Medecine Nucleaire

Saint-Herblain, France

Medecine Nucleaire

Saint-Herblain, France
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PubMed | Imagerie, Medecine nucleaire and Cardiologie
Type: Journal Article | Journal: La Revue de medecine interne | Year: 2016

Current realities and future possibilities of imaging in the ischemic heart diseases are very broad and constantly evolving, with the improvement of existing technologies and the introduction of new features such as dual-energy CT, strain ultrasound, multimodality fusion or perfusion MRI. Regular collaboration between prescribing clinicians, cardiologists, radiologists and nuclear radiologists is therefore essential to tailor the examination to the specific clinical question. The indications for each modality will therefore depend on its diagnostic performance, cost, acquisition and post-processing times and eventual radiation exposure. This review will detail principles and applications of current cardiac imaging examinations: echocardiography, nuclear medicine, MRI, CT and coronary angiography, emphasizing their current strengths and weaknesses in the ischemic heart diseases management.

Bats A.-S.,University of Paris Descartes | Mathevet P.,Hopital Femme Mere Enfant | Mathevet P.,University of Lyon | Buenerd A.,Groupement Hospitalier Est | And 14 more authors.
Annals of Surgical Oncology | Year: 2013

Background: Sentinel lymph node (SLN) biopsy may improve nodal staging in cervical cancer. The aims of this study are to determine the rate of unusual patterns of cervical lymphatic drainage, to determine the rates of micrometastases and isolated tumor cells (ITCs) in SLNs, and to assess the clinical impact of SLN biopsy. Methods: Multicenter prospective study conducted between January 2005 and June 2007 in women undergoing laparoscopic surgery for early cervical cancer. Combined technetium/Patent Blue labeling was used. Lymphoscintigraphy was performed before surgery. SLN location was recorded, and factors associated with location were explored. SLNs underwent step sectioning ± immunohistochemistry. Results: 145 patients were enrolled and 139 included in a modified intention-to-diagnose analysis. Although 80.6 % of SLNs were in external iliac and interiliac areas, 38.2 % of patients had at least one SLN in an unexpected area and 5.1 % had SLNs only in unexpected areas. In unexpected areas, the number of SLNs per patient was not significantly different between lymphoscintigraphy and intraoperative detection (0.79 [0.62-1.02] versus 0.50 [0.37-0.68]; P = 0.096). In expected locations, there were significantly more blue and hot SLNs per patient than blue or hot SLNs (1.70 [1.45-1.99], 0.42 [0.30-0.57], 0.52 [0.39-0.69]). Of 28 metastatic SLNs, 17 contained micrometastases or ITCs. SLN involvement was found only by immunohistochemistry in 39.1 % of patients with positive nodes, and involved SLNs were located in unexpected areas in 17 % of those patients. Conclusions: Sentinel lymph node biopsy detects unusual drainage pathways and micrometastases in a substantial proportion of patients, thus improving nodal staging. © 2012 Society of Surgical Oncology.

Rousseau C.,Medecine Nucleaire | Rousseau C.,University of Nantes | Rousseau T.,Clinique Urologique Nantes Atlantis | Bridji B.,Medecine Nucleaire | And 9 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2012

Purpose: Lymph node metastasis is an important prognostic factor in prostate cancer (PC). The aim of this prospective study was to evaluate the accuracy of sentinel lymph node (SLN) biopsy by laparoscopy in staging locoregional patients with clinically localized PC. Methods: A transrectal ultrasound-guided injection of 0.3 ml/100 MBq 99mTc-sulphur rhenium colloid in each prostatic lobe was performed the day before surgery. Detection was performed intraoperatively with a laparoscopic probe (Gamma Sup CLERAD®) followed by extensive resection. SLN counts were performed in vivo and confirmed ex vivo. Histological analysis was performed by haematoxylin-phloxine- saffron staining, followed by immunohistochemistry (IHC) if the SLN was free of metastasis. Results: The study included 93 patients with PC at intermediate or high risk of lymph node metastases. The intraoperative detection rate was 93.5% (87/93). Nineteen patients had lymph node metastases, nine only in SLN. The false-negative rate was 10.5% (2/19). The internal iliac region was the primary metastatic site (43.3%). Metastatic sentinel nodes in the common iliac region beyond the ureteral junction were present in 13.3%. Limited or standard lymph node resection would have ignored 73.2 and 56.6% of lymph node metastases, respectively. Conclusion: Laparoscopy is suitable for broad identification of SLN metastasis, and targeted resection of these lymph nodes significantly limits the risk of extended surgical resection whilst maintaining the accuracy of the information. © Springer-Verlag 2011.

Fouquet G.,Service des Maladies du Sang | Guidez S.,Service des Maladies du Sang | Herbaux C.,Service des Maladies du Sang | Van De Wyngaert Z.,Service des Maladies du Sang | And 14 more authors.
Clinical Cancer Research | Year: 2014

Purpose: Solitary plasmacytoma (SP) is a localized proliferation of monoclonal plasma cells in either bone or soft tissue, without evidence of multiple myeloma (MM), and whose prognosis is marked by a high risk of transformation to MM. Experimental Design: We studied the impact of FDG-PET/CT (2[18F]fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography) on the risk of transformation of SP to overt MM among other markers in a series of 43 patients diagnosed with SP. Results: Median age was 57.5 years; 48% of patients had an abnormal involved serum-free light chain (sFLC) value, and 64% had an abnormal sFLC ratio at diagnosis. Thirty-three percent had two or more hypermetabolic lesions on initial PET/CT, and 20% had two or more focal lesions on initial MRI. With a median follow-up of 50 months, 14 patients transformed to MM with a median time (TTMM) of 71 months. The risk factors that significantly shortened TTMM at diagnosis were two or more hypermetabolic lesions on PET/CT, abnormal sFLC ratio and involved sFLC, and to a lesser extent at completion of treatment, absence of normalized involved sFLC and PET/CT or MRI. In a multivariate analysis, abnormal initial involved sFLC [OR = 10; 95% confidence interval (CI), 1-87; P = 0.008] and PET/CT (OR = 5; 95% CI, 0-9; P = 0.032) independently shortened TTMM. Conclusions: An abnormal involved sFLC value and the presence of at least two hypermetabolic lesions on PET/CT at diagnosis of SP were the two predictors of early evolution to myeloma in our series. This data analysis will need confirmation in a larger study, and the study of these two risk factors may lead to a different management of patients with SP in the future. ©2014 AACR.

