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To evaluate the concordance between DECT perfusion and ventilation/perfusion (V/Q) scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). Eighty patients underwent V/Q scintigraphy and DECT perfusion on a 2nd- and 3rd-generation dual-source CT system. The imaging criteria for diagnosing CTEPH relied on at least one segmental triangular perfusion defect on DECT perfusion studies and V/Q mismatch on scintigraphy examinations. Based on multidisciplinary expert decisions that did not include DECT perfusion, 36 patients were diagnosed with CTEPH and 44 patients with other aetiologies of PH. On DECT perfusion studies, there were 35 true positives, 6 false positives and 1 false negative (sensitivity 0.97, specificity 0.86, PPV 0.85, NPV 0.97). On V/Q scans, there were 35 true positives and 1 false negative (sensitivity 0.97, specificity 1, PPV 1, NPV 0.98). There was excellent agreement between CT perfusion and scintigraphy in diagnosing CTEPH (kappa value 0.80). Combined information from DECT perfusion and CT angiographic images enabled correct reclassification of the 6 false positives and the unique false negative case of DECT perfusion. There is excellent agreement between DECT perfusion and V/Q scintigraphy in diagnosing CTEPH. The diagnostic accuracy of DECT perfusion is reinforced by the morpho-functional analysis of data sets. • Chronic thromboembolic pulmonary hypertension (CTEPH) is potentially curable by surgery. • The triage of patients with pulmonary hypertension currently relies on scintigraphy. • Dual-energy CT (DECT) can provide standard diagnostic information and lung perfusion from a single acquisition. • There is excellent agreement between DECT perfusion and scintigraphy in separating CTEPH and non-CTEPH patients.

Introduction: Psychogenic non-epileptic seizures (PNES) are paroxysms of either altered subjective or objective manifestations that may mimic epileptic seizures (ES), without abnormal neuronal epileptiform activity. In this report, we present the case of a 39-year-old woman with PNES and functional movement disorders, who was successfully treated with neuro-guided transcranial direct current stimulation (tDCS). Methods: We used a PET-guided tDCS approach, as a hypometabolism of the frontal region was revealed by FDG TEP scan. TDCs was performed 5 days/week, 2 times/day, during 3 weeks. All clinical manifestations were reported in a seizure diary. We also assessed dissociation, depression, alexithymia, psychotraumatic scales, and involuntary movements. Results: The treatment was followed by a decrease of both psychogenic involuntary movements and PNES at 5 weeks. At the same time, PTSD symptoms, dissociative symptoms, depression and alexithymia improved. Conclusion: PET-scan and tDCS seems to be promising tools for the evaluation and treatment of PNES in clinical practice, and may have a specific role on dissociative symptoms.

A 57-year-old man was referred to our institution for F-fluorocholine PET/CT to characterize a pulmonary nodule in a context of hepatocellular carcinoma. F-FDG PET/CT did not show any uptake of the pulmonary nodule. F-fluorocholine PET/CT showed high uptake of the pulmonary nodule, confirming its metastatic origin. Furthermore, liver early dynamic acquisitions allowed better visualization of the hepatocellular carcinoma during the "arterial phase" than at equilibrium.

We report the case of a 31-year-old woman with left foot bones located epithelioid hemangioendothelioma. It is a rare type of vascular tumor, locally aggressive with metastatic potential. It was revealed by a chronic isolated left foot pain. Conventional imaging showed multiple osteolytic lesions of the bones, appearing aggressive. Both bone scintigraphy and F-FDG PET showed an increased uptake of these lesions and confirmed the limited extent to distal extremity of the left lower limb. Final diagnosis was given on a surgical biopsy. Patient was treated by hyperthermic chemotherapy using isolated limb perfusion.

