Introduction Le diabète de type 2 (DT2) et l’obésité sont des facteurs de risque de maladies rénales. Nous avons étudié l’effet séparé du DT2 et de l’obésité sur le débit de filtration glomérulaire ...(DFG) et l’excrétion urinaire d’albumine (EUA). Matériels et méthodes le DFG a été déterminé chez 872 patients (814 DT2) classés selon leurs IMC : < 25 kg/m2 (normal, n = 158), 25 ≤ 30 (surpoids, n = 305), 30 ≤ 40 (obésité, n = 316), et ≥ 40 (obésité morbide, n = 93) par la mesure de la clairance plasmatique du 51Cr-EDTA corrigée ou non sur la surface corporelle. L’EUA (normo-, micro-, macro-albuminurie) a été mesurée sur 3 échantillons urinaires consécutifs. L’association du DFG avec le DT2 (oui/non) et les classes d’obésité a été testée par ANCOVA ajustée sur âge et sexe. L’association avec EUA a été déterminée par le test Cochran-Mantel-Haenszel et régression logistique. Résultats Nous avons observé une interaction entre l’effet de l’obésité et DT2 sur DFG corrigé (p = 0,01). Les patients non diabétiques augmentaient leurs DFG au fur et à mesure de l’augmentation de l’IMC jusqu’à 40 kg/m2 et le diminuaient audessus de 40 kg/m2 93 ± 7 mL/min/1,73m2 (normal), 99 ± 7 (surpoids), 115 ± 6 (obésité), 105 ± 5 (obésité morbide), moyenne ± ESM, p = 0,04. Les patients DT2 diminuaient progressivement leur DFG parallèlement à l’augmentation de l’IMC (91 ± 3 vs 89 ± 2 vs 88 ± 2 vs 73 ± 4, p = 0,0004). Des résultats similaires ont été observés avec DFG non ajusté. L’effet sur EUA était similaire : interaction diabèteobésité (p < 0,0001), effet diabète (p = 0,0005) et effet obésité (p = 0,001). La prévalence de normo-, micro- et macro-albuminurie chez les obèses morbides : 31,2%, 50,5%, 18,3 % respectivement. L’obésité morbide était associée à la microalbuminurie (OR 2,86, IC95% 1,55–5,17, p = 0,0005) et la macroalbuminurie (OR 2,22, IC95% 1,40–3,55, p = 0,0007), ajusté sur sexe, âge, et diabète. Conclusion Nous avons observé une forte interaction entre l’effet de l’obésité et du DT2 sur la fonction rénale avec réduction du DFG et augmentation d’EUA chez les obèses morbides.
We evaluated the impact of partial volume effect (PVE) in the assessment of arterial diseases with (18)FDG PET. An anthropomorphic digital phantom enabling the modeling of aorta related diseases like ...atherosclerosis and arteritis was used. Based on this phantom, we performed GATE Monte Carlo simulations to produce realistic PET images with a known organ segmentation and ground truth activity values. Images corresponding to 15 different activity-concentration ratios between the aortic wall and the blood and to 7 different wall thicknesses were generated. Using the PET images, we compared the theoretical wall-to-blood activity-concentration ratios (WBRs) with the measured WBRs obtained with five measurement methods: (1) measurement made by a physician (Expert), (2) automated measurement supposed to mimic the physician measurements (Max), (3) simple correction based on a recovery coefficient (Max-RC), (4) measurement based on an ideal VOI segmentation (Mean-VOI) and (5) measurement corrected for PVE using an ideal geometric transfer matrix (GTM) method. We found that Mean-VOI WBRs values were strongly affected by PVE. WBRs obtained by the physician measurement, by the Max method and by the Max-RC method were more accurate than WBRs obtained with the Mean-VOI approach. However Expert, Max and Max-RC WBRs strongly depended on the wall thickness. Only the GTM corrected WBRs did not depend on the wall thickness. Using the GTM method, we obtained more reproducible ratio values that could be compared across wall thickness. Yet, the feasibility of the implementation of a GTM-like method on real data remains to be studied.
