[Positron emission tomography using 18F-fluorodeoxyglucose in the management of nonsmall cell lung cancers in 2006]. / La tomographie par émission de positons au 18fluorodésoxyglucose (18FDG-TEP) dans la prise en charge du cancer bronchique non à petites cellules en 2006.

Technological progress and numerous published studies allow to estimate the best place of the 18F-fluorodeoxyglucose positron emission tomography, a real functional metabolic imagery, in the clinical and therapeutic strategy of non small cell lung cancers.

[Positron emission tomography in the diagnosis and follow up of non-small cell lung cancer]. / 18F-FDG-TEP : sa place dans le diagnostic et la surveillance du cancer bronchique non à petites cellules.

In the space of a few years 18F-FDG PET scanning has acquired a place in the management of all stages of the clinical care of patients with lung cancer. Its contributions are being more and more precisely understood during the assessment of mediastinal and metastatic extension and it carries the hope of better therapeutic management and surveillance.

[Positron emission tomography in head and neck squamous cell carcinomas]. / La tomographie par émission de positons dans les carcinomes épidermoïdes de la tête et du cou.

18F-Fluorodeoxyglucose positron emission tomography (PET) is an imaging modality which is becoming increasingly esential in oncology, especially in the management of head and neck squamous cell carcinomas (SCC). The most common uses of the PET are listed in this thematic study: initial staging, cervical lymph node metastases from an unknown primary tumor and post-therapeutic follow-up. The advantages and drawbacks of this imaging tool are exposed here according to both our experience and data from the literature. Decision schemes are suggested for each use so as to optimize the use of this imaging modality in the management of these SCC. Other fields of application for the PET are mentioned, such as the in-progress evaluation of response to chemotherapy, the interest of this imaging tool in radiotherapy as well as current biochemical developments concerning new tracers.

High-grade lymphoma of the bladder visualized on PET.

F-18 FDG PET is used for the staging of many cancers. One of its limits is the analysis of the pelvis and the urinary tract because of physiological radiotracer excretion. We report a rare case of an 82-year-old woman in whom intravenous administration of diuretics (furosemide) allowed the identification of a primary diffuse large B-cell lymphoma of the bladder wall. This pharmaceutical increases urine flow and, therefore, reduces the concentration of radiotracer in the urinary tract, improving the visualization of pelvic or urinary tumors. Furosemide administration is an easy, safe, and noninvasive method, even in case of renal insufficiency. Newer PET cameras with high-performance crystals allow rapid acquisitions and improve the tolerance of an examination with diuretic injection. The 3-dimensional reconstruction of images in new PET cameras reduces the occurrence of hyperactive bladder artifacts. The present case illustrates the advantages of furosemide in a rare pathologic entity.

[Risk from prenatal exposure to ionizing radiation]. / Risques liés à l'exposition d'une grossesse aux rayonnements ionisants.

Exposure to ionizing radiation during pregnancy always is a worrisome event. Knowledge of teratogenic and carcinogenic mechanisms based on reliable scientific data (ICRP 84) allows appropriate management of patients following exposure to ionizing radiation. Radiation exposure in the setting of diagnostic imaging studies is not associated with an increased risk of fetal malformation; however, the risk of childhood malignancy is minimally increased. This information must be provided to parents so they may reach an informed decision with regards to the outcome of the pregnancy. The analysis of the quality and quantity of exposure should be limited to imaging examinations where the abdomen was exposed. Management will be based on the type of exposure. Guidelines are provided for various exposure situations and all radiologists must be able to manage such situations.

[The therapeutic impact of PET-FDG scanning in broncho-pulmonary cancer]. / Impact thérapeutique de l'imagerie TEP-FDG en carcinologie bronchopulmonaire.

