I123-FP-CIT single-photon emission tomography in patients with long-standing mixed tremor.

BACKGROUND AND PURPOSE: Essential tremor is an abnormal movement characterized by postural and/or kinetic tremor. In some essential tremor patients, rest tremor (RT) is observed but it is not clear if this RT is a feature of essential tremor or a symptom of Parkinson's disease (PD). I123-FP-CIT single-photon emission tomography is used to distinguish essential tremor and PD. OBJECTIVES: To analyse I123-FP-CIT single-photon emission tomography in a larger series of patients with mixed tremor (i.e. action tremor associated with RT) without PD criteria. METHODS: We studied 33 consecutives patients (18 men and 15 women) with mixed tremor, clinically and by neuroimaging in all cases. RESULTS: I123-FP-CIT single-photon emission tomography was abnormal in 25 of our patients (75.7%) with mixed tremor, and we noted a reduced uptake mostly in the putamen. In our patients with abnormal imaging, RT was unilateral in 52%. In 15 of these 25 patients, putaminal reduced uptake was bilateral and symmetrical. In the other 10 patients, putaminal reduced uptake was asymmetrical or unilateral. In these 10 cases, six had a unilateral RT corresponding to (crossed) predominant reduced uptake in three cases. In our patients with normal imaging, RT was unilateral in 87.5%. CONCLUSIONS: This study shows that mixed tremor is a heterogeneous entity. The majority of patients with mixed tremor showed nigrostriatal dysfunction on I123-FP-CIT single-photon emission tomography, suggesting that mixed tremor may be a parkinsonian syndrome rather than a clinical variant of essential tremor.

Immunomodulatory effects of targeted radionuclide therapy.

It is now clear that conventional radiation therapy can reinstate cell death immunogenicity. Recent preclinical data indicate that targeted radionuclide therapy that irradiate tumors at continuous low dose rate also can elicit immunostimulatory effects and represents a promising strategy to circumvent immune checkpoint inhibitor resistance. In this perspective, we discuss the accumulating preclinical and clinical data suggesting that activation of the immune system through the cGAS-STING axis and the release of extracellular vesicles by irradiated cells, participate to this antitumor immunity. This should need to be considered for adapting clinical practices to state of the art of the radiobiology and to increase targeted radionuclide therapy effectiveness.

Place of (18)F-FDG-PET with computed tomography in the diagnostic algorithm of patients with fever of unknown origin.

There is evidence for the interest of (18)F-fluoro-deoxyglucose positron emission tomography with computed tomography ((18)F-FDG-PET/CT) in fever of unknown origin (FUO) clinical investigation. However, little and conflicting data exist about its place in the investigation procedure. The aim of this work was to evaluate the clinical value of (18)F-FDG-PET/CT in patients with FUO and identify patients who need early (18)F-FDG-PET/CT rather than a last-resort procedure. We performed a 2-year retrospective cohort study at the Nîmes University Hospital, France. A total of 79 patients (36 men, 43 women, mean age 54.0 ± 16.2 years) with FUO underwent (18)F-FDG-PET/CT. A final diagnosis was established in 61 (77.2 %) cases. Aetiologies of FUO were determined using (18)F-FDG-PET/CT findings in 45 (73.8 % of patients with diagnosis) cases. The sensibility and specificity value were 98 % and 87 %, respectively. The presence of adenopathy, low haemoglobin and increased C-reactive protein (CRP) were predictors of high-yield (18)F-FDG-PET/CT. (18)F-FDG-PET/CT may help to detect most causes of FUO. The predictors of high-yield (18)F-FDG-PET/CT found in this study can help identify patients likely to benefit from specific and early imaging techniques.

Clinical implementation of PLANET® Dose for dosimetric assessment after [177Lu]Lu-DOTA-TATE: comparison with Dosimetry Toolkit® and OLINDA/EXM® V1.0.

