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Resume L’immunotherapie avec les inhibiteurs de points de controle immunitaire est devenue le traitement de reference dans certains types tumoraux, tels que le melanome et le cancer bronchique non a petites cellules. Contrairement aux therapies conventionnelles (chimiotherapie ou therapies ciblees), l’immunotherapie ne cible pas directement la cellule tumorale et permet de restaurer l’immunite antitumorale. Ce changement de paradigme impacte notamment l’imagerie oncologique et notamment la tomographie par emission de positons au 18fluor-fluorodesoxyglucose couplee a la tomodensitometrie (TEP-TDM au 18F-FDG). En effet, de nouveaux profils de reponse ou de progression ont ete mis en evidence, tels que la pseudo-progression, l’hyperprogression, la reponse dissociee, la reponse prolongee et l’effet abscopal (combinaison radio-immunotherapie). Ces profils « atypiques » ont conduit a une adaptation des criteres d’evaluation therapeutique. De plus, certains biomarqueurs extraits a partir de l’imagerie TEP-TDM au 18F-FDG pourraient permettre d’identifier precocement les candidats a l’immunotherapie, ce qui est actuellement un enjeu clinique majeur. En cours de traitement, la TEP-TDM au 18F-FDG peut egalement aider au diagnostic precoce de certains effets secondaires immuno-induits. D’un point de vue plus fondamental, le decryptage du dialogue entre la tumeur, son microenvironnement et les organes lymphoides (rate et moelle osseuse) est utile pour comprendre les mecanismes physiopathologiques de l’immunoresistance. En imagerie TEP-FDG, il semble exister une correlation entre l’activite metabolique de la moelle osseuse et le profil d’expression de certains genes impliques dans la composition cellulaire du microenvironnement tumoral, directement lie au phenotype immunosuppressif des tumeurs. Enfin, l’imagerie avec immuno-TEP, a partir d’anticorps specifiques ciblant les molecules de points de controle immunitaire, les marqueurs de lymphocytes T ou des biomarqueurs de l’activation immunitaire, permettra vraisemblablement d’offrir une approche theranostique indispensable a l’ere de la medecine de precision.

In this paper, we report on the outputs and adoption of the Agrisemantics Working Group of the Research Data Alliance (RDA), consisting of a set of recommendations to facilitate the adoption of semantic technologies and methods for the purpose of data interoperability in the field of agriculture and nutrition. From 2016 to 2019, the group gathered researchers and practitioners at the crossing point between information technology and agricultural science, to study all aspects in the life cycle of semantic resources: Conceptualization, edition, sharing, standardization, services, alignment, long term support. First, the working group realized a landscape study, a study of the uses of semantics in agrifood, then collected use cases for the exploitation of semantics resources a generic term to encompass vocabularies, terminologies, thesauri, ontologies. The resulting requirements were synthesized into 39 hints for users and developers of semantic resources, and providers of semantic resource services. We believe adopting these recommendations will engage agrifood sciences in a necessary transition to leverage data production, sharing and reuse and the adoption of the FAIR data principles. The paper includes examples of adoption of those requirements, and a discussion of their contribution to the field of data science. © 2020 The Author(s). Brandon Whitehead acknowledges with thanks the support of the CABI Development Fund. CABI is an international intergovernmental organization and we gratefully acknowledge the core financial support from our member countries (and lead agencies) including the United Kingdom (Department for International Development), China (Chinese Ministry of Agriculture), Australia (Australian Center for International Agricultural Research), Canada (Agriculture and Agri-Food Canada), Netherlands (Directorate-General for International Cooperation), and Switzerland (Swiss Agency for Development and Cooperation). See https:// www.cabi.org/about-cabi/who-we-work-with/key-donors/ for details. Sophie Aubin, Clement Jonquet, Emna Amdouni, Romain David and Catherine Roussey were supported, in part, by the French National Research Agency (ANR) Data to Knowledge in Agronomy and Biodiversity (D2KAB – www.d2kab.org – ANR-18-CE23-0017). Romain David was partly supported by the EPPN2020 project (H2020 grant N°731013), the EOSC-Life european program (grant agreement N°824087), the ‘Infrastructure Biologie Sante’ PHENOME-EMPHASIS project funded by the French National Research Agency (ANR-11-INBS-0012) and the ‘Programme d’Investissements d’Avenir’.

To determine FDG-PET biomarkers associated with long-term benefit (LTB) and survival in advanced non-small cell lung cancer (NSCLC) patients receiving first-line immunotherapy. In this multicenter study, we retrospectively analyzed advanced NSCLC patients with a PD-L1 tumor proportion score (TPS) ≥ 50%, who underwent FDG-PET/CT before first-line pembrolizumab, received from August 2017 to September 2019. Parameters extracted were SUVmax, SUVmean, TMTV (total metabolic tumor volume) and TLG (total lesion glycolysis). LTB was defined as objective (complete or partial) response or stable disease as best overall response, maintained for ≥ 12 months. A multivariate prediction model was developed using logistic regression for LTB and Cox models for progression-free survival (PFS) and overall survival (OS). On the 63 eligible patients, with a median follow-up of 13.4 (range, 1.5–29.1) months, 17 (27%) had LTB. Median PFS and OS were 7.7 months (95%CI 5.0–10.5) and 12.1 months (95%CI 8.6–15.6). In multivariate analyses, high TMTV (> 84cm3) and high tumor SUVmean (> 10.1) remained independent factors for predicting LTB (OR 0.2; p = 0.03 and OR 3.7; p = 0.04) and PFS (HR 2.2; p = 0.02 and HR 0.5; p = 0.045). High TMTV was significantly associated with poor OS (HR 3.1; p = 0.03). No association was observed between tumor SUVmax or TLG and clinical outcomes. In patients with advanced NSCLC and PD-L1 TPS ≥ 50%, baseline low TMTV and high tumor SUVmean correlate with survival and LTB from upfront pembrolizumab. Beyond the initial staging, FDG-PET/CT scan could provide relevant biomarkers associated with clinical outcomes that should be taken into account when considering first-line treatment options.

