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The first objective of the study was to assess the agreement between the Stratos DR (DMS) and the GE Prodigy (GE) DXAs in determining femoral neck, total hip and lumbar spine aBMD. The second objective was to assess the potential impact of leg positioning (hip flexed at 90° or not) on lumbar spine aBMD.Forty-six individuals (n=42 women, 91.3%), with a mean age of 59.7 ± 13 years and mean BMI of 23.8 ± 4.7 kg/m², were scanned consecutively on the same day using the two devices. In a subgroup (n=30), two consecutive Stratos DR scans (with hip flexed at 90° or not) at the lumbar spine were conducted. Predictive equations for hip and lumbar spine aBMD were derived from linear regression of the data.Correlation coefficients for aBMD measured with the two DXAs were characterised by an R² of 0.76 for the femoral neck, 0.89 for the total hip, and 0.86 for the lumbar spine. However, the derived equations for aBMD determination showed an intercept significantly different from 0 for hip aBMD, and a slope significantly different from 1 for lumbar spine aBMD. These results highlight a bias between the two measurements, thus requiring the determination of specific cross-calibration equations for hip and lumbar spine, femoral neck excepted. When compared with values on the Prodigy, mean aBMD on the Stratos DR was higher at the femoral neck (+4.8%, plt;0.001) and total hip (+9.6%, plt;0.001) and lower at L2-L4 (-8.8%, plt;0.001). The coefficient of variation (CV%) for the two consecutive measures at lumbar spine (with different positioning) with the Stratos DR was 2.9%.The difference in aBMD measured with the two DXAs illustrates the need to define cross-calibration equations when comparing data across systems in order to avoid erroneous conclusions.

International audience; BACKGROUND: All randomised phase 3 studies of selective internal radiation therapy for advanced hepatocellular carcinoma published to date have reported negative results. However, these studies did not use personalised dosimetry. We aimed to compare the efficacy of a personalised versus standard dosimetry approach of selective internal radiation therapy with yttrium-90-loaded glass microspheres in patients with hepatocellular carcinoma.METHODS: DOSISPHERE-01 was a randomised, multicentre, open-label phase 2 trial done at four health-care centres in France. Patients were eligible if they were aged 18 years or older and had unresectable locally advanced hepatocellular carcinoma, at least one measurable lesion 7 cm or more in size, a hepatic reserve of at least 30% after selective internal radiation therapy, no extrahepatic spread (other than to the lymph nodes of the hilum, with a lesion 5% of patients) grade 3 or higher adverse events were ascites (one [3%] patient who received personalised dosimetry vs two [10%] patients who received standard dosimetry), hepatic failure (two [6%] vs none), lymphopenia (12 [34%] vs nine [43%]), increased aspartate aminotransferase concentrations (three [9%] vs two [10%]), increased alanine aminotransferase concentrations (three [9%] vs none), anaemia (two [6%] vs one [5%]), gastrointestinal haemorrhage (none vs two [10%]), and icterus (none vs two [10%]). One treatment-related death occurred in each group.INTERPRETATION: Compared with standard dosimetry, personalised dosimetry significantly improved the objective response rate in patients with locally advanced hepatocellular carcinoma. The results of this study suggest that personalised dosimetry is likely to improve outcomes in clinical practice and should be used in future trials of selective internal radiation therapy. FUNDING: Biocompatibles UK, a Boston Scientific Group company.

Resume L’annonce et la communication des resultats d’un examen de medecine nucleaire au patient, notamment en TEP, relevent de pratiques tres differentes d’un service a l’autre ou d’un praticien a l’autre. Or, la reglementation relative a l’information des patients et a l’acces a leurs donnees de sante ainsi que les recommandations de l’Institut national du cancer concernant l’evolution du dispositif d’annonce d’un cancer plaident pour une plus grande implication des medecins imageurs, radiologues et medecins nucleaires dans le processus d’annonce. Au-dela des considerations legales, il apparait ethiquement et humainement difficile de refuser toute forme de communication medicale au patient qui en fait la demande et le laisser decouvrir seul son resultat sans commentaire ou echange avec le medecin specialiste ayant redige le compte-rendu. Cependant, l’heterogeneite des pratiques au sein de la communaute de medecine nucleaire est reelle et se doit d’etre comprise. Les principaux arguments des medecins ne realisant pas d’annonce sont analyses et des pistes sont evoquees pour tenter de repondre, concretement et de maniere non dogmatique, a l’attente legitime de nombreux patients.

