permis de classer 73 % des foyers. Les acquisitions centrées ont modifié les résultats chez neuf patients. Des foyers additionnels, non présents sur la SO et localisés en dehors de la TDM de l’acquisition centrée ont été retrouvés chez 20 patients. L’agrément interobservateur était pour la SO, les TEMP/TDM basse dose et centrée respectivement de 0,542, 0,68 et 0,694. L’analyse Roc n’a pas montré de différence significative entre les deux types d’acquisitions TEMP/TDM que ce soit pour l’observateur 1 ou l’observateur 2.Cette étude montre que la TEMP/TDM basse dose est suffisante pour préciser le diagnostic chez les patients présentant un foyer isolé sur la SO en cancérologie. Le volume exploré par la TDM ne devrait pas être limité au foyer isolé en raison des foyers additionnels fréquents.To evaluate the usefulness of a low dose SPECT/CT and the added value of an additional “diagnostic” centred CT-scan in cancer patients with a solitary focus observed on planar whole-body bone scintigraphy (PWBS) and classified as indeterminate or suspicious.Sixty consecutive patients underwent a low dose SPECT/CT acquisition (120 kV, 30 mAs, 3 mm slice thickness) followed by a “diagnostic” CT-scan (120 kV, 100 mAs, 1.25 mm slice thickness) centred on the focus. The first observer considered prospectively WBS, low-dose SPECT/CT and finally the centred SPECT/CT. A blinded review was performed by a second observer.PWBS depicted solitary indeterminate or suspicious foci in 38 and 22 patients, respectively. SPECT/CT acquisitions clarified 73% (44/60) of the foci. Additional diagnostic CT-scan altered low-dose SPECT/CT results in nine patients. Additional foci (not found by PWBS) located outside the scanning area of the centred diagnostic CT-scan were found in 20 patients. Inter observer agreement for PWBS, low-dose SPECT/CT and diagnostic SPECT/CT was equal to 0.542, 0.68 and 0.694, respectively. ROC analysis showed no difference between low-dose SPECT/CT and diagnostic SPECT/CT for observer 1 and observer 2.This study shows that a conventional low-dose SPECT/CT in patients presenting with a solitary focus on PWBS is sufficient to improve both accuracy and inter observer variability of bone scanning. A CT volume session should not be limited to the area of the solitary focus since additional foci located outside the centred CT-scan frequently occurred.

Les syndromes coronariens aigus ont été très peu étudiés au sein de la population féminine en Afrique noire. Cette série subsaharienne a montré une progression de la prévalence des syndromes coronariens aigus au sein de la population féminine comparée aux études antérieures. À travers cette étude rétrospective nous avons évalué les particularités épidémiologiques, cliniques, paracliniques, thérapeutiques et évolutifs des syndromes coronariens aigus de la femme à l’hôpital Principal de Dakar.Il s’agissait d’une étude rétrospective, concernant des patients hospitalisés pour un syndrome coronarien aigu sur une période de 5 ans du 1er janvier 2010 au 31 décembre 2014 au service de cardiologie de l’hôpital Principal de Dakar.Les prévalences du diabète et de l’obésité étaient statistiquement plus élevées chez la femme que chez l’homme. Une symptomatologie atypique était beaucoup plus retrouvée (p = 0,0000), des délais d’admission au niveau des services d’accueil des urgences pour un syndrome coronaire aigu relativement plus longs ( = 0,005). Sur le plan thérapeutique, la prise en charge était quasi similaire quel que soit le genre.Au Sénégal, le syndrome coronarien aigu chez la femme est caractérisé par l’atypie de la symptomatologie avec un retard de diagnostic et de prise en charge. La lutte contre cette pathologie réputée masculine passe par une bonne campagne de sensibilisation.Acute coronary syndromes have been rarely studied in the female population in Sub-Saharan Africa. This Sub-Saharan serie has shown an increase in the prevalence of acute coronary syndromes among the female population, compared to previous studies. Through this retrospective study, we evaluated the epidemiological, clinical, paraclinical, therapeutic and evolutionary features of acute coronary syndromes on women at the Principal Hospital of Dakar.This was a retrospective study of patients hospitalized for acute coronary syndrome over a period of 5 years from January 1st, 2010 to December 31st, 2014, at the Cardiology Department of the Principal Hospital of Dakar.The prevalence of diabetes and obesity was statistically higher for women than for men. Atypical symptomatology was much more apparent (P = 0.0000), admission times at the emergency department for acute coronary syndromes were relatively longer ( = 0.005). Therapeutically, medical care was almost identical regardless of gender.In Senegal, acute coronary syndrome in women is characterized by the atypical symptomatology with delayed diagnosis and management. The fight against this reputedly masculine pathology requires a good awareness campaign.