Background CT and fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT performances following immune therapy are not well known in patients with relapsed or refractory Hodgkin lymphoma (RRHL). Purpose To compare CT and PET/CT for prognostic value of early response evaluation following nivolumab therapy. Materials and Methods This retrospective study included patients from 34 institutions who underwent early imaging response evaluation from July 2013 to April 2017. Three experienced readers classified imaging response by using Cheson et al and 2016 Lymphoma Response to Immunomodulatory Therapy Criteria as follows: complete (metabolic) response, partial (metabolic) response, stable disease or no metabolic response, or progressive (metabolic) disease. Primary CT and PET assessments were performed at a median of 2.0 months (interquartile range, 1.7-3.7 months) after nivolumab initiation. Kaplan-Meier analysis was used to determine the relationship of primary CT and PET assessment response categories to overall survival (OS). Agreements between primary and secondary imaging assessments were assessed by using κ analysis. Results A total of 45 patients (median age, 37 years; range, 18-77 years; 25 men) underwent a primary assessment using CT and PET/CT; 36 patients also underwent a subsequent assessment. Eleven patients (24%) died after a median follow-up of 21.2 months. CT and PET response categories were associated with OS (P = .03 for primary CT assessment; P = .02 for primary PET assessment). There was no pseudoprogression at primary CT and PET assessments. At the primary assessment, response categories by using CT were reclassified by using PET in 44% (20 of 45) of patients. Among these, 55% (11 of 20) were reclassified to complete metabolic response (complete metabolic response rate: 29% [13 of 45 patients] vs complete response rate: 4% [two of 45 patients]), with a 2-year OS probability of 100%. At the secondary assessment, complete response rate using CT increased to 17% (six of 36 patients), hence a better agreement with PET (κ = 0.78; P < .001). Conclusion Early CT and PET/CT at a median of 2 months after initiation of nivolumab predicted overall survival in relapsed or refractory Hodgkin lymphoma. Early PET detected additional patients with complete metabolic response. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Scott and Wang in this issue.

The multidimensionality of chronic pain forces us to look beyond isolated assessment such as pain intensity, which does not consider multiple key parameters, particularly in post-operative Persistent Spinal Pain Syndrome (PSPS-T2) patients. Our ambition was to produce a novel Multi-dimensional Clinical Response Index (MCRI), including not only pain intensity but also functional capacity, anxiety-depression, quality of life and quantitative pain mapping, the objective being to achieve instantaneous assessment using machine learning techniques. Two hundred PSPS-T2 patients were enrolled in the real-life observational prospective PREDIBACK study with 12-month follow-up and received various treatments. From a multitude of questionnaires/scores, specific items were combined, as exploratory factor analyses helped to create a single composite MCRI, using pairwise correlations between measurements, it appeared to more accurately represent all pain dimensions than any previous classical score. It represented the best compromise among all existing indexes, showing the highest sensitivity/specificity related to Patient Global Impression of Change (PGIC). Novel composite indexes could help to refine pain assessment by informing the physician’s perception of patient condition on the basis of objective and holistic metrics, and also by providing new insights regarding therapy efficacy/patient outcome assessments, before ultimately being adapted to other pathologies.

Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), (Failed Back Surgery Syndrome), dramatically impacts on patient quality of life, as evidenced by Health-Related Quality of Life (HRQoL) assessment tools. However, the importance of functioning, pain perception and psychological status in HRQoL can substantially vary between subjects. Our goal was to extract patient profiles based on HRQoL dimensions in a sample of PSPS-T2 patients and to identify factors associated with these profiles. Two classes were clearly identified using a mixture of mixed effect models from a clinical data set of 200 patients enrolled in “PREDIBACK”, a multicenter observational prospective study including PSPS-T2 patients with one-year follow-up. We observed that HRQoL was more impacted by functional disability for first class patients (n = 136), and by pain perception for second class patients (n = 62). Males that perceive their work as physical were more impacted by disability than pain intensity. Lower education level, lack of adaptive coping strategies and higher pain intensity were significantly associated with HRQoL being more impacted by pain perception. The identification of such classes allows for a better understanding of HRQoL dimensions and opens the gate towards optimized health-related quality of life evaluation and personalized pain management.

International audience; Persistent Pain after Spinal Surgery can be successfully addressed by Spinal Cord Stimulation (SCS). International guidelines strongly recommend that a lead trial be performed before any permanent implantation. Recent clinical data highlight some major limitations of this approach. First, it appears that patient outcomes, WITH OR WITHOUT lead trial, are similar. In contrast, during trialing, infection rate drops drastically within time and can compromise the therapy. Using composite pain assessment experience and previous research, we hypothesized that ma-chine learning models could be robust screening tools and reliable predictors of long-term SCS efficacy. We developed several algorithms including logistic regression, Regularized Logistic Regression (RLR), naive Bayes classifier, artificial neural networks, random forest and gradient boosted trees to test this hypothesis and to perform internal and external validations, the objec-tive being to confront model predictions with lead trial results using a 1-year composite out-come from 103 patients. While almost all models have demonstrated superiority on lead trial-ing, the RLR model appears to represent the best compromise between complexity and inter-pretability in prediction of SCS efficacy. These results underscore the need to use AI based-predictive medicine, as a synergistic mathematical approach, aimed at helping implanters to optimize their clinical choices on daily practice.

