Subthalamic nucleus stimulation affects orbitofrontal cortex in facial emotion recognition: a PET study.

Deep brain stimulation (DBS) of the bilateral subthalamic nucleus (STN) in Parkinson's disease is thought to produce adverse events such as emotional disorders, and in a recent study, we found fear recognition to be impaired as a result. These changes have been attributed to disturbance of the STN's limbic territory and would appear to confirm that the negative emotion recognition network passes through the STN. In addition, it is now widely acknowledged that damage to the orbitofrontal cortex (OFC), especially the right side, can result in impaired recognition of facial emotions (RFE). In this context, we hypothesized that this reduced recognition of fear is correlated with modifications in the cerebral glucose metabolism of the right OFC. The objective of the present study was first, to reinforce our previous results by demonstrating reduced fear recognition in our Parkinson's disease patient group following STN DBS and, second, to correlate these emotional performances with glucose metabolism using (18)FDG-PET. The (18)FDG-PET and RFE tasks were both performed by a cohort of 13 Parkinson's disease patients 3 months before and 3 months after surgery for STN DBS. As predicted, we observed a significant reduction in fear recognition following surgery and obtained a positive correlation between these neuropsychological results and changes in glucose metabolism, especially in the right OFC. These results confirm the role of the STN as a key basal ganglia structure in limbic circuits.

Description and technical pitfalls of a hepatoma model and of intra-arterial injection of radiolabelled lipiodol in the rat.

Intra-arterial metabolic radiotherapy (using lipiodol labelled with iodine-131 or rhenium-188) is a therapeutic approach that can be used for the treatment of hepatocellular carcinomas (HCC). We propose a detailed description of the tumoral model using the N1-S1 cell line as well as a technique for intra-arterial injection of radiolabelled lipiodol in order to undertake preclinical studies necessary for the evaluation of a new molecule. We also report the principal technical pitfalls that were faced. The speed of injection of the tumoral cells is a key factor in the tumoral induction since slow injections lead to a tumoral induction rate of 36.3% compared with 76.6% (P<0.01) when using very slow injections. This parameter should thus be controlled carefully during the subcapsular injection of the tumoral cells. In addition, when injecting radiolabelled lipiodol, anaesthesia should not be performed with isoflurane since this leads to a reduction in tumoral uptake. Indeed, we found a 'tumour/healthy liver' uptake ratio of only 2.1+/-0.7 with isoflurane as against 4.4+/-2.6 (P<0.05) when anaesthesia was carried out by intraperitoneal injection of ketamine. Lastly, we show that the tumour size has an influence on the tumoral uptake of radiolabelled lipiodol; therefore, this parameter must also be carefully controlled.

Direct quantitation of thoracic gallium-67 uptake in sarcoidosis.

A method of direct quantitation of 67Ga uptake in the lung is described. The attenuation coefficient requires calculation and is obtained simply for each patient by transmission using a planar radionuclide source. The validity of the method was tested with a phantom (error less than 10%). Forty-three patients with pulmonary and/or mediastinal sarcoidosis were classified. The different groups of patients as defined clinically and radiographically (controls, nonactive, and active sarcoidosis) were well-differentiated (p less than 0.001).

Gallium-67 imaging in muscular sarcoidosis.

A case is presented of sarcoid myopathy in which radiogallium was seen to accumulate in the sites of muscle involvement. Uptake of the radiotracer disappeared following institution of corticosteroid therapy. The exceptional nature of this case contrasts with the high frequency of biopsy evidence of sarcoid muscle disease but is consistent with the rarity of clinical evidence of sarcoid granulomas in muscle. Gallium-67 imaging can be used to determine the extent of muscle involvement and, through evaluation of uptake intensity, the degree of disease activity before and after treatment.

Pulmonary uptake of Tc-99m-Labeled methylene diphosphonate in a patient with a parathyroid adenoma.