BACKGROUND: Because of the expected high performances of scintigraphic scans with [18F]-fluorodeoxyglucose (FDG) not only in diagnostics and but also in therapeutic impact, especially in thoracic oncology, there are a lot of French nuclear medicine departments which will soon be equipped with a positron emission tomograph (PET). MATERIAL AND METHODS: The Nuclear Medicine Department of the Hôpital d'Instructions des Armées du Val-de-Grâce, Paris, led a retrospective study among physicians interested in 338 FDG-PET exams performed between may 2000 and march 2002 in order to compare its own results with international literature concerning four indications for lung cancer: pulmonary nodule or mass malignancy diagnostic, lung carcinoma extension evaluation, therapeutic efficiency, recurrence suspicion. RESULTS: There seems to be no divergence, regarding limitation induced by the not exhaustive analysis of the retrospective study: more than every two FDG-PET exam highly influenced the effective therapy. CONCLUSION: That is why clinical FDG-PET has to be widely developed to investigate lung cancer.

[PET scanning in the initial assessment of lung cancer]. / La tomographie par émission de positons au 18Fluoro-deoxy-glucose (18FDG-TEP) et le bilan initial du cancer bronchique.

18FDG-PET scanning enables the imaging of metabolic activity giving an assessment of the local extent of thoracic malignancies as well as an indication of the presence of nodal or metastatic spread. This enables more accurate staging and has revolutionised the management of lung cancer. National and international guidelines describe the role of this technique.

[18-FDG positon emission tomography and distal metastasis from lung cancer]. / Tomographie à émission de positons au [18F]-FDG et métastases distales dans les cancers broncho-pulmonaires.

"Whole body" FDG-PET usually covers the body from the base of the skull to the upper third of the thighs, arms in abduction. Thus, the upper part of the head and the lower limbs are not included in the acquisition field. We report the cases of three patients with non-small-cell lung cancer who developed secondary distal localizations beyond the acquisition field of "whole body" FDG-PET. Lung cancer is known to favor hematogenic dissemination, raising the possibility of early distal metastasis. A pretherapeutic PET scan which includes the extremities can be useful to search for distal extension. These true whole body scans are time consuming and can thus limit machine availability. Furthermore, the diagnostic yield of this type of examination may be low since it can be estimated that about 1% of patients will develop isolated distal metastases (3 out of 293 patients in our series initially treated for non-metastatic non-small-cell lung cancer). In the current context of technical availability, systematic inclusion of the lower limbs in the PET scan acquisition field would not appear warranted for the initial work-up of patients with non-small-cell lung cancer. However, clinicians must be aware that distal metastases (brain, lower limbs) may not be detected.

Multimodal anatomic, functional, and metabolic brain imaging for tumor resection.

OBJECTIVE: Improvement of neurosurgical techniques with a more detailed description of brain tumors and their functional environment. METHODS: We performed: (1) anatomical magnetic resonance imaging (MRI) for reference, (2) functional sequences dedicated to the adjacent cortical structures (sensorimotor, visual, language paradigms), and (3) thallium 201 cerebral tomoscintigraphy to visualize active tumor invasion. Data were transferred to a workstation for automatic registration. RESULTS: All data were combined into one synthetic image showing the foci of high proliferative activity, which have to be completely resected, and the peritumoral functional structures, which have to be spared in order to minimize postoperative sequelae. This trimodal image is entered into a surgical neuronavigation computer for preoperative planning in order to outline tumoral target and functional risk areas. All this information is displayed in the operative microscope (Zeiss MKM) optically linked to MR images. This multimodality technique diminishes operative time by reducing electrocorticography and improves the operative short-term outcome. CONCLUSION: Multimodal imaging is useful for optimization of neurosurgical tumor resection.

[Positron emission tomography in thoracic radiography]. / Apport de la tomographie par émission de positons à la radiothérapie thoracique.

The optimisation of the field of irradiation is the aim of the radiotherapist. Pet-Scan provides information revealing a better cartography of node involvement and allowing a better delineation of the tumour zone. In the follow-up of irradiated patients, PET-Scan provides information on the nature of residual lesions and a possible recurrence.

[Interest in 18-FDG positron emission tomography in radiotherapy planning: example of lung cancer radiotherapy]. / Intérêt de la tomographie à émission de positons au 18fluoro-déoxy-glucose dans la définition des champs de radiothérapie: exemple de la radiothérapie thoracique.