Persistent Spinal Pain Syndrome Type 2 (PSPS-T2) represents a main cause of work disruption. Beyond its societal consequences, occupational inactivity is responsible for a major decrease in physical/mental health in individuals but remains poorly analyzed. We designed a study to prospectively examine Professional Status (PS) evolution and its association with key bio-psychological markers. Data from 151 consecutively included working-age PSPS-T2 patients were analyzed to determine the proportion of professional inactivity and the relationships between PS and Social Gradient of Health (SGH), Numeric Pain Rating Scale (NPRS), EuroQol 5-Dimensional 5-Level (EQ-5D-5L), Oswestry Disability Index (ODI), Hospital Anxiety and Depression Scale (HADS), and Fear-Avoidance Belief Questionnaire work subscale (FABQ-W). Despite optimized medical management, 73.5% of PSPS-T2 patients remained inactive after 1 year of follow-up/p = 0.18. Inactive patients presented a low SGH/p = 0.002, higher NPRS/p = 0.048, lower EQ-5D-5L/p &lt, 0.001, higher ODI/p = 0.018, higher HADS-D/p = 0.019 and higher FABQ-W/p &lt, 0.001. No significant mediation effect of FABQ-W on SGH consequences regarding PS was observed in our structural model/p = 0.057. The link between unemployment and bio-psycho-social pain dimensions appears bidirectional and justifies intense collaboration with social workers. Optimizing therapeutical sequencing towards personalized professional plans implies restoring “Adapted Physical Function” as an initial goal, and tailoring an “Adapted Professional Activity”, matching with patient expectations and capabilities, as a final objective.

Malignant struma ovarii (MSO) is a rare malignant ovarian tumor, histologically identical to differentiated thyroid cancers. Given the rarity of this disease, there are no treatment guidelines, and the place of imaging for response assessment remains controversial. We report a metabolic response assessed by F-FDG PET/CT in a 71-year-old woman with radioiodine-refractory metastatic MSO treated by targeted therapies (first line with lenvatinib and second line with pazopanib). This case of exceptional response also highlights the usefulness of F-FDG PET/CT for therapeutic assessment of targeted drugs in such a rare clinical entity of malignant MSO.

The Social Gradient of Health (SGH), or position in the social hierarchy, is one of the major determinants of health. It influences the development and evolution of many chronic diseases. Chronic pain dramatically affects individual and social condition. Its medico-economic impact is significant and worldwide. Failed Back Surgery Syndrome or Persistent Spinal Pain Syndrome type 2 (PSPS-T2) represents one of its most fascinating and disabling conditions. However, the influence of SGH on PSPS-T2 has been poorly explored. We designed a prospective multicentric study (PREDIBACK study) to assess the SGH prevalence, and to examine its association with medical and psychological variables, in PSPS-T2 patients. This study included 200 patients to determine the SGH association with pain (NPRS), Quality of life (EQ-5D-5L), kinesiophobia (FABQ-Work), catastrophism (CSQ), and functional capacity (ODI). Around 85.3% of PSPS-T2 patients in our study had low SGH. Low SGH patients had a higher FABQ-Work and CSQ-Catastrophizing score than high SGH patients (p &lt, 0.05). High SGH patients have a higher ODI score than low SGH patients (p &lt, 0.10). Our results suggest that SGH is a relevant factor to guide prevention, research, and ultimately intervention in PSPS-T2 patients and could be more widely transposed to chronic pain.

Monoclonal antibodies (mAbs) against programmed cell death 1 (PD-1), such as nivolumab and pembrolizumab, are associated with high response rates in patients with relapsed or refractory classic Hodgkin lymphoma (HL). To date, no prognostic factor for overall survival (OS) has been established with these agents in HL. We examined whether the first early response assessment evaluated using 18F-FDG PET/CT may be associated with OS in this setting. Methods: This retrospective study included 45 patients from 34 institutions. In a masked, centralized review, 3 independent radiologists classified PET/CT scans obtained at a median of 2.0 mo (interquartile range, 1.7-3.7 mo) after nivolumab initiation using existing criteria (i.e., 2014 Lugano classification and 2016 LYRIC). Patients were classified according to 4 possible response categories: complete metabolic response (CMR), partial metabolic response (PMR), no metabolic response (NMR), or progressive metabolic disease (PMD). Because the OS of patients with NMR and PMR was similar, they were grouped together. OS was estimated using the Kaplan-Meier method and compared between groups using log-rank testing. Results: Eleven patients (24%) died after a median follow-up of 21.2 mo. The classification was identical between Lugano and LYRIC because all 16 progression events classified as indeterminate response per LYRIC were confirmed on subsequent evaluations. Both Lugano and LYRIC classified patients as CMR in 13 cases (29%), PMD in 16 (36%), NMR in 4 (9%), and PMR in 12 (27%). The 2-y OS probability was significantly different in patients with PMD (0.53; 95% confidence interval [95%CI], 0.32-0.87), NMR or PMR (0.80; 95%CI, 0.63-1.00), and CMR (1.00; 95%CI, 1.00-1.00) in the overall population (P = 0.02, 45 patients), as well as according to a landmark analysis at 3 mo (P = 0.05, 32 patients). Conclusion: In relapsed or refractory HL patients treated with anti-PD-1 mAbs, the first early PET/CT assessment using either Lugano or LYRIC predicted OS and allowed early risk stratification, suggesting that PET/CT might be used to develop risk-adapted strategies.