Background Most obese women with low-trauma fractures present normal areal bone mineral density (aBMD), suggesting that other bone parameters are more determinant for fracture risk in these patients. Objectives (i) Determine the effects of obesity in young women on areal bone mineral density (aBMD), bone geometry, strength, and volumetric BMD determined by advanced DXA-based methods; (ii) model the profiles of bone parameters for each population with age; and (iii) determine the factors related to body composition (i.e. lean tissue mass and fat mass) potentially implicated in the “bone adaptation” in the femoral region. Subjects and methods Two hundred and twenty adolescent and young women from 18 to 35 years old were enrolled in this study: 128 patients with obesity and 92 age-matched (±6 months) normal-weight controls. aBMD was determined with DXA, whereas hip geometry and strength parameters were assessed by hip structural analysis (HSA) and volumetric BMD by 3D-SHAPER® software. Results Compared with controls, subjects with obesity presented significantly higher aBMD at all bone sites, but the difference was greater at hip compared with lumbar spine or radius. Bone size estimates (i.e. cortical thickness), as well as strength estimates (i.e. cross-sectional area) were higher at all femoral subregions including femoral neck, intertrochanteric region and femoral shaft in young women with obesity. In whole proximal femur and all femoral compartments, vBMD was also higher in subjects with obesity, but the difference between groups was greater for cortical vBMD compared with trabecular vBMD. When hip bone parameters were modelled for each group from individual values, maximal values were reached between 20 and 26 years in both groups but, whatever the age, subjects with obesity presented higher values than controls. In both groups, lean body mass (LBM) was the parameter most positively associated with the greatest number of bone parameters studied. Conclusion Our study confirmed that young women with obesity presented higher aBMD, better hip geometry and greater strength compared with normal-weight controls. Additionally, cortical and trabecular compartments measured by 3D-SHAPER® were favourably and concomitantly modified. However, it remains to be demonstrated whether the evaluation of these new parameters would provide better prediction of fracture risk in this population than aBMD.

Background Sleeve gastrectomy (SG) induces acute weight loss, but its impact on the very early postoperative changes in body composition (BC) is less clear. Objectives This longitudinal study examined the BC changes in the first month after SG according to gender and anatomic site. Methods BC (lean tissue mass [LTM] and fat mass [FM]) were determined by dual-energy x-ray absorptiometry in 41 obese patients (33 women, 80.5%) just before SG and 1 month later. Setting University hospital of Montpellier, France. Results One month after SG, mean weight loss was –9.8±2.6 kg, with a significant decrease in LTM and FM (kg) ranging from –7.3% to 9.5%, depending on site. FM (kg) loss in men exceeded that in women at whole body, upper limbs, and trunk. FM (%) and the LTM/FM ratio decreased only in the trunk in men and the lower limbs in women, but the gender difference was only observed for the trunk. In women, age was positively correlated with relative FM variation (% and kg) in the lower limbs and negatively correlated with LTM and LTM/FM. In men, weight was negatively correlated with the relative LTM and FM (kg) variations in the upper limbs. Conclusion SG induces acute weight loss, but this loss comprises losses in both FM and LTM. Because excessive LTM loss can have deleterious consequences, preventive strategies should be implemented soon after bariatric surgery. The specific changes in BC are highlighted according to gender and anatomic site.