BACKGROUND: The aim of this study was to compare a commercial dosimetry workstation (PLANET® Dose) and the dosimetry approach (GE Dosimetry Toolkit® and OLINDA/EXM® V1.0) currently used in our department for quantification of the absorbed dose (AD) to organs at risk after peptide receptor radionuclide therapy with [177Lu]Lu-DOTA-TATE. METHODS: An evaluation on phantom was performed to determine the SPECT calibration factor variations over time and to compare the Time Integrated Activity Coefficients (TIACs) obtained with the two approaches. Then, dosimetry was carried out with the two tools in 21 patients with neuroendocrine tumours after the first and second injection of 7.2 ± 0.2 GBq of [177Lu]Lu-DOTA-TATE (40 dosimetry analyses with each software). SPECT/CT images were acquired at 4 h, 24 h, 72 h and 192 h post-injection and were reconstructed using the Xeleris software (General Electric). The liver, spleen and kidneys masses and TIACs were determined using Dosimetry Toolkit® (DTK) and PLANET® Dose. The ADs were calculated using OLINDA/EXM® V1.0 and the Local Deposition Method (LDM) or Dose voxel-Kernel convolution (DK) on PLANET® Dose. RESULTS: With the phantom, the 3D calibration factors showed a slight variation (0.8% and 3.3%) over time, and TIACs of 225.19 h and 217.52 h were obtained with DTK and PLANET® Dose, respectively. In patients, the root mean square deviation value was 8.9% for the organ masses, 8.1% for the TIACs, and 9.1% and 7.8% for the ADs calculated with LDM and DK, respectively. The Lin's concordance correlation coefficient was 0.99 and the Bland-Altman plot analysis estimated that the AD value difference between methods ranged from - 0.75 to 0.49 Gy, from - 0.20 to 0.64 Gy, and from - 0.43 to 1.03 Gy for 95% of the 40 liver, kidneys and spleen dosimetry analyses. The dosimetry method had a minor influence on AD differences compared with the image registration and organ segmentation steps. CONCLUSIONS: The ADs to organs at risk obtained with the new workstation PLANET® Dose are concordant with those calculated with the currently used software and in agreement with the literature. These results validate the use of PLANET® Dose in clinical routine for patient dosimetry after targeted radiotherapy with [177Lu]Lu-DOTA-TATE.

Different morphometric and densitometric parameters predict cervical and trochanteric hip fracture: the EPIDOS Study.

We used an experimental software measuring the hip axis length (HAL) and bone mineral density (BMD) in specific regions of the lower and upper part of the femoral neck on dual-energy X-ray absorptiometry scans. To determine whether these parameters were significant predictors of the type of hip fracture, we measured 167 healthy women (controls), 24 women with trochanteric, and 42 women with cervical hip fractures within the EPIDOS prospective cohort. EPIDOS is a multicenter prospective study on risk factors for hip fracture performed in 7575 elderly women living at home, aged 75-95 and conducted in five French centers (Amiens, Lyon, Montpellier, Paris, Toulouse). Measurements were performed on data acquired at baseline before the occurrence of fracture. In the cervical fracture group, HAL was significantly longer than in controls (94.2 vs. 92.3, p = 0.03), and the associated odds ratio (OR) adjusted for age, weight, and total femoral neck BMD was significant (OR = 1.64, 95% confidence interval [CI] 1.06-2.55). In contrast, HAL was not significantly different from controls in the trochanteric fracture group. Femoral neck diameter was not a predictor of fracture. The upper and lower femoral neck BMD was lower in the trochanteric fracture group than in controls, and both measurements predicted trochanteric femoral neck fracture. In contrast, the prediction of cervical femoral neck fracture was enhanced by measuring only the upper part of the femoral neck (OR = 2.79 vs. 1.97 for the total femoral neck) while BMD of the lower part was not different from controls. Hip axis length is a predictor of femoral neck fracture. Femoral neck BMD distribution is different between cervical and trochanteric fractures. These results support the hypothesis of a different pathophysiological mechanism between the two types of hip fractures.

Do ultrasound measurements on the os calcis reflect more the bone microarchitecture than the bone mass?: a two-dimensional histomorphometric study.