International audience; Background: In 30% of patients with brain metastasis (BM), neurological symptoms are the first clinical manifestation of systemic malignancy, referred to as BM from cancer of unknown primary site (BM-CUPS). Here, we define the diagnostic value of 18F-fluordesoxyglucose positron emission tomography (FDG-PET/CT) in the workup of BM-CUPS.Methods: We screened 565 patients operated for BM at the University Hospital Zurich and identified 64 patients with BM-CUPS with data on both FDG-PET/CT and contrast-enhanced chest/abdomen computed tomography (CT) available at BM diagnosis. A cohort of 125 patients with BM-CUPS from Lille and Vienna was used for validation.Results: FDG-PET/CT was not superior to chest/abdomen CT in localising the primary lesion in the discovery cohort, presumably because most primary tumours were lung cancers. However, FDG-PET/CT identified additional lesions suspicious of extracranial metastases in 27 of 64 patients (42%). The inclusion of FDG-PET/CT findings shifted the graded prognostic assessment (GPA) score from 3 with CT alone to 2.5 for PET/CT (p = 3.8 × 10-5, Wilcoxon's test), resulting in a predicted survival of 5.3 versus 3.8 months (p = 6.1 × 10-5; Wilcoxon's test). All observations were confirmed in the validation cohort.Conclusions: Lung cancers are the most common primary tumour in BM-CUPS; accordingly, CT alone shows similar overall sensitivity for detecting the primary tumour as FDG-PET/CT. Yet, FDG-PET/CT improves the accuracy of staging by detecting more metastases, reflected by decreased GPA scores and decreased predicted survival. Therefore, randomised trials on patients with BM should standardise methods of staging, notably when stratifying for GPA.

In 30% of patients with brain metastasis (BM), neurological symptoms are the first clinical manifestation of systemic malignancy, referred to as BM from cancer of unknown primary site (BM-CUPS). Here, we define the diagnostic value ofWe screened 565 patients operated for BM at the University Hospital Zurich and identified 64 patients with BM-CUPS with data on both FDG-PET/CT and contrast-enhanced chest/abdomen computed tomography (CT) available at BM diagnosis. A cohort of 125 patients with BM-CUPS from Lille and Vienna was used for validation.FDG-PET/CT was not superior to chest/abdomen CT in localising the primary lesion in the discovery cohort, presumably because most primary tumours were lung cancers. However, FDG-PET/CT identified additional lesions suspicious of extracranial metastases in 27 of 64 patients (42%). The inclusion of FDG-PET/CT findings shifted the graded prognostic assessment (GPA) score from 3 with CT alone to 2.5 for PET/CT (p = 3.8 × 10Lung cancers are the most common primary tumour in BM-CUPS; accordingly, CT alone shows similar overall sensitivity for detecting the primary tumour as FDG-PET/CT. Yet, FDG-PET/CT improves the accuracy of staging by detecting more metastases, reflected by decreased GPA scores and decreased predicted survival. Therefore, randomised trials on patients with BM should standardise methods of staging, notably when stratifying for GPA.

Background Because of growing body of interest on the association between fibrosing idiopathic interstitial pneumonias (f-IIP) and ischaemic heart disease, we initiated this prospective study to evaluate the prevalence of asymptomatic coronary artery disease (CAD) in patients with f-IIP. Methods Forty-two patients with f-IIP underwent noninvasive screening for CAD that included (a) a chest CT examination enabling calculation of the coronary artery calcium (CAC) score, then depiction of coronary artery stenosis; and (b) stress myocardial perfusion scintigraphy (MPS). Patients with significant coronary abnormalities, defined by a CAC score >400 or coronary artery stenosis >50% at CT and/or perfusion defect >5% at MPS, were referred to the cardiologist. Coronary angiography was indicated in presence of a perfusion defect >10% at MPS or significant left main or proximal left anterior descending stenosis whatever MPS findings. Results Combining CT and MPS, significant abnormalities were detected in 32/42 patients (76%). The cardiologist: (a) did not consider further investigation in 21 patients (CT abnormalities but no ischaemia at MPS: 12/21; false-positive findings at MPS: 3/21; poor respiratory condition: 6/21); (b) proceeded to coronary angiography in 11 patients which confirmed significant stenoses in 5 patients (5/42; 12%). In the worst-case-scenario (i.e., inclusion of 6 patients with significant coronary artery abnormalities who were not investigated due to poor respiratory condition), the prevalence of CAD reached 26% (11/42). Conclusion In the studied population of patients with f-IIP, asymptomatic CAD ranged between 12% and 26%.