Introduction Les fievres prolongees inexpliquees (FPI) restent un defi diagnostique majeur en medecine interne. En apportant des informations morphologiques et fonctionnelles de maniere non invasive, l’avenement du FDG PET/CT en a modifie la demarche diagnostique. L’objectif de notre etude etait d’evaluer la contribution diagnostique du FDG PET/CT, d’en determiner la place au sein de la demarche diagnostique de la FPI et d’identifier des facteurs clinicobiologiques predictifs d’une meilleure rentabilite. Patients et methodes Il s’agit d’une etude retrospective d’usage du FDG PET/CT dans l’indication FPI, en analysant les donnees des patients adultes ayant realise un FDG PET/CT entre avril 2012 et decembre 2017 au CHU de Montpellier dans l’indication FPI. Les caracteristiques clinicobiologiques des patients ainsi que les examens paracliniques effectues avant et apres le FDG PET/CT etaient releves. Les FDG PET/CT qui mettaient en evidence une anomalie en lien avec le diagnostic final etaient juges contributifs. Resultats 44 patients presentant une FPI ont ete inclus. L’âge median etait de 60 ans. La duree mediane d’hospitalisation avant le FDG PET/CT etait de 13 jours. Pour 70 % des patients, un diagnostic etait pose a l’issue des explorations. On retrouvait une maladie inflammatoire non infectieuse pour 39 % des patients (dont 6 cas d’arterite a cellules geantes et 3 cas de maladie de Still), une pathologie infectieuse pour 20 %, une neoplasie pour 7 %. Le FDG PET/CT etait juge contributif au diagnostic chez 44 % des patients, sa sensibilite evaluee a 85 % et sa specificite a 37 %. Pour un total de 135 examens d’imagerie, d’endoscopie ou prelevements histologiques differents realises avant le FDG PET/CT, le nombre median d’examens paracliniques realises etait de 3, les plus couramment effectues etant le scanner (93 %) principalement thoraco-abdomino-pelvien (TAP, 77 %) et l’echocardiographie transthoracique (ETT, 59 %). Avoir eu un FDG PET/CT ne reduisait pas le nombre d’examens complementaires effectues apres. Pour un total de 108 examens realises apres le FDG PET/CT, le nombre median d’examens paracliniques etait de 2, les plus couramment effectues etant les prelevements histologiques (BAT) et l’IRM. Sur 51 prelevements histologiques realises apres le FDG PET/CT, 35 % ont ete directement guides par les resultats du FDG PET/CT parmi lesquels seulement 22 % ont ete contributifs. Parmi les prelevements non contributifs guides par le FDG PET/CT, 42 % etaient des biopsies digestives. Ces resultats suggerent de reserver l’endoscopie digestive aux seuls cas d’hyperfixations digestives focales intenses suspectes. Le FDG PET/CT etait retrouve superieur au TAP chez 32 % des patients ayant beneficie des 2 examens. Aucun facteur clinique ou biologique n’etait associe a la presence d’un diagnostic final. En revanche, chez les patients pour lesquels le FDG PET/CT etait contributif, le taux d’hemoglobine etait significativement plus bas (OR.0,41, 95 %CI [0,20–0,87], p = 0,019) en analyse multivariee. Le taux de CRP n’etait pas associe a l’interet diagnostique du FDG PET/CT. Discussion Notre etude confirme la rentabilite diagnostique du FDG PET/CT [1] et son utilisation de plus en plus precoce en routine dans un groupe homogene de patients FPI representatif de la pratique clinique. Son accessibilite croissante, son caractere non invasif et sa meilleure contribution diagnostique que le scanner TAP pourraient en faire un examen de premiere ligne. Comme cela avait ete rapporte Crouzet et al. [2] , la presence d’une anemie, et non d’une elevation de la CRP [3] , etait associee a une meilleure rentabilite du FDG PET/CT. Conclusion L’importance de la contribution diagnostique du FDG PET/CT, examen non invasif et d’accessibilite croissante, suggere d’en faire un examen de premiere intention dans l’algorithme diagnostique de la FPI.

Resume Objectif L’objectif principal etait d’evaluer la valeur pronostique de la fixation de 18 F-fluorodeoxyglucose de la tumeur primitive mesuree par la Standardized Uptake Value (SUV max ) definie par la tomographie par emission de positons (TEP) dans le cancer du col uterin. L’objectif secondaire etait de determiner les performances diagnostiques de la TEP pour la stadification ganglionnaire pelvienne et lombo-aortique. Methode Nous avons inclus, retrospectivement, 49 patientes presentant un cancer cervical uterin de stade FIGO IB1-IVB. La valeur pronostique de la SUV max a ete recherchee par une analyse univariee. La survie a ete analysee par la methode de Kaplan-Meier. L’analyse histologique des ganglions etait le gold standard . Resultats Une difference significative des SUV max tumorales etait observee entre le stade I et II, le stade I et IV et la taille de la tumeur ≤ 4 cm et > 4 cm ( p = 0,0001). Il existait une correlation entre la SUV max et le grand axe de la tumeur ( r = 0,597) ( p p = 0,0007). La valeur predictive negative (VPN) de la TEP pour les ganglions lombo-aortiques ( n = 24) etait de 100 % dans les stades IB2-IVA. La specificite et la VPN pour les ganglions pelviens ( n = 8) etaient de 100 % et 87,5 % (7/8), respectivement, dans les stades precoces. Le ganglion faussement negatif mesurait moins de 2 mm. Conclusion Nos resultats demontrent une correlation entre la SUV max et le grand axe tumoral, qui represente un indicateur de l’agressivite tumorale. La TEP a une bonne VPN pour la stadification ganglionnaire lombo-aortique dans les stades localement avances. Elle reste cependant insuffisante pour predire l’atteinte ganglionnaire pelvienne et ne permet pas d’eviter la lymphadenectomie dans les stades precoces.