Few studies have analyzed the relationship between ultrasound measurements (US) and corresponding histomorphometric parameters of the calcaneus. To address this question we have compared US and histomorphometric parameters in 17 whole human os calcis from amputation or necropsy. Speed of sound (SOS), broadband ultrasound attenuation (BUA), and bone mineral density (BMD) were measured on the whole foot at the calcaneal site using an Achilles device and a DPX-L densitometer (Lunar). The os calcis was dissected and a 1-cm-wide transcortical parallelepiped extracted with a biopsy needle, focused on the center of the measured area. Histomorphometry was performed on undecalcified biopsies. Structural and connectivity parameters were measured on 7-microns-thick sections with both automatic (Biocom) and semiautomatic analyzers (Ibas 1, Kontron). We found that all ultrasonic and densitometric parameters reflected the true amount of bone and were correlated with only some of the parameters reflecting bone microarchitecture. From stepwise regression analysis, we found that 68%, 67%, 72%, and 74% of the variance of SOS, BUA stiffness, and BMD, respectively, were explained significantly by trabeculae thickness only. Ultrasonic measurements appear to reflect bone quantity rather than bone microarchitecture. The current conclusion is fairly negative with respect to the ability of ultrasound to assess structural parameters, but our limited sample size did not give enough power to our study to reach statistically significant correlations. In addition, the calcaneus is anisotropic and the ultrasound interaction in bone is a three-dimensional phenomenon. So, a three-dimensional study rather than a two-dimensional one should be performed.

Prototype of dual energy x-ray tomodensimeter for lumbar spine bone mineral density measurement: choice of the reconstruction algorithm and first experimental results.

A dual-energy x-ray tomodensimeter adapted for the determination of bone mineral density (BMD) of the lumbar vertebrae has been directly developed from a typical dual-energy x-ray absorptiometer. This apparatus consists of two fundamental parts: a dual energy x-ray tube, and a multidetector made by an array of 24 NaI(T1) crystals. It provides both tomographic and non-tomographic (anteroposterior, lateral etc) measurement. The detection area is limited to 132 mm. In this condition, the choice of the best reconstruction algorithm in order to give a direct BDM is considered. Preliminary studies based on numerical simulated projections and hydroxyapatite phantoms demonstrated the superiority of algebraic reconstruction algorithms, such as conjugated gradient, in order to resolve the problems of (i) the impossibility of defining an internal calibration, and (ii) the potential for reconstruction errors due to the presence of bone structures located out of the detection area. The accuracy of BMD measurement is within 2%, with in vitro precision approximately 1%, and linearity characterized by a standard error of estimation (SEE) of 2 mg cm-3 in the range of lumbar BMD (less than 400 mg cm-3). Experimental data derived from two volunteers are presented.

Theoretical and experimental limits of triple photon energy absorptiometry in the measurement of bone mineral.

Theoretical and experimental studies have been conducted to explore the possibilities of triple photon energy absorptiometry in the measurement of bone mineral content. The purpose of this technique is to correct the measured bone mineral density for fat and soft tissues. However, theoretical considerations lead us to doubt the precision and accuracy of such measurements. In a first approximation the absorption coefficient can be split into Compton and photoelectric energy-independent factors. A consequence of such a model is the impossibility of finding more than two independent mass attenuation coefficients for different energies. The existence of an energy-dependent third factor may justify the use of triple photon energy absorptiometry but experimental tests and numerical simulations have shown that its value is too low for triple photon energy absorptiometry to be considered as an adequate method for the measurement of bone mineral content.

Measurement of the bone mineral density of the os calcis as an indication of vertebral fracture in women with lumbar osteoarthritis.

In women with lumbar osteoarthritis, measurement of the os calcis bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA) as an indication of vertebral fracture was evaluated. The in vivo precision of the method was 1.28%. Age- and sex-matched control curves were evaluated using a control of 193 females. The correlation between spine BMD and os calcis BMD was significant (r = 0.65, p << 0.001). For the osteoporotic women without osteoarthritis (n = 34), there was no significant difference in the spine and the os calcis Z-scores (-1.99SD and -1.83SD respectively). Whereas for osteoporotic women with osteoarthritis (n = 30) the spine Z-score was -0.49SD the os calcis Z-score was -1.92SD. The difference was significant (p < 0.001). Receiver operating characteristic (ROC) curves demonstrate the superiority of the os calcis as a measurement site over the lumbar spine, in correlation with existing crush fractures in the presence of osteoarthritis. It is concluded that when lumbar osteoarthritis occurs measurement of the os calcis BMD using DEXA is clinically useful for the estimation of bone mass.