An imaging-based stratification tool is needed to identify melanoma patients who will benefit from anti Programmed Death-1 antibody (anti-PD1). We aimed at identifying biomarkers for survival and response evaluated in lymphoid tissue metabolism in spleen and bone marrow before initiation of therapy. This retrospective study included 55 patients from two institutions who underwent 18F-FDG PET/CT before anti-PD1. Parameters extracted were SUVmax, SUVmean, HISUV (SUV-based Heterogeneity Index), TMTV (total metabolic tumor volume), TLG (total lesion glycolysis), BLR (Bone marrow-to-Liver SUVmax ratio), and SLR (Spleen-to-Liver SUVmax ratio). Each parameter was dichotomized using the median as a threshold. Association with survival, best overall response (BOR), and transcriptomic analyses (NanoString assay) were evaluated using Cox prediction models, Wilcoxon tests, and Spearman’s correlation, respectively. At 20.7 months median follow-up, 33 patients had responded, and 29 patients died. Median PFS and OS were 11.4 (95%CI 2.7–20.2) and 28.5 (95%CI 13.4–43.8) months. TMTV (>25cm3), SLR (>0.77), and BLR (>0.79) correlated with shorter survival. High TMTV (>25 cm3), SLR (>0.77), and BLR (>0.79) correlated with shorter survival, with TMTV (HR PFS 2.2, p = 0.02, and HR OS 2.5, p = 0.02) and BLR (HR OS 2.3, p = 0.04) remaining significant in a multivariable analysis. Low TMTV and TLG correlated with BOR (p = 0.03). Increased glucose metabolism in bone marrow (BLR) was associated with transcriptomic profiles including regulatory T cell markers (p

Objective: To explore the validity of energy expenditure estimates using the SenseWear Armband during a sequence of four daily living activities in patients post-stroke. Method: Patients with stroke who were able to walk during 6 min without human assistance were asked to wear the SenseWear Armband on the non-paretic arm while performing transfers, a manual task, walking, and walking up and down stairs. The energy expenditure estimated using the SenseWear Armband was compared to the energy expenditure calculated from oxygen consumption, measured by a portable indirect calorimeter (Metamax 3B). The mean of energy expenditure was pooled for each task. Accuracy was explored by mean bias (MB) of Bland-Altman analysis and root mean square error (RMSE), agreement by 95% of limits of agreement (95%LoA) and coefficient of correlation (r). Results: Thirty-eight participants (65.7 ± 13.5 years) were included. The SenseWear Armband globally underestimated energy expenditure, MB = 9.77 kcal for the whole sequence. RMSE were large, accounting for 15% to 41% of the measured energy expenditure. Agreement was low with r < 0.70 and 95%LoA from 42% to 93% of the measured energy expenditure. Conclusions: This study reported a global underestimation and a low level of agreement of the energy expenditure estimated by SenseWear Armband in four daily living activities in patients after stroke. Abbreviations: EE: Energy Expenditure; NIHSS: National Institute of Health Stroke Score.

International audience; Purpose We evaluated whether biomarkers on baseline [ 18 F]-FDG PET/CT are associated with recurrence after surgery in patients with invasive breast cancer of no special type (NST). Methods In this retrospective single-center study, we included consecutive patients with non-metastatic breast cancer of NST who underwent [ 18 F]-FDG PET/CT before treatment, including surgery, between 2011 and 2016. Clinicopathological data were collected. Tumor SUVmax, total metabolic tumor volume (TMTV), and spleen-and bone marrow-to-liver SUVmax ratios (SLR, BLR) were measured from the PET images. Cutoff values were determined using predictiveness curves to predict 5-year recurrence-free survival (5y-RFS). A multivariable prediction model was developed using Cox regression. The association with stromal tumor-infiltrating lymphocytes (TILs) levels (low if 20 cm3) and high SLR (>0.76) were associated with shorter 5y-RFS (HR 2.4, 95%CI 1.3-4.5, and HR 1.9, 95%CI 1.0-3.6). In logistic regression, high SLR was the only independent factor associated with low stromal TILs (OR 2.8, 95%CI 1.4-5.7). Conclusion High total metabolic tumor volume and high spleen glucose metabolism on baseline [ 18 F]-FDG PET/CT were associated with poor 5y-RFS after surgical resection in patients with breast cancer of NST. Spleen metabolism was inversely correlated with stromal TILs and might be a surrogate for an immunosuppressive tumor microenvironment. Keywords Invasive breast cancer of no special type. [18F]-FDG PET/CT. Prognosis. Total metabolic tumor volume. Spleen glucose metabolism. Stromal tumor-infiltrating lymphocytes This article is part of the Topical Collection on Oncology-General

Recent studies reported that wearable sensor devices show low validity for assessing the amount of energy expenditure in individuals after stroke.We aimed to evaluate the validity of energy expenditure calculation based on the product of energy cost and walked distance estimated by wearable devices in individuals after hemispheric stroke.We recruited individuals with hemispheric stroke sequelae who were able to walk without human assistance. The participants wore a tri-axial accelerometer (Actigraph GT3x) and a pedometer (ONStep 400) on the unaffected hip in addition to a respiratory gas exchange analyzer (METAMAX 3B) during 6min of walking at their self-selected walking speed and mode. The energy expenditure was calculated from the product of energy cost measured by the METAMAX 3B and the distance estimated by wearable devices. It was compared to the energy expenditure measured by the METAMAX 3B and the energy expenditure values recorded by the devices according to the manufacturer's algorithms. The validity was investigated by Bland-Altman analysis (mean bias [MB], root mean square error [RMSE], limits of agreement [95%LoA]), and Pearson correlation analysis (r).We included 26 participants (mean [SD] age 64.6 [14.8] years). With the pedometer, the energy expenditure calculated from the product of energy cost and walked distance showed high accuracy and agreement with METAMAX 3B values (MB=-1.6kcal; RMSE=4.1kcal; 95%LoA=-9.9; 6.6kcal; r=0.87, P0.01) but low accuracy and agreement with Actigraph GT3x values (MB=15.7kcal; RMSE=8.7kcal; 95%LoA=-1.3; 32.6kcal; r=0.44, P=0.02) because of poorer estimation of walked distance. With the pedometer, this new method of calculation strongly increased the validity parameter values for estimating energy expenditure as compared with the manufacturer's algorithm.This new method based on the energy cost and distance estimated by wearable devices provided better energy expenditure estimates for the pedometer than did the manufacturer's algorithm. The validity of this method depended on the accuracy of the sensor to measure the distance walked by an individual after stroke.