Resume Objectifs L’analyse de la contraction ventriculaire gauche a une importance majeure dans le diagnostic et la prise en charge des patients atteints de cardiopathies. Le but de notre etude a ete de comparer les parametres etudiant la cinetique globale et segmentaire du ventricule gauche fournis par la tomoventriculographie isotopique et par la scintigraphie de perfusion myocardique. Materiel et methodes Deux groupes ont ete constitues, le premier comprenant 23 scintigraphies de perfusion a la 99m Tc-Tetrofosmine et le second 50 scintigraphies de perfusion au chlorure de 201 Thallium, dont les donnees ont ete comparees a celles de tomoventriculographies isotopiques realisees de facon rapprochee. Resultats Nous avons obtenu de bonnes correlations ( r = 0,81 a 0,94) en ce qui concerne les parametres fonctionnels globaux (fraction d’ejection et volumes telediastolique et telesystolique) dans les deux groupes. D’assez bonnes correlations existaient egalement a l’echelle segmentaire ( r = 0,49 a 0,62), entre la fraction d’ejection segmentaire obtenue en tomoventriculographie et l’epaississement parietal (« Thickening ») ou le deplacement de la surface endocardique en systole (« Motion ») calcules en scintigraphie de perfusion. Ces correlations etaient significativement plus faibles dans le groupe bilante par scintigraphie au chlorure de 201 Thallium, et ce d’autant plus pour les segments hypokinetiques. Conclusion Bien que ces deux explorations scintigraphiques utilisent des approches tres differentes, la tomoventriculographie isotopique et la scintigraphie de perfusion myocardique permettent une etude de la contraction ventriculaire gauche a l’echelle globale et segmentaire, avec des donnees bien correlees mais restant neanmoins non interchangeables.

Elite Rhythmic Gymnasts (RGs) constitute a unique metabolic model and they are prone to developing Anorexia Athletica. The aim of the present study was to evaluate the effect of training intensity on salivary adiponectin levels and assess a possible role of salivary adiponectin levels as a predictive factor of reproductive dysfunction and bone mass acquisition in elite RGs. The study included 80 elite female RGs participating in the World Rhythmic Gymnastics Championship tournament held in Montpellier, France on September 2011. Anthropometric values were assessed, training data and menstrual pattern were recorded, bone mass was measured with Broadband ultrasound attenuation (dB/Mhz) and baseline salivary adiponectin levels were determined. The athletes were classified as intensely and very intensely trained, considering the mean training intensity (40.84h/week). Moreover, considering their reproductive status, they were divided into RG's with normal menstruation, primary amenorrhea and oligomenorrhea. All comparisons were adjusted to age, BMI and body fat percentage differences. Very intensely trained RGs showed higher salivary adiponectin levels (p=0.05). Moreover, salivary adiponectin levels showed significant correlation with training intensity (r=0.409, p=0.003). On the other hand, no association of salivary adiponectin levels was documented with either reproductive function or bone mass acquisition. The results of the present study suggest that, in elite RGs, salivary adiponectin levels are associated with the intensity of training, possibly reflecting the deterioration of energy balance rather than the training stress. On the other hand, a predictive role of salivary adiponectin levels in reproductive dysfunction or bone mass acquisition could not be supported.

Introduction The aim of this study was to analyze the differences between 99 m Tc-MAA SPECT and 90 Y-microsphere PET dosimetry investigating imaging (spatial resolution, partial volume effect, noise) and clinical factors (catheter positioning, modified vascularization, MAA/microsphere distribution). Methods Nineteen 90 Y-glass microsphere radioembolizations of hepatocellular carcinoma patients were analyzed in this study. For each treatment, predictive and post-treatment doses to tumor and normal liver (NL) were calculated with a dedicated software (PLANET® Dose, DOSIsoft, Cachan, France) applying a convolution method based on voxel-S factors. The mean ( ± standard deviation) administered activity was 3.5 GBq ( ± 1.2) for a mean tumor volume of 546 mL ( ± 408mL). In addition to the tumor average dose ( D avg ) , dose metrics extracted from dose volume histograms were analyzed: minimum dose to 70% and 50% of the tumor volume ( D 70 and D 50 ) and percentage of the tumor volume receiving at least 205 Gy ( V 205 ) , as recommended in the literature for glass-microsphere treatments [1] . Difference and correlation between predictive and post-treatment doses were assessed using a paired Student’s t test and Pearson’s correlation coefficient. Spatial concordance analysis at the voxel level between MAA and microsphere distributions is ongoing. This should provide additional information to better understand the part of dose differences related to clinical factors. Results Dose results showed a good correlation between 99 m Tc-MAA SPECT and 90 Y-microsphere PET based dosimetry (Table 1). However, difference between them was significant for all tumor and NL dose metrics considered. A 90 Y-microsphere PET tendency to underestimate 99 m Tc-MAA SPECT based doses was observed. Preliminary results indicate that the largest dose discrepancies can be explained by clinical differences in terms of administration procedure and particle distribution. Download : Download high-res image (249KB) Download : Download full-size image Conclusions The overall good correlation observed between predictive and post-treatment dosimetry confirm the MAA predictive value. A tendency of 90 Y-microsphere PET to underestimate 99 m Tc-MAA SPECT doses was observed.