[Evaluation of the size of thrombolysed myocardial infarction by serum myosin determination]. / Evaluation de la taille de l'infarctus du myocarde thrombolysé par le dosage de la myosine sérique.

The prognosis of myocardial infarction is very dependent on the size of the infarct. The measurement of the infarct size after thrombolysis remains difficult despite the large number of methods available, all of which have drawbacks. This parameter is however essential to assess prognosis and the efficacy of thrombolytic therapy. Serum beta heavy chain myosin determination is a recently introduced method of evaluating infarct size; there are relatively few published studies, especially concerning post-thrombolytic patients. A prospective study was undertaken in 40 patients (37 men and 3 women: average age 55.6 years) with a primary myocardial infarction treated by thrombolysis. Myosin levels (peak and area under curve of 5 samples in 10 days) were compared with other methods of assessing infarct size: electrocardiogram (number of leads with Q waves, ST segment analysis), cardiac enzymes (peak and release integrals of CK abd LDH), contrast ventriculography (segmental asynergy score, ejection fraction), coronary angiography and resting MIBI myocardial scintigraphy. The peak and integral of myosin release correlated well with the other methods (p < 0.01): a correlation was particularly apparent between the integral of myosin release and MIBI scintigraphy scores (r = 0.77, p < 0.001). Complex myosin release kinetics were observed significantly more often in patients with large infarcts (p < 0.01) or in those with occlusion of the artery responsible for infarction at coronary angiography on the 6th day (p = 0.001). In conclusion, with 5 blood samples over a 10 day period, it is possible to estimate the infarct size after thrombolysis in everyday cardiological practice: this method could help identify high risk subjects (complex kinetics of myosin release and high peak myosin levels) and also could be used to assess efficacy of thrombolytic therapy in large scale trials.

[Mid-term prognostic value of plasma heavy-chain myosin in thrombolysed myocardial infarction]. / Valeur pronostique à moyen terme du dosage des chaines lourdes de la myosine plasmatique dans l'infarctus du myocarde thrombolysé.

Plasma myosin heavy chain assay, which can be easily performed during the acute phase of myocardial infarction, is a recent method allowing quantitative assessment of the extent of infarction. However, to our knowledge, its prognostic value has not been studied in contrast with serum myosin light chain assay. We monitored the state of health of 40 patients (including 37 men with a mean age of 56 years) for two years after a first myocardial infarction, thrombolized during the acute phase. Their survival (mortality) and the development of "cardiac events" (MI, angina, sudden death, etc.) were evaluated at 2 years. The results observed at 2 years were correlated with the initial plasma myosin assay results and other direct and indirect methods of assessment of the extent of infarction, performed during the acute phase of myocardial infarction (cardiac enzymes, contrast angiography). The main result of this study is the demonstration that an unusual plasma myosin release kinetic (complex appearance) is predictive for the medium-term development of heart failure (p = 0.04) and/or destabilization of coronary insufficiency (p = 0.02). These results need to be emphasized, as with only 5 serum myosin assays performed over a 10-day period, it seems possible to identify a group of patients at high risk of medium-term complications, who possess a complex release kinetic during the acute phase of myocardial infarction and a value for area under the curve greater than 10.470 microliters U/L (cut-off value, p = 0.043).

[Contribution of 99m Tc-HMPAO single-photon emission-computed tomography to the perioperative evaluation of subarachnoid hemorrhage caused by ruptured aneurysms]. / Apport de la tomographie d'émission monophotonique par 99mTc-H.M.P.A.O. a l'évaluation hémodynamique périopératoire des hémorragies méningées par rupture d'anévrisme.