The radiologist is liable for his medical practice. In carrying out X-ray imaging procedures (X-rays or CT-scans), it is often necessary to use iodinated contrast media, which like other drugs, have contraindications and are likely to cause many side effects. Some of these effects are potentially very dangerous and can cause harm to the patient. We want here to consider the main possible complications through the prism of current knowledge of the specialty and practical recommendations of learned societies. The aim is to provide the medical expert, whom has to examine a victim file, with a basis for recognizing the good practice from the medical malpractice on the part of the practitioner, the therapeutic risk from the medical fault. © 2012 Elsevier Masson SAS.

Sarlon-Bartoli G.,Rythmologie et Hypertension Arterielle | Michel N.,Rythmologie et Hypertension Arterielle | Taieb D.,Medecine Nucleaire | Mancini J.,Service de Sante Publique SSPIM | And 8 more authors.
Journal of Hypertension | Year: 2011

Objective: To assess the additional value of adrenal venous sampling (AVS) to diagnose primary aldosteronism sub-types in patients who have a unilateral nodule detected by computed tomography (CT scan) and who should undergo an adrenalectomy. Methods: A retrospective study to assess consecutive patients with primary aldosteronism undergoing an adrenal CT scan and AVS. Criterion for selective cannulation was an equal or higher cortisol level in the adrenal vein compared to the inferior vena cava. An adrenal-vein aldosterone-to-cortisol ratio of at least two times higher than the other side defined lateralization of aldosterone production. Results: Sixty-seven patients (mean age 52 years, 39 men) underwent a CT scan and AVS. In nine patients (13%), cannulation of the right adrenal vein led to a technical failure. Both procedures led to diagnosis of 29 patients with adenoma-producing aldosterone (APA; 50%), 23 bilateral adrenal hyperplasias (40%), and six unilateral adrenal hyperplasias (10%). Of the 45 patients with a nodule detected by CT, subsequent AVS showed bilateral secretion in 16 patients (36%). Compared to the strategy of coupling CT scans with AVS to diagnosis APA, a CT scan alone had an accuracy of 72.4% (P < 0.001). Among patients with a macronodule detected by CT, 13 (37%) had bilateral secretion as assessed by AVS. The patients with a macronodule detected by CT alone had the same risk of a discrepancy as those with a small nodule (P = 0.99). Conclusion: AVS is essential to diagnose the unilateral hypersecretion of aldosterone, even in patients in whom a unilateral macronodule is detected by CT, to avoid unnecessary surgery. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Positron emission tomography (PET) is a well-established medical imaging method. PET is increasingly used for diagnostic purposes, especially in oncology. The most widely used radiopharmaceutical is FDG, a glucose analogue. Other radiopharmaceuticals have recently been registered or are in development. We outline technical improvements of PET machines during more than a decade of clinical use in France. Even though image quality has improved considerably and PET-CT hybrid machines have emerged, spending per examination has remained remarkably constant. Replacement and maintenance costs have remained in the range of 170-190 € per examination since 1997, whether early CDET gamma cameras or the latest time-of-flight PET/CT devices are used. This is mainly due to shorter acquisition times and more efficient use of FDG. New reimbursement rates for PET/CT are needed in France in order to favor regular acquisition of state-of-the-art devices. One major development is the coupling of PET and MR imaging.

Moulin A.-M.,University Paris Diderot | Baulieu J.-L.,Medecine Nucleaire | Baulieu J.-L.,University of Tours
Medecine/Sciences | Year: 2010

A short historical survey recalls the main techniques of medical imaging, based on modern physico-chemistry and computer science. Imagery has provided novel visions of the inside of the body, which are not self-obvious but require a training of the gaze, yet, these new images have permeated the contemporary mind and inspired esthetic ventures. The popularity of these images may be related to their ambiguous status, between real and virtual. The images, reminiscent of Vesalius' De humani corporis fabrica crosslink art, science and society in a specific way: which role will they play in the « empowerment » of the tomorrow patient?

Giammarile F.,Medecine Nucleaire
Clinical nuclear medicine | Year: 2011

We report the case of a 65-year-old man presented with polymyalgia rheumatica. After a week on corticosteroid (40 mg/d), pain was relieved rapidly. Bone scan, requested to precisely localize osteoarticular lesions, showed high uptake in the external aspect of the head of left femur. In the clinical setting, bone scan and MRI appearances are suggestive of osteonecrosis, probably of recent onset. The final diagnosis of atypical necrosis of the femoral head, most probably secondary to corticoid therapy, was thus established.

Functional exploration of neuroendocrine tumor (NET) has the benefit of getting several radiopharmaceuticals. The main ones are MIBG, radiolabeled somatostatin analogues, 18F-DOPA, and 18FFDG. Their main indications are reminded in medullary thyroid cancer, pheochromocytoma, and paraganglioma and digestive endocrine tumors. © 2013 Springer-Verlag France.

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