Intensive physical training may have a sport-dependent effect on bone mass acquisition. This cross-sectional study evaluated bone mass acquisition in girls practicing sports that put different mechanical loads on bone.Eighty girls from 10.7 to 18.0 years old (mean 13.83 ± 1.97) were recruited: 20 artistic gymnasts (AG; high-impact activity), 20 rhythmic gymnasts (RG; medium-impact activity), 20 swimmers (SW, no-impact activity), and 20 age-matched controls (CON; leisure physical activity3h/wk). Areal bone mineral density (aBMD) was determined using DEXA. Hip structural analysis applied at the femur evaluated cross-sectional area (CSA, cm(2)), section modulus (Z, cm(3)), and buckling ratio. Bone turnover markers and OPG/RANKL levels were analyzed.AG had higher aBMD than SW and CON at all bone sites and higher values than RG in the lumbar spine and radius. RG had higher aBMD than SW and CON only in the femoral region. CSA and mean cortical thickness were significantly higher and the buckling ratio was significantly lower in both gymnast groups compared with SW and CON. In RG only, endocortical diameter and width were reduced, while Z was only increased in AG compared with SW and CON. Reduced bone remodeling was observed in RG compared with AG only when groups were subdivided according to menarcheal status. All groups showed similar OPG concentrations, while RANKL concentrations increased with age and were decreased in SW.High-impact activity clearly had a favorable effect on aBMD and bone geometry during the growth period, although the bone health benefits seem to be more marked after menarche.

Resume La tomoscintigraphie myocardique de perfusion est un examen de routine pour l’evaluation de patients atteints de cardiopathie ischemique. Cependant, des artefacts d’attenuation peuvent entrainer une diminution de la specificite. Ils peuvent etre corriges avec une correction d’attenuation. Nous avons inclus de maniere prospective 70 patients ayant beneficie d’une tomoscintigraphie myocardique de perfusion avec et sans correction d’attenuation a l’aide d’une imagerie de transmission tomodensitometrique integree dans le systeme d’acquisition d’emission chez des patients a faible prevalence de cardiopathie ischemique. Une analyse quantitative automatique constituant des scores sommes de stress (SSS) et de repos (SRS) et un score somme de differences (SDS) a ete utilisee comme criteres d’interpretation. Les resultats ont montre une specificite de 80 % pour les images avec correction d’attenuation (IRAC) et 56 % pour les images sans correction d’attenuation (IRNC), une valeur predictive positive de 40 % pour les IRAC et 23 % pour les IRNC, sans modification significative de la sensibilite. Un test de Student non apparie n’a pas mis en evidence de difference significative entre la population globale et celle ou un artefact a ete corrige pour la frequence cardiaque et respiratoire, l’index de masse corporelle (IMC), le perimetre abdominal, thoracique et le rapport de ces deux derniers. La correction d’attenuation ameliore nettement la specificite de la scintigraphie myocardique sans difference significative de la sensibilite. La majorite des corrections ont concerne des artefacts de la paroi inferieure chez des hommes. Il n’y a pas de correlation entre les parametres anthropomorphiques et physiologiques et la survenue d’un artefact d’attenuation corrige par les donnees de tomodensitometrie.

Fattal C, Mariano-Goulart D, Thomas E, Rouays-Mabit H, Verollet C, Maimoun L. Osteoporosis in persons with spinal cord injury: the need for a targeted therapeutic education. Objectives To identify circumstances surrounding the onset of fracture and common risk factors in persons with spinal cord injury (SCI) and to suggest an alternative or complement to the pharmacologic approach by evaluating the need for a prospective study based on the impact of a targeted therapeutic education on risk management of fractures in this population. Design Retrospective study. Setting Hospital and Rehabilitation Center Setting. Participants Women (n=7) and men (n=25; N=32; with ≥1 fracture after the initial SCI that occurred at home or in a hospital setting; mean ± SD age, 53±12y at the time of clinical review) with bone mineral density (BMD) measurements. Interventions Not applicable. Main Outcome Measures Demographics, main circumstances of onset, and complications of fractures, as well as transversal bone mineral density evaluation. Results Nine patients had more than 1 fracture and 23 patients had only 1 fracture (total, 43 fractures; mean age at onset of fracture, 49±12y; median time since injury, 13.9y; mean delay in diagnosis, 6.5±15d). Fractures occurred mostly in the lower limbs. The circumstances of onset of these fractures were different and very stereotyped. In 3 cases, no trauma was reported. The most frequent mechanisms identified were forced maneuvers by the patient or a third party and falls. In 10 cases, the fracture occurred during a wheelchair transfer with forced maneuver or a fall from the wheelchair. Twenty-five patients were confined to bed after the fracture (mean duration of bed confinement, 18±28d; range, 0–120d). Postfracture follow-up showed that for 43 cases of fractures, 19 had at least 1 orthopedic complication, 15 had local complications, and 23 had general complications. Patients (23 of 32) benefited from dual-energy X-ray absorptiometry to assess BMD a few months or years after the fracture (mean femoral neck BMD, 0.574±0.197g/cm 2 ; mean femoral neck T score, −3.8±1.5). Conclusion With this retrospective analysis of common risk factors and circumstances of onset of secondary fractures, there is a clear future for a prospective study to evaluate the impact of targeted therapeutic education on risk factors for secondary fractures in patients with SCI.