The majority of glomus tumors are localized to cutaneous sites and are benign. However, extracutaneous malignant glomus tumors have been reported and are aggressive. Here, we report a case of a 45-year-old man who presented severe dysphagia, diagnosed with malignant glomus tumor of the esophagus. F-FDG PET/CT played a decisive role in several phases of the patient management offering previously unknown accuracy. It was first performed in the initial staging of local tumor extent before surgery. A year and a half after, F-FDG PET/CT helped to detect recurrence and, finally, was performed for response evaluation of several systemic therapies.

Background. Understanding the factors that limit mobility in stroke patients is fundamental for proposing appropriate rehabilitation strategies. A high oxygen cost during walking (Cw) has a strong impact on the community ambulation of hemiparetic patients. The Cw in poststroke cerebellar ataxia is poorly evaluated, unlike hemiparetic gait. Objective. To compare the oxygen cost/self-selected walking speed (S) relationship in stroke individuals with cerebellar ataxia or hemiparetic gait. Methods. Thirty-three subjects were included (14 cerebellar stroke, 19 hemispheric stroke), with stroke confirmed by brain imaging and able to walk without human assistance. We measured Cw using the Metamax3B. The relationship between Cw and self-selected walking speed was modelled by logistic regression and then compared between the cerebellar and hemispheric groups. Results. No significant difference was found between the 2 groups for all characteristics of the population, except motor impairments, spasticity, and ataxia ( P < .01). We identified 2 separate Cw/S relationships with different logistic regression equations for the 2 groups. Faster than 0.4 m s−1, Cw was 30.6% to 39.9% higher in patients with cerebellar stroke in comparison with hemispheric stroke individuals. The Cw was correlated with ataxia ( r = 0.88; P < .001) in the cerebellar group, whereas there was a correlation with motor impairments ( r = −0.61; P < .01), spasticity ( r = 0.59; P < .01), and ataxia ( r = 0.81; P < .01) in hemispheric stroke individuals. Conclusion. The Cw in poststroke cerebellar ataxia is significantly higher compared with hemiparetic patients at an equivalent walking speed. The impact on community walking needs to be explored in stroke survivors with cerebellar stroke.

Resume Les exemples et les cas cliniques presentes dans cette partie n’ont pas vocation a etre consideres comme des modeles absolus en termes de qualite image ou de parametrage des appareils. Les exemples doivent contribuer a initier une reflexion individuelle concernant le parametrage du scanner en fonction de la situation clinique, du niveau de scanner que l’on souhaite realiser et de l’appareillage dont on dispose. Ils permettent de presenter de maniere concrete, a partir d’images de selection, des exemples des differents niveaux de scanner envisageables dans une situation donnee.

Resume L’administration de PCI en medecine nucleaire se concoit dans le cadre de pratiques de TDM de niveaux 3 et 4. L’utilisation des PCI en medecine nucleaire dans le cadre des examens de TEMP/TDM ou TEP/TDM est soumise a l’evaluation pour chaque patient du rapport benefice–risque, tenant compte des examens qui ont deja eu lieu, de leurs resultats et de leur disponibilite/accessibilite le jour de l’examen de MN. Les benefices attendus d’une injection de PCI sont une amelioration globale des performances diagnostiques de l’examen.

Resume Les exemples et les cas cliniques presentes dans cette partie n’ont pas vocation a etre consideres comme des modeles absolus en termes de qualite image ou de parametrage des appareils. Les exemples doivent contribuer a initier une reflexion individuelle concernant le parametrage du scanner en fonction de la situation clinique, du niveau de scanner que l’on souhaite realiser et de l’appareillage dont on dispose. Ils permettent de presenter de maniere concrete, a partir d’images de selection, des exemples des differents niveaux de scanner envisageables dans une situation donnee.

Resume Les artefacts resultent d’une discordance entre les valeurs de densite estimees de l’image reconstruite et les valeurs reelles d’attenuation. Ils peuvent provenir d’une multitude de sources differentes (patient, materiel, algorithme, physique du rayonnement X) et entrainer une degradation significative de la qualite des images TDM avec le risque de fausser aussi la correction d’attenuation en TEP ou TEMP.

Resume Les exemples et les cas cliniques presentes dans cette partie n’ont pas vocation a etre consideres comme des modeles absolus en termes de qualite image ou de parametrage des appareils. Les exemples doivent contribuer a initier une reflexion individuelle concernant le parametrage du scanner en fonction de la situation clinique, du niveau de scanner que l’on souhaite realiser et de l’appareillage dont on dispose. Ils permettent de presenter de maniere concrete, a partir d’images de selection, des exemples des differents niveaux de scanner envisageables dans une situation donnee.

Resume Les exemples et les cas cliniques presentes dans cette partie n’ont pas vocation a etre consideres comme des modeles absolus en termes de qualite image ou de parametrage des appareils. Les exemples doivent contribuer a initier une reflexion individuelle concernant le parametrage du scanner en fonction de la situation clinique, du niveau de scanner que l’on souhaite realiser et de l’appareillage dont on dispose. Ils permettent de presenter de maniere concrete, a partir d’images de selection, des exemples des differents niveaux de scanner envisageables dans une situation donnee.

Resume Les exemples et les cas cliniques presentes dans cette partie n’ont pas vocation a etre consideres comme des modeles absolus en termes de qualite image ou de parametrage des appareils. Les exemples doivent contribuer a initier une reflexion individuelle concernant le parametrage du scanner en fonction de la situation clinique, du niveau de scanner que l’on souhaite realiser et de l’appareillage dont on dispose. Ils permettent de presenter de maniere concrete, a partir d’images de selection, des exemples des differents niveaux de scanner envisageables dans une situation donnee.