18 FDG positon emission tomography provides metabolic images and allows better local and metastatic staging than radiologic methods. A best cartography of node involvement and a best delineation of the tumor zone should allow an optimal radiotherapy. Lung cancer is a good example of the interest of this new method.

[Value of scintigraphy using meta-iodo-benzyl-guanidine (MIBG) in the investigation of cardiac autonomic neuropathy in diabetic patients. Comparison with Ewing tests]. / Apport de la scintigraphie à la méta-iodo-benzyl-guanidine (MIBG) dans l'exploration de la neuropathie végétative cardiaque du diabétique. Comparaison avec les tests d'ewing.

UNLABELLED: Cardiac autonomic neuropathy is a frequent complication of diabetes leading to resting tachycardia, postural hypotension, painless myocardial ischaemia, rhythm disturbances and sudden cardiac death. The aim of the study was to evaluate in a diabetic population the sensitivity of two exploration modes of autonomic neuropathy in diabetics: the Ewing tests which are, at present time, the reference method and the (123-I) meta-iodo-benzyl-guanidine (MIBG) single photon emission computed tomography (SPECT) which evaluates the cardiac sympathetic innervation. PATIENTS AND METHODS: 9 male insulin-dependent diabetes mellitus patients were studied. Mean age was 40.7 +/- 15 years and diabetes duration was 10.8 +/- 6 years. None had hypertension or macroangiography as demonstrated by patient's history, clinical examination, rest and exercise electrocardiography and ambulatory blood pressure monitoring. The complications observed were background retinopathy in 2 patients, incipient nephropathy in 3 and a peripheral neuropathy in 1 patient. Ewing tests, i.e. Valsalva maneuver, beat to beat heart rate variation during deep breathing and standing, blood pressure response to standing and to sustained handgrip, were performed. The results were considered as pathologic when the score was over 2. After injection of 10 mCi (123-I) MIBG, planar images were realized at times 1, 2 and 4 hours and SPECT images after 2 hours. The heart/mediastinum uptake ratio was calculated. RESULTS: We noted abnormalities of planar images in 3 patients, SPECT images in 1, and both in 1 patient. None was positive for Ewing tests. CONCLUSION: Although MIBG SPECT will explore only the sympathetic innervation, these preliminary findings suggest that this technique could be more sensitive for the evaluation of cardiac autonomic neuropathy. Nevertheless cost and lack of disponibility of this technique should limit its use.

[Technique and indications in pediatric oncology. Positron emission tomography with 18F-fluorodeoxyglucose]. / Nouvelle technique d'imagerie scintigraphique. Tomographie par émission de positions au 18F-fluorodéoxyglucose: technique et indications en oncologie pédiatrique.

Positron emission tomography is the last non invasive imaging technique introduced in clinical practice. Its remarkable efficiency for cancer diagnosis and for the optimization of the therapeutical management of adult patients in oncology is now well known. Pathophysiology of tumors being comparable, the same results are expected for children. Highly interesting reports have already established such good performances about lymphoma or bone sarcomas. Complementary data are necessary to define the optimal place of PET in the care of children cancer because PET can be regarded as only at the eve of its development with the upraising of new technical possibilities and new radiopharmaceuticals providing various and complementary informations about tumors.

[Positron emission tomography in clinical oncology]. / Tomographie par émission de positons en oncologie clinique.

A NEW FORM OF MEDICAL IMAGING: Positron emission tomography (PET) is used for the non-invasive in vivo visualisation of biochemical cell processes. It reveals the metabolic characteristics of neoplastic lesions and hence their identification by compensating the lack of lesion specificity of radiological techniques. VARIOUS INDICATIONS: Using the current oncology marker, 18F-fluorodeoxyglucose (FDG), excellent results with PET have been established at all stages of neoplasia, notably for the diagnosis of initial malignancy and the identification of residual lesions and early detection of relapses. Moreover, the fact that the whole of the body can be explored makes PET the tool of choice in the control of the extension and operability of cancers. With the close correlation between imaging and the metabolism of the lesions, PET is the earliest and most precise for assessing the effects of treatment. LIMITS AND PERSPECTIVES: The existence of benign inflammatory FDG binding should lead to the development of markers of other metabolisms directly linked to cell proliferation. The lack of anatomical reference points characteristic of PET does not permit the precise localisation of the lesions detected and could be corrected by combining, in a single apparatus, the PET camera and an X scan, the anatomical resolution of which is irreplaceable. This type of equipment represents the development of a new branch of medical imaging, oncological imaging.