Background Right ventricular (RV) systolic function is a powerful prognostic factor in patients with systolic heart failure. The accurate estimation of RV function remains difficult. The aim of the study was to determine the diagnostic accuracy of 2D-speckle tracking RV strain in patients with systolic heart failure, analyzing both free and posterolateral walls. Methods Seventy-six patients with dilated cardiopathy (left ventricular end-diastolic volume≥75ml/m 2 ) and left ventricular ejection fraction≤45% had an analysis of the RV strain. Feasibility, reproducibility and diagnostic accuracy of RV strain were analyzed and compared to other echocardiographic parameters of RV function. RV dysfunction was defined as a RV ejection fraction≤40% measured by radionuclide angiography. Results RV strain feasibility was 93.9% for the free-wall and 79.8% for the posterolateral wall. RV strain reproducibility was good (intra-observer and inter-observer bias and limits of agreement of 0.16±1.2% [−2.2–2.5] and 0.84±2.4 [−5.5–3.8], respectively). Patients with left heart failure have a RV systolic dysfunction that can be unmasked by advanced echocardiographic imaging: mean RV strain was −21±5.7% in patients without RV dysfunction and −15.8±5.1% in patients with RV dysfunction (p=0.0001). Mean RV strain showed the highest diagnostic accuracy to predict depressed RVEF (area under the curve (AUC) 0.75) with moderate sensitivity (60.5%) but high specificity (87.5%) using a cutoff value of −16%. Conclusions RV strain seems to be a promising and more efficient measure than previous RV echocardiographic parameters for the diagnosis of RV systolic dysfunction.

This study aims at assessing whether EANM harmonisation strategy combined with EQ·PET methodology could be successfully applied to harmonize brain 2-deoxy-2[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography (PET) images. The NEMA NU 2 body phantom was prepared according to the EANM guidelines with an [18F]FDG solution. Raw PET phantom data were reconstructed with three different reconstruction protocols frequently used in clinical PET brain imaging: ([Formula: see text]) Ordered subset expectation maximization (OSEM) 3D with time of flight (TOF), 2 iterations and 21 subsets; ([Formula: see text]) OSEM 3D with TOF, 6 iterations and 21 subsets; and ([Formula: see text]) OSEM 3D with TOF, point spread function (PSF), and 8 iterations and 21 subsets. EQ·PET filters were computed as the Gaussian smoothing that best independently aligned the recovery coefficients (RCs) of reconstructions [Formula: see text] and [Formula: see text] with the RCs of the reference reconstruction, [Formula: see text]. The performance of the EQ·PET filter to reduce variations in quantification due to differences in reconstruction was investigated using clinical PET brain images of 35 early-onset Alzheimer's disease (EOAD) patients. Qualitative assessments and multiple quantitative metrics on the cortical surface at different scale levels with or without partial volume effect correction were evaluated on the [18F]FDG brain data before and after application of the EQ·PET filter. The EQ·PET methodology succeeded in finding the optimal smoothing that minimised root-mean-square error (RMSE) calculated using human brain [18F]FDG-PET datasets of EOAD patients, providing harmonized comparisons in the neurological context. Performance was superior for TOF than for TOF + PSF reconstructions. Results showed the capability of the EQ·PET methodology to minimize reconstruction-induced variabilities between brain [18F]FDG-PET images. However, moderate variabilities remained after harmonizing PSF reconstructions with standard non-PSF OSEM reconstructions, suggesting that precautions should be taken when using PSF modelling.