Background We aimed to define the depth and time of maximal anti-tumour response to programmed death-1 blockade antibodies (anti-PD1) in heavily pre-treated patients with classical Hodgkin lymphoma (HL). To this end, we evaluated the kinetics of response for up to two years. Materials and methods The 18F-FDG positron-emission tomography (PET) and contrast-enhanced computerised tomography (CECT) data of all relapsed or refractory HL treated at Gustave Roussy, Villejuif, France, from 2013 to 2015 were retrospectively reviewed according to the International Harmonisation Project Cheson 2014 criteria and the LYmphoma Response to Immunomodulatory therapy Criteria (LYRIC). Results Sixteen patients were included. The median (range) treatment duration was 18.4 (2.8–23.7) months. Fifty-six percent of patients (9/16) achieved an objective response at 3 months, including 19% (3/16) of complete response. Seventeen percent (1/6) of partial responders at 3 months were converted in a complete response. 22% (2/9) of responders at 3 months relapsed before one year. The nadir was reached at 12.7 (3.0–23.0) months. The median (range) depth of response at nadir was −77% (−50% to 100%). Conclusion We concluded that complete metabolic responses occurred within 6 months, a minority of partial responses were converted in complete response, and the median nadir was observed one year after treatment initiation. These data could help to better define the optimal treatment strategy by PET or CECT-directed approaches.

Walking impairments are common and represent a major challenge for rehabilitation after stroke (Dobkin 2005). To face functional disability due to foot drop consequences, the gold-standard care com...

We assessed whether quantitative imaging biomarkers derived from fluorodeoxyglucose-positron emission tomography (18F-FDG PET) could be extracted from perineural spread (PNS) in head and neck malignancies (HNM) to improve patient risk stratification. A case–control exploratory study (1:2 ratio) enrolled 81 patients with FDG-avid HNM. The case-group comprised 28 patients with documented PNS (reference: expert consensus), including 14 squamous cell carcinomas (SCC). Imaging biomarkers were extracted from the PNS on 18F-FDG PET, CT-scan, and MRI. The control-group enrolled 53 SCCs. The Cox proportional-hazards regression model explored the association with overall survival by univariate and multivariate analyses. The rate of PNS detection by 18F-FDG PET was 100% in the case-group. Quantitative imaging biomarkers were not associated with the presence of sensory (p>0.20) or motor (p>0.10) symptoms. In SCC patients (case: 14; control: 53), PNS was associated with a hazard ratio of death of 5.5 (95%CI: 1.4:20.9) by multivariate analysis. Increased cranial nerve SUVmax was significantly associated with poorer overall survival by univariate analysis (p=0.001). Our pilot study showed the feasibility of extracting 18F-FDG PET biomarkers from PNS in FDG-avid HNM. Our results encourage the development of new PET/CT- or PET/MRI-guided management strategies in further prospective studies. • 18F-FDG PET/CT detects PNS in FDG-avid HNM. • PNS metabolism is more heterogeneous than healthy tissue. • PNS diagnosis is crucial: most patients were asymptomatic, N0 and M0. • PNS diagnosis is associated with poorer overall survival in SCC. • PET/CT- or PET/MRI-guided management strategies should be evaluated.

TO THE EDITOR: A recent ahead-of-print publication by Castello et al. ([1][1]) provides fascinating insights on the potential prognostic role of 18F-FDG PET/CT in patients with non–small cell lung cancer treated with immune checkpoint inhibitors (ICIs). The authors unraveled the prognostic value

Resume L’imagerie hybride correspond en medecine nucleaire a l’evolution technologique des cameras de detection qui sont desormais tres souvent couplees a un dispositif d’imagerie anatomique, essentiellement tomodensitometrique. Faisant suite a une forte demande de la part des medecins nucleaires eux-memes, mais egalement de l’Autorite de surete nucleaire, ce guide est destine a l’ensemble de la communaute de medecine nucleaire pour integrer a la fois les aspects de radioprotection lies a la TDM couplee, mais aussi ceux lies a la qualite de l’image tomodensitometrique attendue en fonction du contexte clinique.

To compare the prognostic value of imaging biomarkers derived from a quantitative analysis of baseline 18F-FDG-PET/CT in patients with mucosal melanoma (Muc-M) or cutaneous melanoma (Cut-M) treated with immune checkpoint inhibitors (ICIs). In this retrospective monocentric study, we included 56 patients with non-resectable Muc-M (n = 24) or Cut-M (n = 32) who underwent baseline 18F-FDG-PET/CT before treatment with ICIs between 2011 and 2017. Parameters were extracted from (i) tumoral tissues: SUVmax, SUVmean, TMTV (total metabolic tumor volume), and TLG (total lesion glycolysis) and (ii) lymphoid tissues: BLR (bone marrow-to-liver SUVmax ratio) and SLR (spleen-to-liver SUVmax ratio). Association with survival and response was evaluated using Cox prediction models, Student’s t tests, and Spearman’s correlation respectively. p

International audience; The majority of gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) are diagnosed at a non-resectable stage due to non-specific clinical syndromes, late manifestations from mass effects, or incidental detection of a clinically silent disease. Management strategies include curative or cytoreduction surgery, imaging-guided intervention, chemotherapy, immunotherapy, and radionuclide therapies. In this step-by-step review, we provide a structured approach for standardized reading and reporting of medical imaging studies covering content and terminology. This review explains which imaging studies should be used for different NETs and what should be reported when interpreting these studies. This standardized data collection guide should enable precision medicine for the management of patients with GEP-NETs of neuroectodermal origin: gastrointestinal-NETs (giNETs) and pancreatic NETs (pNETs). To improve outcomes from GEP-NETs, it contains a comprehensive evaluation of imaging aids for determining surgical non-resectability, and serves as a surrogate measure for tumor differentiation and proliferation, assessing the spatial and temporal heterogeneity of the tumor sites with prognostic and therapeutic implications.