The relationship between bone mass and muscle mass may be due to the site-specific effects of loading on bone in adults and to lifestyle, nutritional, and hormonal factors. Another hypothesis is that the maintenance with aging of both appendicular muscle and bone mass may be determined by factors independent of all these previous factors, including genetic factors. In 160 healthy men aged 20 to 72years, we recorded femoral neck bone mineral density (FN BMD), relative appendicular skeletal muscle mass [RASM; appendicular skeletal muscle mass (kg)/height (cm)], age, body mass, maximum grip and knee extension strength, lifetime physical activities, calcium intake, tobacco smoking, and serum parathyroid hormone (PTH), estradiol (E2), free testosterone, dehydroepiandrosterone sulphate (DHEAS), insulin-like growth factor (IGF-I), sex hormone-binding globulin (SHBG), calcium, 25(OH) vitamin D, albumin, and creatinine clearance. The correlation between FN BMD and RASM (that includes upper and lower limb muscle mass) was of slightly greater magnitude than that between FN BMD and the relative upper limb muscle mass and between FN BMD and the relative leg muscle mass (r=0.39; p< or =0.001 versus r=0.36; p< or =0.001 and r=0.34; p< or =0.001, respectively). The stepwise multiple linear regression model showed that FN BMD was significantly associated with RASM (15% of FN BMD variance, p

Introduction Today, dose computation for Selective internal radiation therapy (SIRT) is based on methods easy to apply clinically. Several studies highlight dose-effect relationship for SIRT. As a result, interest enhances for advanced calculations and dose analysis tools as the ones used in external beam radiation therapy (EBRT). The Nuclear Medicine department of Montpellier University Hospital (MUH) implemented a new system to meet this need. This study describes the methodology applied, its interest and the questions raised illustrated by some clinical cases. Methods For every patient treated by SIRT, the dosimetry referred as “standard” applied at MUH follows the method described by Garin et al. [1] . This is based on the partition model for which the volumes of interest are defined using Syngo® software (Siemens, Erlangen, Germany) on SPECT images acquired after the injection of macro-aggregates of albumin (MAA) labelled with 99Tcm. Recently, the implementation of a treatment planning system (TPS), PLANET® Dose (DOSIsoft, Cachan, France), allows to perform dosimetry at the voxel level. This is done through two major steps: predictive dosimetry based on MAA-SPECT images and in vivo control dosimetry using PET images acquired after the injection of yttrium-90 (90Y) microspheres ( Fig. 1 ). Dose distribution is especially evaluated for tumoral and non-tumoral liver delineated on the injected CT or MR images by the radiology team. Dose computation rests on a convolution method based on voxel S factors. Pre and post treatment dosimetries are analyzed by the mean dose to the volume, the dose-volume histograms (DVH) and the isodose curves. Results The comparison between both dosimetric approaches (standard and at the voxel level) pointed out some differences. This particularly allowed to highlight the TPS contribution according to various aspects that were observed through clinical cases. A first aspect is related to the volume definition (functional only vs. anatomical and/or functional) for which the TPS contribution is especially interesting for complex clinical cases (multiple tumor sites, heterogeneous or partially targeted lesions, liver failure). This kind of system then allows dose evaluation in any compartment (volume at risk, portal vein thrombosis, multiple lesions, viable tumor, etc.). Moreover, voxelized dosimetry allows to analyze dose distribution uniformity with advanced tools (isodoses, DVH, etc.) in order to better assess areas of over/under dosing. Finally, being able to perform post-treatment dosimetry in order to know the real delivered dose and to sum several treatment sessions can play an important role in the patient therapeutic care. Conclusion Integrating a TPS like the ones used in EBRT in the SIRT process allowed to increase the medical team confidence and accuracy in the prescription of the activity to administer and to better control the dose delivered during the treatment. Setting up these new tools open the way to a more advanced personalization of this therapy.