OBJECTIVE To evaluate the role of ¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in the assessment of tumor response after the completion of neoadjuvant chemoradiation (CRT) in patients with locally advanced resectable esophageal cancer. BACKGROUND After primary CRT, a noninvasive evaluation of the tumor response could help in the treatment decision to identify patients who may benefit from surgery. Whether FDG-PET provides clinically relevant information remains questionable. METHODS Operable patients with locally advanced esophageal cancer (clinically staged T3 N0-1 M0) were enrolled in this prospective study. The complete treatment plan included neoadjuvant CRT (cisplatin + 5-fluorouracil/45 Gy) followed 6 to 8 weeks later by a transthoracic en bloc esophagectomy. Morphological evaluation combined with FDG-PET was performed 2 weeks before the start of CRT and 4 to 6 weeks after the completion of CRT. Intratumoral pre- and posttreatment FDG-standardized uptake values (SUV1, SUV2, percentage change) were assessed. These variables were correlated with pathological and morphologic responses and survival. Investigators were blinded to the FDG-PET results unless they revealed metastatic disease. RESULTS Of 60 total patients, 46 underwent the complete treatment plan (median age: 60.1 years; adenocarcinoma: 25 patients; squamous cell cancer: 21 patients). A major pathological response occurred in 45.7% of patients and was associated with a favorable outcome (P = 0.057). Neoadjuvant CRT led to a significant reduction in intratumoral FDG-uptake (P 0.280). The SUV2 value was correlated with a morphological response and the possibility to perform an R0 resection (P < 0.018; receiver operating characteristic curve analysis: SUV2 threshold = 5.5). No significant association was found between metabolic imaging and recurrence or survival. CONCLUSIONS FDG-PET does not effectively correlate with pathological response and long-term survival in patients with locally advanced esophageal cancer undergoing neoadjuvant CRT followed by surgery. (Registered on the www.e-cancer RECF0350.).

Background Combination of bevacizumab and weekly paclitaxel showed synergitic effects, anti-tumor efficacy and a good toxicity profile for patients with breast cancer but has never been evaluated in non small cell lung cancer (NSCLC). We retrospectively reviewed safety and efficacy of this regimen in metastatic non-squamous NSCLC as fourth-line therapy or beyond. Methods Patients were identified from a prospective database. Treatment consisted in paclitaxel 80 mg/m 2 on days 1, 8 and 15 and bevacizumab 15 mg/kg on day 1, every 3 weeks until progression or unacceptable toxicity. Results Twenty patients were included in this study. Objective response rate at first evaluation was 40% (8/20), confirmed response rate was 15% (3/20) and disease control rate was 75% (15/20). The median progression-free survival and overall survival were 6.4 months (CI95% 4.1–9) and 9.6 months (CI95% 7–19.7). Grade 3–4 adverse events included neutropenia (4/20), onycholysis (2/20) and infection (2/20). One patient died from a bowel perforation and another one died from unknown cause. Prolonged responses were observed in a patient who had received bevacizumab as part of first-line chemotherapy and in another one who harbored an ALK rearrangement. Conclusions In our experience, combination of bevacizumab and weekly paclitaxel exhibited acceptable toxicity and had encouraging anti-tumor efficacy as fourth-line treatment or beyond for non-squamous NSCLC patients, supporting further evaluation in larger prospective studies.

Hypometabolism in the fronto-mesial cortex and in the anterior cingulate cortex were reported in patients with progressive supranuclear palsy (PSP). Severe neuronal loss, associated with gliosis and neurofibrillary tangles were reported in the superior colliculi of patients with PSP in the initial clinico-neuropathological description of the disease by Steele, Richardson and Olszewski. Nowadays, high-resolution positron emission tomography with [fluorine-18] fluoro-D-glucose (18F-FDG PET) with magnetic resonance (MR) image fusion can reveal hypometabolism in the superior colliculi in patients with PSP.