Background: Health professionals need valid devices to assess a stroke individual&rsquo, s ability to walk. The aim was to evaluate the validity of the estimation of the walked distance by wearable devices and the impact of the sensor&rsquo, s position in stroke individuals. Methods: Post-stroke patients able to walk without human assistance were equipped with several wearable devices: pedometers, Actigraph, and Sensewear Armband placed according to the manufacturers' recommendations. Participants walked for 6 min at a comfortable speed wearing all sensors at the same time. We analyzed the validity of sensor-estimated distances according to their position using Bland&ndash, Altman analysis, root-mean-square error, and coefficient of correlation. Results: In total, 35 individuals were included (mean age = 65 &plusmn, 15 years). The best estimations were given by the Actigraph worn on the unaffected ankle (mean bias (MB) = 22.6 &plusmn, 32.4 m, p = 0.37) and by the pedometer worn on the unaffected hip (MB = 20.5 &plusmn, 24.6 m, p = 0.46). The other sensors and positions provided large estimation errors over 95 m (p &lt, 0.05). Conclusion: This study led to a recommendation of a pedometer worn on the unaffected hip or an Actigraph worn on the unaffected ankle to get a valid estimation of the distance walked by stroke individuals.

Background: We aimed to assess the clinical utility of a previously published score combining the total metabolic tumor volume (TMTV) on baseline FDG-PET/CT and pretreatment derived from the neutrophils to lymphocytes ratio (dNLR) for prognostication in NSCLC patients undergoing first-line immunotherapy (IT). Methods: In this multicenter retrospective study, 63 advanced NSCLC patients with a PD-L1 tumor proportion score (TPS) &ge, 50%, who underwent FDG-PET/CT before first-line IT, treated from January 2017 to September 2019, were enrolled. Associations between this score and the progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and overall response rate (ORR) were evaluated. Results: The median (m) PFS and mOS were 7.7 (95% CI 4.9&ndash, 10.6) and 12.1 (8.6&ndash, 15.6) months, respectively, and DCR and ORR were 65% and 58%, respectively. mOS was 17.9 months (14.6 not reached) for the good group versus 13.8 (95%CI 8.4&ndash, 18.9) and 6.6 (CI 2.0&ndash, 11.2) months for the intermediate and poor groups, respectively. mPFS was 15.1 (95%CI 12.1&ndash, 20.0) months for the good group versus 5.2 (1.9&ndash, 8.5) and 1.9 (95%CI 1.3&ndash, 2.5) months for the intermediate and poor groups, respectively. The poor prognosis group was associated with DCR and ORR (p &lt, 0.05). Conclusions: The metabolic score combining TMTV on the baseline FDG-PET/CT scan and pretreatment dNLR was associated with the survival and response in a cohort of advanced NSCLC patients with &ge, 50% PD-L1 receiving frontline IT.

The response evaluation criteria in patients with Hodgkin lymphoma (HL) were designed for the assessment of chemotherapy and targeted molecular agents. We investigated the accuracy of 3-mo 18F-FDG PET/CT for the identification of HL patients responding to immune-checkpoint blockade by anti-programmed death 1 antibodies (anti-PD1). We also reported the frequency of new immune patterns of response and progression. Methods: Retrospectively, we recruited consecutive HL patients treated by anti-PD1 (pembrolizumab or nivolumab) at Gustave Roussy from 2013 to 2015. 18F-FDG PET/CT and contrast-enhanced CT scans were acquired every 3 mo. We recorded the best overall response according to the International Harmonization Project Cheson 2014 criteria and LYmphoma Response to Immunomodulatory therapy Criteria (LYRIC) (2016 revised criteria). Patients achieving an objective response at any time during the anti-PD1 treatment were classified as responders. Results: Sixteen relapsed or refractory classic HL patients were included. The median age was 39 y (age range, 19-69 y). The median previous lines of therapy was 6 (range, 3-13). The mean follow-up was 22.6 mo. Nine of 16 patients (56%) achieved an objective response. Two deaths occurred due to progressive disease at 7 mo. 18F-FDG PET/CT detected all responders at 3 mo and reclassified best overall response in 5 patients compared with CT alone. A decrease in tumor metabolism and volume (SUVmean, metabolic tumor volume) and increase in healthy splenic metabolism at 3 mo were observed in responders (area under the curve > 0.85, P < 0.04). Five of 16 patients (31%) displayed new imaging patterns related to anti-PD1; we observed 2 transient progressions consistent with indeterminate response according to the LYRIC (2016) (IR2b at 14 mo and IR3 at 18 mo) and 3 patients with new lesions associated with immune-related adverse events. Conclusion: Three-month 18F-FDG PET/CT scans detected HL patients responding to anti-PD1. New patterns were encountered in 31% of patients, emphasizing the need for further evaluation in larger series and close collaboration between imaging and oncology specialists on a per-patient basis.

Fusariosis is an opportunistic infection, caused by a filamentous fungus, found on plants and in soil. The treatment of disseminated pattern, seen in immunocompromised patients with severe neutropenia, is difficult because of antifungal therapy resistance. A 12-year-old girl, who was diagnosed with B-cell acute lymphoblastic leukemia, developed multiple widespread skin papules and subcutaneous nodules, at day 20 of consolidation therapy. Histological examination with cultures of skin tissue revealed Fusarium species. Treatment was started with intravenous liposomal amphotericin B and voriconazole. To assess treatment response, FDG PET/CT performed at baseline, at 2 and 4 months, showed a partial response.