Twenty one cases of proven subarachnoid hemorrhage (S.A.H.) have been analysed in a protocol especially including transcranial doppler (T.C.D.) and 88mTc-H.M.P.A.O. single photon emission tomography (H.M.P.A.O.-S.P.E.C.T.). Seventeen patients were intraoperatively studied. All data were compared with clinical grading, computerized tomography (C.T.) and angiography. S.P.E.C.T. is a quite recent method of measuring and three-dimensional imaging of brain perfusion. It provides important information for the diagnosis of ischemic syndromes in S.A.H. Sixty-two S.P.E.C.T.-scans were performed in twenty one patients. Fifty-eight were abnormal and showed significant abnormalities of brain perfusion varying in extent and severity. In this preliminary study, we set out to validate the clinical use of H.M.P.A.O.-S.P.E.C.T. for the diagnosis of "vapospasm" comparing S.P.E.C.T. data with classical criteria. We propose a classification which allowed us to quantify the ischemic risk in an attempt to adapt the global therapeutic management to hemodynamic data. This method appears to be very sensitive and reliable in this field. It will introduce, if these first results are confirmed, important criteria for the evaluation of patients presenting with S.A.H. as far as prognosis and treatment are concerned, especially in regard to timing of surgery and institution of medical hemodynamic therapy.

Image resolution and magnification using a cone beam densitometer: optimizing data acquisition for hip morphometric analysis.

Bone mineral density (BMD) is a primary determinant of hip fracture risk. However, other factors, notably the femoral geometry, can influence hip fracture risk. The purpose of this study was to evaluate the potential of a new cone beam densitometer, the DMS Lexxos, in order to visualise femoral morphometry. Resolution, magnification and distortion were assessed in vitro using a line pair test pattern and a matrix test object. Results were given in comparison with currently available systems: the Hologic Discovery A and the Lunar Prodigy densitometers. The DMS Lexxos image resolution was the same in the longitudinal and transversal directions evaluated between 1.4 and 0.5 line pairs/mm (lps/mm) for an attenuation varying from 25 to 325 mm of Perplex. The longitudinal resolution was evaluated between 0.9 and 0.5 lps/mm with the Hologic Discovery densitometer, and inferior to 0.5 with the Lunar Prodigy; as for transversal resolution, it varied from 0.63 to 0.5 lps/mm and from 0.6 to inferior 0.5 lps/mm, respectively. The image was isotropic without magnification with the GE-Lunar Prodigy, whereas there was only a transversal magnification with the Hologic Discovery device. The magnification was about 1.17% cm(-1 )in the two directions, while increasing the distance of the phantom above the examination table with the Lexxos. This magnification was isotropic without distortion. The magnification could be evaluated from two images taken before and after translation of the C-arm, and a magnification correction could be applied. This method was applied to a phantom and to a human cadaver femoral bone.

Depressive illness, depressive symptomatology and regional cerebral blood flow in elderly people with sub-clinical cognitive impairment.

BACKGROUND: Depressive illness in dementia is often assumed to be a unitary clinical phenomenon. AIM: To describe changes in patterns of depressive symptomatology with time, and associated changes in cerebral blood flow to the frontal and temporal regions. METHOD AND RESULTS: 397 elderly people with sub-clinical cognitive dysfunction were observed over 3 years. Sixteen percent of them developed dementia during the study The prevalence of depressive symptomatology was higher in this group than in the general population, especially in women, who also had higher recovery rates. A changing profile of depressive symptoms was found in depressed elderly people progressing to dementia, with fewer affective symptoms and increases in agitation and motor slowing. These changes were paralleled by greater reductions in left temporal regional cerebral blood flow than in non-depressed subjects with Alzheimer's disease. CONCLUSION: In dementia, there may be two separate and interacting depressive syndromes whose differentiation may be clinically important.

In corticosteroid-treated respiratory diseases, monofluorophosphate increases lumbar bone density: a double-masked randomized study.