[Positron emission tomography in head and neck oncology]. / Tomographie par émission de positons en oncologie de la tête et du cou.

Defining a therapeutic strategy in oncology requires a substantial amount of imaging data provided by modern techniques. While the description of the lesions and their environment has become very precise, there remains a certain degree of uncertainty concerning tissue typing. Positron emission tomography is a scintigraphy technique which can produce quantitative images of metabolic characteristics. 18F-fluorodeoxyglucose is a tracer allowing an analysis of glucose metabolism known to be highly increased in malignant tissues. Increased uptake is an indication of malignancy with an established correlation with proliferative capacity. The only limitation of the method is the generally weak uptake observed in benign hypermetabolic inflammatory or infectious areas. All stages of the disease are concerned for head and neck cancer patients. Clinical experience to date indicates that PET can be applied most usefully to search or residual disease with a possible differentiation between post-therapeutic fibrosis and viable tumor tissue as well as the identification of early relapse. Study of early response to chemotherapy is also an interesting application. Search for extension can also be improved with this technique allowing both regional and whole body explorations. Positron emission tomography is not widely available in France at the present time so all patients cannot be examined with this technique. Positron emission tomography is an evolving technique with improvements being proposed both in the technique and in tracer elements. Further information will be available with new developments in this non-invasive exploration tool.

[Positron emission tomography in head and neck oncology: five cases]. / La tomographie à émission de positons en oncologie ORL. Une revue à propos de 5 cas.

FDG-PET (18-fluoro-desoxyglucose positron emission tomography) is a fonctionnal imaging method based on the high rate of glycolysis in different types of cancer-cells. We report the first five cases where FDG-PET was used in France for head and neck cancers. The results were analyzed on the basis of data reported to date in the literature, leading to a proposal for rational use of this diagnostic available in only a few centers in France. For primary assessment of cervicofacial carcinomas, different imaging techniques such as CT and MRI have improved tumor staging. Although 18-FDG-PET cannot replace these techniques used to monitor size and structural changes in tumors and lymph nodes, it will be helpful in following their metabolic activity. This diagnostic tool consequently is greatly helpful for detection and post-therapeutic evaluation of head and neck carcinomas and their recurrence. 18-FDG-PET is currently under evaluation as a tool for detecting cervical lymph nodes and early assessment of response to chemotherapy.

[Value of positron-emission tomography in the post-treatment follow-up of epidermoid carcinoma of the head and neck]. / Intérêt de la tomographie par émission de positons dans le suivi post-thérapeutique des carcinomes épidermoïdes de la tête et du cou.

UNLABELLED: This study aimed at pointing out the supply of the positron emission tomography (PET) in the posttherapeutic follow-up of the head and neck squamous cell carcinomas and to determine the best period to perform this test. PATIENTS AND METHODS: Twenty patients have been included in this series, 16 men and 4 women. The PET was performed between 3 and 6 months after the end of all therapy. It systematically included radiation therapy. The results of the PET have been compared with those obtained by histology. The average distance of the follow-up of the patients after the achievement of the test was 11 months. RESULTS: They divided up according to the presence or not of an abnormal fixation on the PET imaging. Negative PETs: eight cases. Among those, a patient showed a metastatic cervical adenopathy at five months. Positive PETs: twelve cases which can be divided into three groups according to the area of the fixation. Primary site: 8 cases, 4 of which false-positive. Cervical lymph nodes: one case. Other sites: three cases. In our series PET had a sensitivity of 87% and a specificity of 67%. CONCLUSION: The PET is an original imaging as it allows a corporal metabolic study at one go. It seems to be very useful in the follow-up of patients who show a head and neck squamous cell carcinoma. The best period to perform it is the third or fourth posttherapeutic month. The high sensitivity is interesting within the context of an early detection of a residual tumour, for it allows to think of a suitable therapy quicker.