Time-of-flight PET improves the image quality by increasing signal-to-noise ratio. This improvement increases with time resolution. Recent data confirm the clinical benefits of time-of-flight PET. The signal-to-noise gain has led to a dose reduction, shorter scans, better image quality especially in patients with high Body Mass Index, and improvement in detection of smaller lesions. (C) 2011 Elsevier Masson SAS. All rights reserved.

L'hyperexpression des récepteurs de la somatostatine, notamment le sous-type 2, est une caractéristique des tumeurs neuroendocrines gastro-entéropancréatiques (TNE-GEP) différenciées, mise à profit depuis de nombreuses années pour l'imagerie et plus récemment pour la radiothérapie interne vectorisée (RIV) dans une approche théranostique. L'accès à la RIV a longtemps été limité à quelques centres spécialisés européens malgré des résultats cliniques très prometteurs et un nombre important de patients porteurs de TNE traitées. Ces deux dernières années sont marquées par la validation, grâce à l'essai randomisé (NETTER-1), de l'intérêt de la RIV par 177Lu-DOTATATE pour le traitement des TNE de l'intestin moyen ayant abouti à l'autorisation de mise sur le marché du 177Lu-DOTATATE (LUTATHER®) par les autorités de santé américaine et européenne. L'accès à la RIV des TNE-GEP est devenu une réalité dans une vingtaine de centres français, avec une prise en charge financière de la RIV attendue dans les TNE intestinales en début 2019. La place de la RIV par rapport aux autres modalités thérapeutiques des TNE non intestinales reste à valider par les essais en cours, mais on anticipe déjà un développement important de cette nouvelle modalité thérapeutique. Les succès rapportés de la RIV et le développement de nouveaux radiopharmaceutiques devraient dépasser le champ des TNE et nécessitera une organisation des services de médecine nucléaire et une formation des équipes avec une orientation plus clinique du métier de médecin nucléaire. L'objectif de cet article est de faire le point sur la RIV par les analogues radiomarqués de la somatostatine en France en 2019, en précisant les indications et les modalités d'accès au traitement, et en abordant des aspects pratiques de sélection et de prise en charge des patients, en se basant sur les données de la littérature et des retours d'expériences des centres (incluant les résultats de l'enquête conduite par le groupe endocrinologie de la SFMN en 2017). Seront également abordés les aspects de radioprotection et les perspectives d'optimisation futures dans les TNE-GEP.Somatostatin receptors are overexpressed in differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NET). Radiolabeled somatostatin analogs have been used for a few decades for imaging and more recently for peptide receptor radionuclide therapy (PRRT) in a theranostic approach. Medical access to PRRT has long been limited to a few European specialized medical centers despite promising results in large cohorts of patients. NETTER-1, a phase 3 randomized trial, has demonstrated a drastic improvement of midgut NET patients progression-free survival in PRRT arm as compared to somatostatin analogs, leading to marketing authorizations in USA and Europe. PRRT clinical availability is growing in France, with around 20 medical centers offering this innovative treatment for GEP-NET patients care in 2019. PPRT success-story should lead to improvements of radionuclide therapy developments, which will reshape our medical specialty to a more "clinically" practice. This review aims to detail PRRT in clinical practice in France in 2019, with emphasize on treatment indications, planning and practical aspects. Radioprotection aspects and future optimization perspectives will also be discussed.