The efficacy of a monofluorophosphate-calcium combination (MFP-Ca) in increasing lumbar bone mineral density (BMD) was assessed in a prospective double-masked study. Patients (n = 35), who had been treated for 1 year or more with prednisone-equivalent doses > or = 7 mg/day for asthma or other respiratory diseases, were randomly assigned to receive twice a day, for 2 years, either one MFP-Ca tablet [100 mg sodium monofluorophosphate (13.2 mg F-) + 500.5 mg Ca2+] or one Ca tablet (500.5 mg Ca2+). BMD was measured from L2 to L4 using a dual photon absorptiometer. The eligible patients (7 premenopausal women, 21 men), who had no previous vertebral fractures and were aged 46.5 (21-65) years, had received 18 (7.5-60) mg prednisone-equivalent/day and had a mean lumbar BMD of 0.917 +/- 0.141 g/cm2 at baseline (MO); in these 28 patients, the mean increase in lumbar BMD at final assessment was significantly greater in the MFP-Ca group (p = 0.05; Mann-Whitney). There was also a significant difference after 2 years between the two groups (p = 0.05, ANOVA) in favour of MFP-Ca, with an increase in lumbar BMD of 11% (MFP-Ca) compared with 1% (Ca); thus, with MFP-Ca, lumbar BMD increased by an average of approximately 5.5%/year. There was no statistically significant difference between the two groups in doses of corticosteroids used during the 2 study years, rate of vertebral fractures, or frequency of side-effects (which were all minor). No bone fissure was observed. Thus, the daily dose of 200 mg monofluorophosphate (26.4 mg F-) combined with 1 g Ca2+ in patients with long-term corticosteroid-treated respiratory diseases appears to be a safe and efficient way of increasing lumbar BMD, suggesting that its use should be further studied in corticosteroid-induced osteoporosis.

Optimum tomographic reconstruction parameters for HMPAO brain SPET imaging: a practical approach based on subjective and objective indexes.

The purpose of this study was to define an optimal strategy for the tomographic reconstruction procedure in routine brain single-photon emission tomography (SPET) studies, including the number of projections, filter function and matrix size. A set of projection data with different count densities was obtained from a technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) brain SPET acquisition from one volunteer. The projections were reconstructed with different filters and the quality of the reconstructed images was determined using both a subjective observer rating score and the Gilbert index. For each count density, the observers' choice corresponded to images with the lowest Gilbert index. The noise level in brain SPET sections was estimated and correlated with the fractal dimension. The results of this study indicate that although noise represents a fundamental component of brain SPET imaging, image quality also depends on the reconstructed spatial resolution. Image quality is satisfactorily described by fractal dimension. In addition the optimal filter function depends on the available count density. For high count levels, optimal reconstruction may be obtained by using a high-resolution matrix and a slightly smoother reconstruction filter. When count densities are low, best results are obtained by using a low-resolution matrix and a sharper filter. Finally, this study suggests that image quality is not influenced by the number of projections for equivalent count densities. These results were confirmed by 30 HMPAO brain SPET studies acquired in a routine clinical setting.

[Dual-photon absorptiometry of the calcaneum in osteoporosis. Preliminary results]. / L'absorptiométrie biphotonique du calcanéum dans l'ostéoporose. Résultats préliminaires.

Anteroposterior views of the lumbar spine are commonly used for the measurement of bone mineral density (BMD) by diphoton absorptiometry (DPA). Values in lumbar vertebral BMD can be increased by the existence of a compression fracture, osteoarthrosis, scoliosis or aortic calcifications. Evaluation of bone loss at a peripheral site, such as the calcaneum (essentially trabecular site), could compensate for the principal causes of error associated with vertebral measurement. Calcaneal BMD in 195 control women was used to establish reference values closely correlated with lumbar BMD (p less than 0.001). The same study was undertaken in osteoporotic women. Preliminary results based upon 38 cases are reported here. Measurement of BMD of the calcaneum was correlated with vertebral trabecular bone density measured by double energy CT scan, indicating that this peripheral site offers a good reflection of what is happening at vertebral trabecular level. In contrast, calcaneal BMD was not correlated with spinal BMD, except if patients with osteoarthrosis and/or scoliosis were eliminated. Measurement of the BMD of the calcaneum by DPA is thus a simple, rapid and reproducible method for evaluation of a trabecular bone site which could be complementary to the measurement of lumbar BMD when the latter is falsified by artefacts.