Ageing is associated with a gradual bone loss and physical activity has been suggested as practical strategy for a non-pharmacological prevention of osteoporosis. However, until now, the specific mechanism by which physical activity affects bone tissue is not thoroughly understood. The aim of this study was to evaluate the effect of strenuous exercise on bone metabolism as a function of age and fitness level. Eighteen physically highly active elderly participants (mean age 71.7 ± 7.3 years, HAcEl group), 18 moderately active elderly participants (mean age 71.9 ± 8.6 years, ModEl group) and 9 young physically active participants (mean age 25.8 ± 2.3 years, AcYo) participated in this study. Concentrations of plasma ionised calcium (iCa), serum parathyroid hormone (iPTH), 25-hydroxy-vitamin D [25(OH)D], and 1,25-dihydroxy-vitamin D3 [1,25(OH)2D3] as well as the bone biochemical markers type-I collagen C-telopeptide (CTX) for bone resorption and osteocalcin (OC) and bone alkaline phosphatase (B-ALP) for bone formation, were analyzed before and after a maximal incremental exercise test. In all groups, iCa decreased significantly (p

Resume A l’heure actuelle, du fait de l’utilisation croissante de greffons marginaux, il persiste une difference significative en termes de demi-vie entre des greffons de donneur vivant ou de donneur decede. L’objectif principal de cette etude fut de determiner la valeur pronostique de divers parametres scintigraphiques disponibles le jour de la greffe pour le succes a un an de la transplantation renale. Une etude retrospective portant sur 100 patients greffes renaux au CHU de Montpellier, operes entre 1999 et 2006 et ayant beneficie d’une scintigraphie renale au MAG-3 dans les 72 heures apres la transplantation renale, a ete realisee. Il s’agissait de mesurer differents parametres scintigraphiques quantitatifs des phases angiographique et tubulaire du nephrogramme, evalues sur trois regions d’interet (ROI) differentes, puis de les comparer statistiquement au critere de jugement, a savoir le succes ou non de la greffe au cours de la premiere annee. Les resultats de notre etude ont confirme l’importance des parametres vasculaires, et en particulier l’index de Kirchner, avec une bonne correlation avec la fonction renale a un an ; un greffon bien vascularise avait, conformement aux hypotheses physiopathologiques, d’excellentes chances de survie a court terme. Cet index a une valeur predictive negative (VPN) superieure a 90 % pour le succes de la transplantation a un an (VPP = 75 %). Les parametres evaluant plus specifiquement la reserve fonctionnelle nephronique (pente de la fonction tubulaire, rapport du pic de captation sur pic de perfusion) du greffon sont des facteurs de risques independants de l’echec au cours des trois premiers mois.

Multimodal images registration can be very helpful for diagnostic applications. However, even if a lot of registration algorithms exist, only a few really work in clinical routines. We developed a method based on surface matching and compared two minimization algorithms: Powell's and Downhill Simplex. We studied the influence of some factors (chamfer map computation, number and order of parameters to determine, minimization criteria) on the final accuracy of the algorithm. Using this comparison, we improved some processing steps to allow a clinical use, and selected the simplex algorithm which presented the best results.

Objectifs Le corticosurrenalome est une tumeur rare de l’enfant. Il sera suspecte devant une symptomatologie liee a une secretion hormonale d’origine tumorale (90 % des cas), devant un syndrome de masse tumorale ou lors de la decouverte fortuite d’une lesion surrenalienne. Patiente et methodes L’echographie fœtale realisee chez une femme enceinte a 37 SA revele une masse surrenalienne droite tissulaire vascularisee de 38 mm de grand axe. En periode post-natale, le bilan biologique revele un hypercorticisme et une augmentation des derives androgeniques. Le diagnostic de corticosurrenalome est fortement suspecte devant la presentation clinico-biologique. Le bilan a distance sera evalue par TDM et par TEP/TDM au 18FDG. Resultats L’examen objective un hypermetabolisme intense de la masse surrenalienne droite (SUVmax = 14,7) sans foyer hyperfixant locoregional ou a distance. Cette fixation est concordante avec un corticosurrenalome stade T1N0M0 selon la classification OMS de 2004. Les resultats histologiques de l’exerese de cette masse confirment un corticosurrenalome malin (score de Weiss modifie = 4) en marges R0. Pour la realisation de la TEP/TDM chez un nourrisson de 26 jours, les recommandations europeennes ont ete suivies. Un jeun de 4 h a ete respecte avant l’injection de 3 MBq/kg de 18FDG et le nourrisson a ete nourri 30 min apres l’injection du radiotraceur dans les bras de sa mere afin qu’il s’endorme sous la camera, place dans un matelas coquille, une fois le delai de 1 h respecte entre l’injection et l’acquisition. La dose efficace a ete estimee a 6 mSv (18FDG : 5 mSV ; TDM : 1 mSv). Conclusions Bien que l’utilisation de la TEP/TDM au 18FDG n’ait pas encore ete evaluee dans cette indication chez l’enfant, elle semble pouvoir etre utile dans le bilan d’extension de la maladie. Afin que sa realisation se fasse dans les meilleures conditions, il est necessaire de bien informer le personnel paramedical ainsi que les parents du deroulement de l’examen et d’adapter le moment de l’examen au rythme des tetees de l’enfant. Un jeune de 4 h parait suffisant et la sedation chez le nourrisson peut etre favorisee par une tetee 30 minutes avant le debut de l’acquisition TEP/TDM.