Background Given that memantine is thought to decrease N-methyl-D-aspartic-acid-related (NMDA) glutamatergic hyperactivity and improve locomotion in rats, we sought to assess the drug9s impact on axial symptoms in advanced Parkinson9s disease (PD). Methods We performed a 90-day, randomised, double-blind, study with two parallel arms: 20 mg/day memantine versus placebo (ClinicalTrials.gov:NCT01108029). The main inclusion criterion was the presence of a severe gait disorder and an abnormal, forward-leaning stance. The following parameters were analysed under standardised conditions before and after acute administration of L-dopa: gait (stride length as primary criterion), the United-Parkinson9s-Disease-Rating-Scale (UPDRS) motor score and its axial subscore, the hypertonia and strength of the axial extensors and flexors (isokinetic dynamometer), the Dyskinesia Rating Scale score (DRS) and its axial subscore. Results Twenty-five patients were included. The memantine and placebo group did not differ significantly in terms of stride length. However, in the memantine group, we observed significantly better results (vs placebo) for the overall UPDRS score (F (1,21) =4.9; p=0.039(−1)) and its axial subscore (F (1,21) =7.2; p=0.014(−1.1)), axial hypertonia, the axial and overall DRS and axial strength. Conclusions Memantine treatment was associated with lower axial motor symptom and dyskinesia scores but did not improve gait. These benefits must be confirmed in a broader population of patients.

International audience; After more than 50 years of treating Parkinson’s disease with l-DOPA, there are still no guidelines on setting the optimal dose for a given patient. The dopamine transporter type 1, now known as solute carrier family 6 (neurotransmitter transporter), member 3 (SLC6A3) is the most powerful determinant of dopamine neurotransmission and might therefore influence the treatment response. We recently demonstrated that methylphenidate (a dopamine transporter inhibitor) is effective in patients with Parkinson’s disease with motor and gait disorders. The objective of the present study was to determine whether genetic variants of the dopamine transporter type 1-encoding gene (SLC6A3) are associated with differences in the response to treatment of motor symptoms and gait disorders with l-DOPA and methylphenidate (with respect to the demographic, the disease and the treatment parameters and the other genes involved in the dopaminergic neurotransmission). This analysis was part of a multicentre, parallel-group, double-blind, placebo-controlled, randomized clinical trial of methylphenidate in Parkinson’s disease (Protocol ID:2008-005801-20; ClinicalTrials.gov:NCT00914095). We scored the motor Unified Parkinson's Disease Rating Scale and the Stand-Walk-Sit Test before and after a standardized acute l-DOPA challenge before randomization and then after 3 months of methylphenidate treatment. Patients were screened for variants of genes involved in dopamine metabolism: rs28363170 and rs3836790 polymorphisms in the SLC6A3 gene, rs921451 and rs3837091 in the DDC gene (encoding the aromatic L-amino acid decarboxylase involved in the synthesis of dopamine from l-DOPA), rs1799836 in the MAOB gene (coding for monoamine oxidase B) and rs4680 in the COMT gene (coding for catechol-O-methyltransferase). Investigators and patients were blinded to the genotyping data throughout the study. Eighty-one subjects were genotyped and 61 were analysed for their acute motor response to l-DOPA. The SLC6A3 variants were significantly associated with greater efficacy of l-DOPA for motor symptoms. The SLC6A3 variants were also associated with greater efficacy of methylphenidate for motor symptoms and gait disorders in the ON l-DOPA condition. The difference between motor Unified Parkinson's Disease Rating Scale scores for patients with different SLC6A3 genotypes was statistically significant in a multivariate analysis that took account of other disease-related, treatment-related and pharmacogenetic parameters. Our preliminary results suggest that variants of SLC6A3 are genetic modifiers of the treatment response to l-DOPA and methylphenidate in Parkinson’s disease. Further studies are required to assess the possible value of these genotypes for (i) guiding l-DOPA dose adaptations over the long term; and (ii) establishing the risk/benefit balance associated with methylphenidate treatment for gait disorders.