Semi-automatic segmentation of gated blood pool emission tomographic images by watersheds:application to the determination of right and left ejection fractions.

Tomographic multi-gated blood pool scintigraphy (TMUGA) is a widely available method which permits simultaneous assessment of right and left ventricular ejection fractions. However, the widespread clinical use of this technique is impeded by the lack of segmentation methods dedicated to an automatic analysis of ventricular activities. In this study we evaluated how a watershed algorithm succeeds in providing semi-automatic segmentation of ventricular activities in order to measure right and left ejection fractions by TMUGA. The left ejection fractions of 30 patients were evaluated both with TMUGA and with planar multi-gated blood pool scintigraphy (PMUGA). Likewise, the right ejection fractions of 25 patients were evaluated with first-pass scintigraphy (FP) and with TMUGA. The watershed algorithm was applied to the reconstructed slices in order to group together the voxels whose activity came from one specific cardiac cavity. First, the results of the watershed algorithm were compared with manual drawing around left and right ventricles. Left ejection fractions evaluated by TMUGA with the watershed procedure were not significantly different (p=0. 30) from manual outlines whereas a small but significant difference was found for right ejection fractions (p=0.004). Then right and left ejection fractions evaluated by TMUGA (with the semi-automatic segmentation procedure) were compared with the results obtained by FP or PMUGA. Left ventricular ejection fractions evaluated by TMUGA showed an excellent correlation with those evaluated by PMUGA (r=0. 93; SEE=5.93%; slope=0.99; intercept = 4.17%). The measurements of these ejection fractions were significantly higher with TMUGA than with PMUGA (P<0.01). The interoperator variability for the measurement of left ejection fractions by TMUGA was 4.6%. Right ventricular ejection fractions evaluated by TMUGA showed a good correlation with those evaluated by FP (r = 0.81; SEE = 6.68%; slope = 1.00; intercept = 0.85%) and were not significantly different (P = 0.42). The interoperator variability with TMUGA was 6.7% for the right ventricle. Thus, the watershed algorithm proposed is an efficient segmentation tool for the semi-automatic analysis of right and left ventricular ejection fractions by TMUGA. Further studies are necessary to check whether this procedure can be used to evaluate ventricular volumes and cardiac outflow.

The relationship between osteoarthritis of the hands, bone mineral density, and osteoporotic fractures in elderly women.

To study the relationship between osteoarthritis (OA) and osteoporosis (OP), radiographic osteoarthritis lesions of the hands (HOA) were quantified in 300 healthy women, aged 75 years or more, as a subgroup of a cohort originally recruited for a multi-centre study of risk factors for femoral neck fracture. The HOA combined score (i.e. the sum of the grades of joint-space narrowing, osteophytes, erosions and joint misalignment), the osteophytosis score and the joint-space narrowing score were calculated on a radiograph of both hands. Bone mineral density (BMD) was measured using dual-energy X-ray absortiometry (Lunar DPX) at the femoral neck, Ward's triangle and the total body. BMDs of the total spine, lumbar spine, and the upper and lower limbs were derived from the regional analyses of the total body measurement. Correlations between bone mass, HOA scores and other variables were explored by multiple linear regression and stepwise logistic regression analysis. The HOA combined score was positively correlated with increasing age but not with body mass index. In the multiple regression analyses the HOA combined score positively correlated with BMD and the joint-space narrowing score. According to stepwise logistic regression and after off adjustment of BMD for age, women with an HOA combined score higher than 20 had significantly higher BMD values at all skeletal sites. Sixty-nine women (23%) reported a history of osteoporotic fracture; among them, 20 (6.6%) reported a history of vertebral fracture. The OA score of both subgroups was significantly lower than that of women with no history of fracture. These data suggest that in elderly women the severity of HOA is positively correlated with bone mass and that women with a higher score of HOA more rarely report a history of osteoporotic fracture.