The aim of this study was to evaluate if bone marrow (BM) SUVmax measured on pre-treatment 18F-FDG PET/CT predicts the clinical outcome of locally advanced cervical cancer (LACC). We recruited retrospectively patients with LACC who underwent staging 18F-FDG PET/CT and had baseline blood tests, then treated by chemoradiation therapy (CRT), followed by image-guided adaptive brachytherapy (IGABT). BM SUVmax was calculated and correlated to inflammatory blood markers. Tumor size and pelvic lymph node involvement were evaluated on baseline MRI. Prognostic value of SUV uptake and blood markers regarding overall survival (OS), pelvic and extra-pelvic recurrence-free survival (PRFS and EPRFS respectively) was assessed using Cox models with adjusted p-values. 116 patients with FIGO stage Ib-IVa cervical cancer, treated between 2005 and 2014, were analyzed. The median follow-up was 75.5 months. BM SUVmax was significantly correlated to tumor SUVmax. In multivariate analysis, PRFS was significantly poorer in patients with high BM SUVmax (>2.8) and neutrophilia (p 5 vs ≤5 cm) could predict PRFS, EPRFS and OS (p 12 vs ≤12) were not prognostic for OS or pelvic and extra-pelvic relapses. Patients with LACC and high BM SUVmax on 18F-FDG PET have worse PFRS following CRT plus IGABT. These results can be potentially explained by the pro-inflammatory role of the tumor microenvironment and G-CSF expressed by tumor cells. These data support the role of PET as a potential indicator of disease aggressiveness beyond tumor staging.

BACKGROUND: Drugs targeting programmed death receptor-1 (PD-1) and its ligand PD-L1 have shown activity in multiple malignancies. Considering their novel mechanism of action, whether traditional prognostic scores also apply to patients treated with these drugs is unknown. We investigated whether a baseline 3-point (pt) computed tomography (CT) scan (PS3-CT) score and a 7-pt prognostic (PS7) score allowed identifying long-term survivors on anti-PD-1/-L1 therapy. MATERIALS AND METHODS: We reviewed 251 consecutive patients enrolled in phase I trials evaluating anti-PD-1/-L1 agents between 26th December 2011 and 7th September 2015. PS3-CT was calculated using high tumour burden (TB1D-RECIST > 9 cm), low skeletal muscle index (SMI < 53 cm(2) m(-2)) and non-pulmonary visceral metastases (NPVM) (1 pt each). PS7 was calculated by adding lower performance status, decreased serum albumin, increased serum lactate dehydrogenase and more than two distant metastases (1 pt each). Effect on overall survival (OS) of each parameter was tested using Kaplan-Meier and multivariable Cox analyses. RESULTS: PS3-CT was a significant independent predictor of OS (hazard ratio [HR] = 1.39 [95% confidence interval {CI} = 1.07-1.81], p = 0.01) when compared to the Royal Marsden Hospital, Barbot and American Joint Committee on Cancer scores. High TB (n = 78), low SMI (n = 55) and NPVM (n = 146) were associated with poorer survival (p < 0.01). High TB and low SMI were independent predictors of OS (respective HR of death: 2.00 [95% CI = 1.38-2.88], p < 0.01 and 1.75 [95% CI = 1.15-2.66], p < 0.01). PS7 was a significant predictor of OS (HR = 1.40 [95% CI = 1.25-1.56], p < 0.01). CONCLUSION: Objective and rapid-risk scoring based on three CT scan parameters allows identifying patients with prolonged OS on anti-PD-1/-L1 therapy, independently from conventional clinical-biological prognostic scores.

Introduction Les anticorps anti-Programmed Death-1 (Ac anti-PD-1) ont montre un taux de reponse superieur a 70 % dans la maladie de Hodgkin (MdH) classique refractaire. Nous decrivons ici le premier cas d’effet abscopal dans la MdH traitee par Pembrolizumab. Histoire clinique Un patient de 33 ans, suivi pour une MdH classique diagnostiquee en avril 2006, de stade IIB (Ann-Arbor) recut une chimiotherapie classique (ABVD) puis 2 lignes de sauvetage et une intensification-autogreffe de cellules souches en 2007. Une recidive sus et sous-diaphragmatique est confirmee histologiquement en 2012. Apres 3 nouvelles lignes de traitement, incluant le Brentuximab Vedotin, le patient presenta des signes B et une progression tumorale. Devant cette MdH refractaire, le patient est inclus dans un essai clinique de phase I et recoit 10 mg/kg de Pembrolizumab, en intraveineux, toutes les 2 semaines, des decembre 2013. Durant 10 mois, la maladie fut stable morphologiquement (TDM) et metaboliquement (TEP-FDG). L’apparition d’une toux en octobre 2014 revele une augmentation en taille d’une adenopathie mediastino-hilaire droite, responsable d’une compression sur la bronche souche. Une radiotherapie externe (RTE) conformationnelle (30 Gy en 10 fractions), localisee sur l’adenopathie hilaire droite a visee palliative est debutee en novembre 2014. La TDM et la TEP ont ete utilisees pour suivre les lesions en dehors du champ de RTE : 5 cibles selectionnees selon les criteres de Cheson. Deux mois apres, la TEP a montre une disparition complete de l’adenopathie hilaire droite irradiee associee a une regression de la somme des volumes (diminution de 42 % de la somme des diametres des lesions cibles selon Cheson) et des activites glycolytiques (diminution en moyenne de 38 % du metabolisme des lesions cibles avec le SUVmax) des lesions en dehors du champ de RTE (reponse partielle selon Percist). Conclusion Nous decrivons le premier cas d’effet synergique et abscopal decrit en TEP-FDG/TDM chez un patient traite par immunotherapie anti-PD-1 couplee a la RTE. Apres celle-ci, nous avons observe une reponse complete du site traite par RTE associee a une reponse metabolique partielle en dehors du champ. L’effet abscopal se definit par la regression des metastases a distance du site traite par radiotherapie, liee a une stimulation de l’immunite anti-tumorale par la liberation d’antigenes et est potentialise par l’administration d’inhibiteur de checkpoint immunitaire.