The therapeutic management of brain metastases depends upon their diagnosis and characteristics. It is therefore imperative that imaging provides accurate diagnosis, identification, size and localization information of intracranial lesions in patients with presumed cerebral metastatic disease. MRI exhibits superior sensitivity to CT for small lesions identification and to evaluate their precise anatomical location. The CT-scan will be made only in case of MRI's contraindication or if MRI cannot be obtained in an acceptable delay for the management of the patient. In clinical practice, the radiologic metastasis evaluation is based on visual image analyses. Thus, a particular attention is paid to the imaging protocol with the aim to optimize the diagnosis of small lesions and to evaluate their evolution. The MRI protocol must include: 1) non-contrast T1, 2) diffusion, 3) T2* or susceptibility-weighted imaging, 4) dynamic susceptibility contrast perfusion, 5) FLAIR with contrast injection, 6) T1 with contrast injection preferentially using the 3D spin echo images. The role of the nuclear medicine imaging is still limited in the diagnosis of brain metastasis. The Tc-sestamibi brain imaging or PET with amino acid tracers can differentiate local brain metastasis recurrence from radionecrosis but still to be evaluated.

2076 Background: Brain metastasis (BM) are the first clinical presentation of cancer in around 30% of patients. They are then referred as BM from cancer of unknown primary site (BM-CUPS). The value of 18F-fluordesoxyglucose positron emission tomography (FDG-PET)/CT has not yet be determined for the management of these patients. Methods: A total of 566 patients were operated for BM at the University Hospital Zurich between 2004 and 2014, of whom 127 were identified as BM-CUPS patients. Two cohorts from other independent centers (n = 100 and 120) were used for the validation of data. Results: No difference in determining the localization of the primary lesion was observed between FDG-PET/CT and CT (FDG-PET/CT: 73/78, 93.6%; CT: n = 70/78, 89.7%; p = 0.25, McNemar’s test). The same pattern of primary lesion and other extracranial lesions was observed in 36 of 64 patients (56.3%). Additional suspicious extracranial metastases were identified by FDG-PET/CT in 28 patients (43.7%). The median graded prognostic assessment (GPA) scores were 2.5 determined according to FDG-PET/CT and 3 according to CT alone (p = 3.8x10-5), resulting in predicted survival times of 3.8 versus 5.3 months (p = 6.1x10-5; Wilcoxon’s test). Conclusions: A similar sensitivity of FDG-PET/CT and chest CT was observed for the detection of the primary tumor in BM-CUPS, however, FDG-PET/CT significantly improved the accuracy of staging. FDG-PET/CT should be preferred for the management of BM-CUPS and may help to avoid redundant CT imaging.

INTRODUCTION The prognostic value of standardized uptake values (SUVs) at initiation of and during chemotherapy remains controversial in lung cancer patients. However, metabolic volume (MV) and total lesion glycolysis (TLG) have shown promise in lung cancer stratification before treatment. Our aim was to define the prognostic value of MV and TLG in a homogenous group of advanced-stage lung cancer patients treated with bevacizumab and paclitaxel. MATERIALS AND METHODS Fifty (18)F-fluorodeoxyglucose PET-computed tomography examinations were studied. SUV, MV and TLG were measured for each detectable lesion (classified as primary tumour, node or distant metastasis). MV values were added to compute tumour MV (MVt), nodal MV (MVn), metastatic MV (MVm) and whole-body MV (MVwb). TLGt, TLGn, TLGm and TLGwb were computed using the same method. Maximal SUVt, SUVn, SUVm and SUVwb were measured. Patients were stratified according to each parameter. Overall survival was compared between parameter-stratified groups using the log rank test. RESULTS At initiation of bevacizumab and paclitaxel therapy (n=12), only TLGwb and TLGn had strong prognostic value with hazard ratios (HRs) of 11.8 and 5.6, respectively (P