Liver metastases are common in gastroenteropancreatic neuroendocrine tumors and significantly impair survival. Hepatic resection is the only potential curative treatment. The records of 41 ...consecutive patients undergoing exhaustive resection of liver-only endocrine metastases and followed between 1992 and 2006 were reviewed. Patient's outcome and diagnostic accuracy of somatostatin receptor scintigraphy (SRS) and morphological imaging (MI) for detection of recurrences during post-operative follow-up were assessed. All identified primary had been resected. MI studies including abdominal computed tomography (CT) and/or liver magnetic resonance imaging and thoracic CT if indicated were performed every 6 months; SRS timing was decided by referring clinician. Tumor recurrences were confirmed by pathology or subsequent imaging studies. The results of 136 MI and SRS examinations performed within a 30-day interval from each other were retrospectively compared. Median post-operative follow-up was 51 months (7-165). Recurrences developed in 32 patients (78%), mainly in the liver (n=24) after a median of 19 months (2-79). Five-year overall and disease-free survival rates were 79 and 3% respectively. For recurrence detection, sensitivity, specificity, and accuracy were 89, 94, and 91% for SRS, 68, 91, and 74% for MI respectively. In 11 out of 32 patients (34%), abdominal or extra-abdominal metastases were detected 15.5 months earlier by SRS than MI. In conclusion, despite exhaustive liver surgery for endocrine metastases, hepatic or extra-hepatic recurrences are frequent and develop early. SRS is highly accurate for the detection of recurrences during post-operative follow-up and permitted early diagnosis in one third of patients; therapeutic implications of this early diagnosis remain to be determined.
La place de la cardiologie en TEP est en train d’émerger grâce, d’une part, à la plus grande disponibilité des caméras pour des indications non oncologiques, et, d’autre part, à l’arrivée d’agents ...d’imagerie dédiés, en particulier pour la perfusion myocardique. Cet article décrit brièvement les principales indications dans lesquelles la TEP a un rôle important à jouer.
Cardiovascular PET imaging is progressively emerging, owing to wider availability of cameras for non-oncology indications, as well as to the development of dedicated imaging agents. This article briefly reviews main indications of cardiovascular PET.
Radionuclide imaging of cardiac function represents a number of well-validated techniques for accurate determination of right (RV) and left ventricular (LV) ejection fraction (EF) and LV volumes. ...These first European guidelines give recommendations for how and when to use first-pass and equilibrium radionuclide ventriculography, gated myocardial perfusion scintigraphy, gated PET, and studies with non-imaging devices for the evaluation of cardiac function. The items covered are presented in 11 sections: clinical indications, radiopharmaceuticals and dosimetry, study acquisition, RV EF, LV EF, LV volumes, LV regional function, LV diastolic function, reports and image display and reference values from the literature of RVEF, LVEF and LV volumes. If specific recommendations given cannot be based on evidence from original, scientific studies, referral is given to “prevailing or general consensus”. The guidelines are designed to assist in the practice of referral to, performance, interpretation and reporting of nuclear cardiology studies for the evaluation of cardiac performance.
Le développement de la radiothérapie interne vectorisée (RIV) ces 50 dernières années ne s’est pas accompagné d’un développement de la dosimétrie personnalisée. Des raisons conceptuelles et ...technologiques peuvent expliquer cet état de fait. Le développement récent de la radiothérapie interne sélective (RTIS) par microsphères d’yttrium 90 dans le traitement des carcinomes hépatocellulaires peut relancer le développement de la dosimétrie personnalisée, de part son implémentation simplifiée et des résultats prometteurs publiés récemment dans la littérature montrant la valeur prédictive de la dosimétrie sur la réponse et la survie. Dans cet article nous verrons qu’une dosimétrie à l’échelle de l’organe peut être facilement implémentée en routine clinique pour cette application. Nous verrons également un exemple de dosimétrie à l’échelle du voxel, ou dosimétrie 3D, montrant sa faisabilité et son intérêt potentiel dans la prise en charge des patients.
The targeted radionuclide therapy (TRT) during last 50 years was not followed by a development of a personalized clinical dosimetry. Technological and conceptual reasons can be argued. The recent development of selective internal radionuclide therapy (SIRT) with yttrium 90 microspheres in the treatment of hepatocellular carcinoma can relaunched the development of personalized dosimetry, tanks to its easiest implementation in clinical routine and promising results obtained in the literature, showing its predictive value on response and survival. In this article, we will address the clinical implementation of organ level dosimetry. We will also present an example of voxel level dosimetry, or 3D dosimetry, showing its clinical feasibility and potential interest in the patient care.
This position statement was prepared by the European Council of Nuclear Cardiology and summarises the current and future potential of PET as a clinical cardiovascular diagnostic imaging tool. The ...first section describes how methodological developments have positively influenced the transition of PET from a research tool towards a clinical diagnostic test. In the second section, evidence in support of its superior diagnostic accuracy, its value to guide decision making and to predict outcome and its cost effectiveness is summarised. The third section finally outlines new PET-based approaches and concepts, which will likely influence clinical cardiovascular medicine in the future. The notion that integration of cardiac PET into healthcare systems and disease management algorithms will advance quality of care is increasingly supported by the literature highlighted in this statement.
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