L’imagerie hybride en oncologie (TEP-scanner) a été d’un apport déterminant, améliorant les performances du TEP en termes de sensibilité et de spécificité. Les auteurs passent en revue plusieurs situations où l’imagerie hybride s’est avérée décisive et insistent sur la nécessaire collaboration avec les radiologues afin d’exploiter de façon optimale les capacités du scanner couplé au TEP.

La prise en charge diagnostique d’un patient présentant une suspicion d’embolie pulmonaire ne repose pas sur la réalisation d’un seul et unique examen, mais sur l’application de stratégies diagnostiques, intégrant la probabilité clinique, les D-dimères et des examens d’imagerie. Les algorithmes diagnostiques validés à ce jour utilisent comme pierre angulaire l’angioscanner pulmonaire ou la scintigraphie pulmonaire planaire de ventilation–perfusion, chacun présentant des avantages et des inconvénients. La tomoscintigraphie pulmonaire offre des perspectives intéressantes pour se positionner comme une alternative idéale à ces deux examens. La validation d’un algorithme diagnostique intégrant la tomoscintigraphie demeure néanmoins nécessaire.Diagnostic management of a patient with suspected acute pulmonary embolism is not based on a single and definitive test but on the application of integrated diagnostic strategies including clinical probability assessment, D-dimer, and imaging tests. Currently validated diagnostic algorithm use as cornerstone either computed tomography pulmonary angiography, or planar pulmonary ventilation–perfusion, each with advantages and drawbacks. Pulmonary single photon emission computed tomography provides interesting perspectives to position itself as an ideal alternative to these two diagnostic tests. However, the validation of a diagnostic strategy including pulmonary single photon emission computed tomography is still required.

It has been suggested that metoclopramide may reduce artefacts caused by intestinal activity super-imposed on myocardial uptake of MIBI SPET. This study compared the abdominal activity of MIBI in patients given metoclopramide versus a control group. Forty-seven patients with normal scintigrams or with completely normal inferior wall perfusion underwent rest 201T1 + stress MIBI testing. Twenty-four patients arbitrarily received 10 mg metoclopramide orally 45 min before the MIBI injection and 23 patients no metoclopramide. The patients were divided according to the stress performed: 23 patients had exercise and 24 patients dipyridamole infusion, and a comparison was done between patients with metoclopramide and those without. Myocardial and abdominal activity were assessed at 15 and 60 min on three separate projections and the mean myocardium-to-abdomen ratios were computed. The ratio was 1.30 +/- 0.19 and 1.57 +/- 0.23 in the patients with exercise and metoclopramide versus 1.36 +/- 0.18 and 1.64 +/- 0.23 in the patients with exercise alone at 15 and 60 min respectively. The ratio was 0.92 +/- 0.13 and 1.21 +/- 0.21 in the patients with dipyridamole infusion and metoclopramide versus 1.02 +/- 0.17 and 1.33 +/- 0.16 in the patients with dipyridamole alone at 15 and 60 min respectively. These differences were not statistically significant. In conclusion, metoclopramide has no effect on MIBI abdominal activity and is not recommended in routine practice.

The chemical structure of (99m)Tc-GSH has been estabilished using the (99)Tc isotope. Labeling of glutathione with technetium in the presence of stanous chloride gave a high yield result. In a comparative study between (99)Tc and (99)Tc glutathione, the Tc-GSH complex obtained was purified and characterized by uv, visible spectroscopy, HPLC, Biogel chromatography, mass and NMR spectroscopy. Stoichiometric analysis showed a 2 : 1 molar ratio of GSH/Tc for the reaction. The molecular mass assessed by mass spectroscopy was 727 Da corresponding to an oxo(bis) glutathione technetate. NMR studies demonstrated that each glutathione molecule was coordinated to technetium via cysteinyl sulfur and nitrogen atoms. The biodistribution of the complex was studied in normal rats. Blood clearance was rapid during the first hour involving a biexponential curve ( t1/2 (1) : 50 min, t1/2 (2) : 400 min ). No radioactive accumulation was found in any specific organ except kidney and bladder. All the activity excreted was found unchanged in urine. In conclusion, Tc-GSH displayed an anionic dimer form as GSH-Tc-GSH. We assume that the complex is a tetradentate (2N,2S) complex containing a pentavalent technetium coordinated by two thiol and nitrogen atoms of both GSH ligands, and an apical oxo group.