Introduction Le resurfacage de hanche est une technique d’arthroplastie dediee au sujet jeune. Cette intervention presente une courbe d’apprentissage importante et de nombreuses complications peuvent etre imputees a l’inexperience du chirurgien. A l’heure actuelle, nous restons demunis pour detecter les complications femorales du fait de la presence de l’alliage metallique recouvrant la tete femorale (descellements, collapses…). Le SPECT-CT est un examen d’imagerie nucleaire hybride qui combine une imagerie metabolique avec une imagerie morphologique. Il permet d’evaluer la vascularisation et le remodelage osseux tout en localisant de facon precise ces deux phenomenes. Notre objectif principal etait d’evaluer la capacite du SPECT-CT a mesurer le flux sanguin et l’importance du remaniement osseux sous les cupules femorales en fonction du suivi. Patients et methode Nous avons realise une etude prospective mono-operateur. Quarante-cinq resurfacage ont ete etudies sur 41 patients. Vingt et un presentaient une fixation cimentee contre 24 sans ciment. Tous les patients ont beneficies d’un SPECT-CT en postoperatoire (j3) et a 1 an. Nous avons analyse la vascularisation et compare le remodelage osseux sous les cupules femorales en utilisant une quantification objective de la fixation par SPECT-CT afin d’evaluer l’osteo-integration des implants et la viabilite de la tete femorale. Cette quantification est originale et permet de visualiser l’entierete de la tete. Resultats Le SPECT-CT a permis de confirmer la vascularisation de toutes les tetes femorales a 1 an postoperatoire et l’absence de signe de descellement. Ceci restait vrai quel que soit le type de fixation utilisee. La comparaison des implants sans et avec ciment, n’a pas permis de mettre en evidence de difference statistiquement significative sur leur taux de fixation (p = 0,079). La fixation des implants a la tete femorale a ete consideree comme excellente dans 96 % des cas. Conclusion Le SPECT-CT permet de visualiser la vascularisation de la tete femorale avec precision. Cet examen a egalement offert la possibilite de realiser une etude fine et reproductible du remodelage osseux. Son interet depasse celui du resurfacage et ouvre des perspectives seduisantes pour d’autres arthroplasties. Il semble ainsi possible de deceler precocement des problemes de fixations ou de descellement precoces des protheses de genou, difficilement visualisables avec d’autres examens. Le SPECT-CT a ainsi permit de confirmer une fixation des cupules non cimentees au moins equivalente a celle des cupules cimentees qui constituent actuellement le gold standard des resurfacages.

In this focus, we review, in the light of the recent literature, the modalities and indications of surgical cerebral revascularization for Moyamoya (MM) disease or syndrome. We also report our experience in the surgical management of adult MM. In symptomatic forms, with presence of severe disturbances of perfusion or cerebrovascular reactivity on multimodal imaging work-up, the risks of recurrent ischemic or hemorrhagic stroke is high (respectively 10–13%/yr and 2–7%/yr). The objective of treatment is to augment cerebral perfusion (in ischemic forms) or to reduce lenticulo-striate neovessel overload (in hemorrhagic forms), by initiating the development of a cortical neovascularization and/or by directly increasing cerebral blood flow. The risk of immediate postoperative death or stroke is similar between indirect and direct or combined techniques and respectively 0–0.5% and 3–6%, provided a strict perioperative anesthetic management is applied (normocapnia, normoxia and controlled hypertension). Indirect techniques (i.e. encephalo-duro-arterio-myo-periosteo-synangiosis or multiple burr-holes) are technically easy, allow wide cortical revascularization and are very efficient in children: absence of clinical recurrence in more than 95% of cases and presence of a good neovascularization in 83%. However, their effect is delayed for several months, the impact on the hemorrhagic risk is moderate and the global response is uncertain in adults. Direct (superficial temporal artery to middle cerebral artery bypass) or combined techniques improve cerebral blood flow immediately and significantly. They are associated with a higher rate of stroke-free survival at 5 years (95% vs 85%). A recent randomized study has proven that they could reduce the hemorrhagic risk by 2- to 3-fold in comparison with conservative treatment alone. However, their feasibility in children is limited by the very small size of vessels. We present also our results in the surgical management of 12 adult MM patients (mean age 41.3, sex ratio = 1) operated between 2009 and 2014 (14 revascularization procedures: EDAMS 2, multiple burr-holes 1, combined revascularization procedures 11). MM types according to clinical presentation were the following: ischemic 8, hemorrhagic 2, combined 2. All patients were recently symptomatic, with recurrent ischemic/hemorrhagic events (2/3) or crescendo neurological deficit (1/3) in association with severe alterations of cerebral blood flow. Mean clinical and radiological follow-up was 22 months. Postoperative mRS at 6 months was improved or stable in 92%. None of the patients suffered recurring stroke. In conclusion, surgical treatment should be discussed quickly in symptomatic forms of MM (progressive or recurring) because of their poor outcome. Indirect techniques are favored in pediatric patients due to their simplicity and good clinical results. Direct, or preferentially combined techniques would be more effective in adult patients to prevent the recurrence of ischemic or hemorrhagic stroke.