Objectifs L’infiltration du systeme nerveux peripherique par des cellules lymphomateuses (ou neurolymphomatose) est une manifestation extra ganglionnaire rare rencontree essentiellement dans les lymphomes non hodgkiniens de type B. L’atteinte peut etre unique ou multiple et peut interesser un nerf crânien, un nerf peripherique ou une racine nerveuse. Patient et methodes Sept mois apres la fin de traitement d’un lymphome B diffus a grandes cellules de localisation naso-sinusienne droite en remission complete, le patient se plaint de cephalees frontales isolees. L’IRM cerebrale est en faveur d’une pachymeningite et la ponction lombaire objective un infiltrat de nombreuses cellules lymphoides atypiques d’allure blastique. Une TEP/TDM au 18FDG est realisee dans le bilan d’extension de cette recidive tumorale. Resultats La TEP/TDM met en evidence plusieurs foyers hyperfixants etages a l’emergence des racines nerveuses evoquant une polyradiculopathie d’origine lymphomateuse. Il n’existe pas d’argument en faveur d’une recidive locale naso-sinusienne ou d’une atteinte ganglionnaire. Le patient a beneficie de 6 cycles de chimiotherapie generale et d’injections intrathecales. L’examen TEP/TDM realise en fin de traitement montre une reponse complete avec disparition de l’ensemble des foyers hyperfixants radiculaires. Conclusions L’envahissement lymphomateux du systeme nerveux peripherique est une atteinte rare de diagnostic difficile. L’analyse du liquide cephalorachidien est souvent negative et la biopsie nerveuse a l’aveugle est regulierement non contributive. Plusieurs auteurs considerent que les resultats concordants de la TEP/TDM et de l’IRM permettent de suggerer le diagnostic de neurolymphomatose. Peu de cas ont ete decrits en TEP/TDM, mais celle-ci semble jouer un role important pour evoquer le diagnostic, realiser un bilan d’extension, orienter un geste biopsique et evaluer l’efficacite therapeutique.

Objectifs Evaluer la necessite d’une correction du diffuse dans l’evaluation des zones gâchettes (ZG) post-infarctus par TEMP myocardique double isotope 201Tl/123I-MIBG sur camera CZT. Evaluer la necessite de l’acquisition tardive 123I-MIBG pour l’exploration de ces ZG. Patients et methodes Nous avons inclus 69 patients apres revascularisation pour SCA ST+ pour recherche de ZG (myocarde viable mais denerve). Trois tomoscintigraphies myocardiques de repos etaient realisees : 201Tl simple isotope, 201Tl/123I-MIBG precoce et tardive. Les projections 201Tl de la troisieme etaient reconstruites sans et avec correction du diffuse (methode du triple fenetrage). La viabilite et la denervation etaient appreciees par des scores sommes de perfusion (SS Tl) et d’innervation (SS MIBG) selon un modele a 17 segments. Un score somme gâchette (SSG) etait calcule selon le meme modele. Nous avons compare les performances diagnostiques des differentes acquisitions 201Tl avec et sans correction du diffuse dans l’identification des necroses considerant l’IRM ou l’ETT comme gold standard. Resultats Tous les patients presentaient des zones gâchettes (37 % ± 18 de la surface du VG). Sans correction du diffuse, le diffuse de l’123I induit des differences significatives entre les SS Tl simple et double isotope (p Conclusions Malgre une resolution en energie accrue des CZT, une correction du diffuse est necessaire pour les acquisitions 201Tl/123I-MIBG dans l’exploration des zones gâchettes post-infarctus.