[18Fluoro-deoxy-glucose positron emission tomography (18FGT-PET) and lung cancer]. / Tomographie par émission de positons au 18Fluoro-déoxy-glucose (18FDG-TEP) et cancer bronchique.

In pulmonary oncology, positron emission tomography provides metabolic imaging with a sensitivity and specificity of around 90%. Such results are of particular interest in the diagnosis of the benigness or malignancy of a pulmonary nodule, for the staging and the follow-up of lung cancers. Studies are ongoing to assess its interest in the appreciation of the prognosis and response to chemo- and radiotherapy.

[Fluorodeoxyglucose and bronchopulmonary cancer. Initial French results with positron emission tomography]. / Fluoro-déoxy-glucose et cancer bronchopulmonaire. Les premiers résultats français en caméra à positons.

Despite recent advances, the contribution of medical imaging techniques is limited, particularly in terms of tissue characterization, in the diagnosis of pulmonary nodules and search for extension of bronchogenic cancer. The metabolic properties of the glucose analog deoxyglucose labeled with 18F1 would allow metabolic imaging. Positron emission tomography (PET) provides clinicians with quality images with an interesting sensitivity. We report the results of a feasibility study conducted in our first 17 patients. We observed 14 true positives, 1 true negative and 1 false positive and 1 false negative in patients with a malignant primary lesion. We analyzed the causes of error. Ten disseminated localizations were identified. Possible developments in terms of therapeutic strategy are discussed. The agreement between our findings and data reported in the literature prompted us to develop a study protocol using 18-fluorodeoxyglucose PET in patients with bronchogenic cancer.

[Fluorodeoxyglucose (FDO) positron emission tomography (PET) in testicular germ cell tumors in adults: preliminary French clinical evaluation, development of the technique and its clinical applications]. / Tomographie à émission de positons (T.E.P.) au fluorodéoxyglucose (F.D.G.) dans les tumeurs germinales testiculaires de l'adulte: première évaluation clinique française, mise au point sur la technique et ses applications cliniques.

OBJECTIVES: Metabolic positron emission tomography (PET) is a new imaging modality for the detection of tumours, which uses fluorodeoxyglucose (FDG) to demonstrate increased carbohydrate metabolism of malignant cells. The management of testicular germ cell tumours in adults raises three clinical problems poorly resolved by conventional imaging techniques: identification of suspected recurrences in a context of elevated circulating serum markers, initial staging assessment after orchidectomy, evaluation of the response to treatment. MATERIAL AND METHODS: The authors report the data obtained in 16 patients (6 cases of seminoma and 10 cases of non seminomatous germ cell tumour [NSGCT]), investigated in the Frédéric-Joliot Department using a dedicated PET camera, 60 minutes after intravenous injection of 270 MBq of FDG. RESULTS: In 9 cases of assessment of elevated serum markers with no tumour identified by conventional examinations, PET demonstrated images likely to correspond to tumour sites in 7 patients (5 true-positives [TP] and 2 false-positives [FP] due to postoperative inflammatory changes). PET was negative in 2 out of 9 patients, in whom subsequent follow-up showed spontaneous but delayed return to normal of tumour markers. In 3 of the 4 cases of initial staging of the disease, PET excluded an extension suspected by conventional imaging and the 4th case was a FP for PET. In 3 cases of evaluation of the response to treatment, PET concluded on the absence of viable residual tumour mass, with a false-negative result in one case. CONCLUSIONS: These results are in line with those reported in the literature, which emphasize the diagnostic difficulties encountered in this disease. The significant contribution of FDG-PET should be confirmed by larger series of patients investigated by this new modality.