Near-infrared Fourier transform Raman spectroscopy is a rapid and nondestructive technique that can provide reliable qualitative in situ information about the chemistry of biological samples. We have combined this technique with partial least-squares (PLS) regression to perform a quantitative determination of free and esterified cholesterol in two synthetic sample series. In 66 ternary mixtures containing various proportions of cholesterol, cholesterol linoleate, and oleate, the standard errors of prediction were 1.27, 1.17, and 0.94%, respectively. For the second series of experiments concerning the sensitive problem of quantitative analysis of cholesterol palmitate and stearate mixtures, the standard error of prediction for 49 samples was 3.02%. It is also possible to extract quantitative information for a single component of the ternary mixtures independently. These results are of great importance when-as in the case of arterial samples-many chemical species are present. Comparison between Raman spectra of ternary mixtures and atherosclerotic rabbit aorta shows that many bands, assignable to free and esterified cholesterol, are easily observed in the aorta spectrum.

spheres and SPEC!' blood flow agents has demonstrated that the relationship is curvilinear. Recently, several re searchers suggested that the rising asymptotic plateau is caused by washout from high-flow regions (3,4). The up take, extraction fraction and retention of the agents used vaiy among different regions of normal and abnormal brain (1) and the fixation can be altered by local or regional parameters. The kinetic behavior and trapping mechanism specific to each tracer must be well understood for the cm ical application and interpretation of SPECT images. Tech netium-99m-d,1HMPAO (exametazime) and @Fc-1,1 ECD (bicisate) are both available and easy to label, however, HMPAO has poor in vitro stability (RP = 85% after 30 min) (5) and susceptibility to radiolysis, whereas ECD is much morestable(RP = 96%at6 hr)(6). These technetium-amines demonstrate in vivo instability following blood contact and have a short arterial input of the bioavailable compound (7-9). The moiety of compoundschangesin circulating blood, which results in relative'y poor extraction (E) by the brain (HMPAO 77%, ECD 60%) (Table 1). The retention in the brain parenchymais linked to the enzymatic reactions with glutathione (GSH) for HMPAO (10,11) and with ste reospecific deesterification to acid derivatives for ECD (12— 15). These mechanisms have slow turnover and yield non diffusible polar metabolites. The first-passextractionrate is flow-dependentfor ECD, similar to HMPAO, and results in decreased uptake in the higher flow of a normal range (16). Conversely, extraction is higherwhen the flow is reduced. Due to a low backflux from brain (k2), the retention of ECD is higher than HMPAO (Table 1). Backdiffusionof HMPAO is more pro nounced in high flow regions and a higher extraction in low flow regions results in poor contrast. Technetium-99mECD images hold a slightly better contrast between high and low flow regions. ECD has some washout from the brain and negligible redistribution (17,18). HMPAO has slow clearance and liver accumulation contrary to ECD, which has rapid blood clearance with renal excretion of acid metabolites (EC) yielding a better signal-to-noise ratio. IMP, which is not readily available in every country and is cumbersome to label, was the first iodo-amine (19) used for brain imagingwith a high brain extraction rate (96%) J NuciMed1995;36:359-363

Twenty eight patients with severe, intractable spasticity have been treated by chronic intrathecal administration of baclofen. An implantable programmable drug-administration-device (DAD) was used with a permanent intrathecal catheter. Infusion of 50 to 800 micrograms/day of baclofen completely abolished spasticity. Follow-up was up to two years. Therapeutic effect was documented by clinical assessment of tone, spasms and reflexes and by electrophysiological recordings of mono- and polysynaptic reflex activity. Complications and untoward side-effects of the procedure were few. This procedure is recommended for spasticity of spinal origin refractory to physiotherapy and oral medication. It is a preferable alternative to ablative surgical intervention.