Item does not contain fulltext BACKGROUND: Despite optimum medical management, many patients with Parkinson's disease are incapacitated by gait disorders including freezing of gait. We aimed to assess whether methylphenidate--through its combined action on dopamine and noradrenaline reuptake--would improve gait disorders and freezing of gate in patients with advanced Parkinson's disease without dementia who also received subthalamic nucleus stimulation. METHODS: This multicentre, parallel, double-blind, placebo-controlled, randomised trial was done in 13 movement disorders departments in France between October, 2009, and December, 2011. Eligible patients were younger than 80 years and had Parkinson's disease, severe gait disorders, and freezing of gate despite optimised treatment of motor fluctuations with dopaminergic drugs and subthalamic stimulation. We randomly assigned patients (1:1 with a computer random-number generator in blocks of four) to receive methylphenidate (1 mg/kg per day) or placebo capsules for 90 days. Patients, their carers, study staff, investigators, and data analysts were masked to treatment allocation. To control for confounding effects of levodopa we assessed patients under standardised conditions with an acute levodopa challenge. Our primary outcome was a change in the number of steps during the stand-walk-sit (SWS) test without levodopa. We compared the respective mean numbers of steps at day 90 in the methylphenidate and placebo groups in a covariance analysis and adjusted for baseline differences. This trial is registered with ClinicalTrials.gov, number NCT00914095. FINDINGS: We screened 81 patients and randomly assigned 35 to receive methylphenidate and 34 to receive placebo. 33 patients in the methylphenidate group and 32 patients in the placebo group completed the study. Efficacy outcomes were assessed in the patients who completed the study. Compared with patients in the placebo group (median 33 steps [IQR 26-45]), the patients in the methylphenidate group made fewer steps at 90 days (31 [26-42], F((1, 62))=6.1, p=0.017, adjusted size effect 0.61). Adverse events were analysed in all randomly assigned patients. There were significantly more adverse events in the methylphenidate group compared with placebo. Patients on methylphenidate had a significant increase in heart rate (mean 3.6 [SD 7.2] beats per min) and decrease in weight (mean 2.2 [SD 1.8] kg) compared with the placebo group. INTERPRETATION: Methylphenidate improved gait hypokinesia and freezing in patients with advanced Parkinson's disease receiving subthalamic nucleus stimulation. Methylphenidate represents a therapeutic option in the treatment of gait disorders at the advanced stage of Parkinson's disease. The long term risk-benefit balance should be further studied. FUNDING: French Ministry of Health and Novartis Pharma. 01 juli 2012

Periostitis of long bones is a possible yet rare manifestation of vasculitides such as polyarteritis nodosa (PAN).1 We report on a periostitis revealing a PAN, an exceptional situation.2 A man in his 40s, with no medical record, presented with a 3-month history of bilateral leg pain, diffuse myalgias, weight loss and fatigue. Physical examination showed permanent pain in both thighs, with no signs of arthritis or muscle weakness. Erythrocyte sedimentation rate and C reactive protein (CRP) levels were elevated (96 mm and 304 mg/L, respectively). Immunological tests …