Intense diffuse uptake of Tc-99m-labeled methylene diphosphonate was seen in both lungs of a patient submitted to surgery for a primary parathyroid adenoma. Five scans performed over the 3 yr following the operation showed persistence of lung uptake despite restoration of normal blood calcium concentration. Mild chronic renal failure caused by the hypercalcemia also persisted postoperatively. The present case confirms that pulmonary uptake of bone tracer can occur asymptomatically when both hypercalcemia and renal failure are present. Lung uptake of a bone tracer probably reflects tissue deposition of hydroxyapatite rather than of amorphous structures. Correction of the hypercalcemia failed to resolve the abnormal scan pictures.

Evaluation of human thyroid tumors by proton nuclear magnetic resonance.

Proton nuclear magnetic resonance (NMR) was used in a study of 40 patients with thyroid tumors following partial or total thyroidectomy. Three patient groups were considered: those with nodules showing increased uptake, those with solitary nodules with decreased uptake, and those with multinodular goiters. Spin-lattice and spin-spin relaxation times (T1 and T2) were measured on samples of nodular and extranodular tissue from each patient. Increased T1 and T2 were observed for benign cold nodules, an increase in T1 alone for nodules with increased uptake, and a wide fluctuation in T1 and T2 for multinodular goiters. The four cancers in the series did not show a distinctive proton NMR pattern in comparison with the other nodular structures studied. The results point to the feasibility of applying NMR techniques to the detection of thyroid disease.

Evaluation of a liver transplant by Tc-99m dimethyl-IDA scintigraphy.

In liver-transplant patients, it is always difficult to differentiate between rejection crises and extrahepatic biliary obstruction on the basis of standard biochemical tests alone. A case is reported of a patient who received a transplant following total hepatectomy performed because of a hepatoma. Scintigraphy with Tc-99m N-(dimethylphenylcarbamoylmethyl)iminodiacetic acid pointed conclusively to an obstructive process, which was confirmed at re-operation.

Scintigraphic assessment of indium-111-labeled granulocyte splenic pooling: a new approach to inflammatory bowel disease activity.

We have conducted a prospective study into the sensitivity and the specificity of the fall in splenic activity (FSA) as an index of activity in inflammatory bowel disease (IBD). FSA was measured on scintiscans obtained at 3 and 24 hr postinjection of indium-111-labeled granulocytes. One hundred and twenty-two scans were acquired in 96 patients who were divided into six groups: Gr. I = normal volunteers (n = 10); Gr. II = inflammatory rheumatism (n = 10); Gr. III = abscesses (n = 17); Gr. IV = ulcerative colitis (UC: n = 23); Gr. V = colonic Crohn's disease (CCD: n = 22); and Gr. VI = ileal Crohn's disease (ICD: n = 14). FSA for Groups I and II was constantly below 10%, but it was increased in the other four groups (abscesses: 39% +/- 12%; UC: 35% +/- 13.5%; CCD: 23.7% +/- 14.7%; ICD: 21.5% +/- 11.7%). There was a significant correlation between fecal excretion of 111In (FEI) and FSA in patients with IBD (UC: r = 0.71, p less than 0.001; CCD: r = 0.74, p less than 0.001; ICD: r = 0.43, p less than 0.001). FSA was followed in 16 patients with IBD after medical treatment and there was a significant correlation between variations in FSA and in FEI (r = 0.879, p less than 0.001). FSA is a very sensitive although nonspecific index of disease activity in IBD and may replace FEI in the assessment of IBD activity.

Safe radiation exposure of medical personnel by using simple methods of radioprotection while administering 131I-lipiodol therapy for hepatocellular carcinoma.

The intra-arterial administration of 131I-lipiodol is a therapeutic approach increasingly used for the treatment of inoperable hepatocellular carcinomas. This technique has even become the reference treatment for hepatocellular carcinomas with portal thrombosis and is the only effective treatment to reduce the risk of recurrence among patients who could benefit from surgical operation. Currently, few data have been published concerning the levels of exposure for personnel carrying out this type of treatment. We undertook a dosimetric study targeted mainly on the exposure of the person performing the injection of 131I-lipiodol to show that this treatment can be carried out with an exposure at the extremities distinctly lower than the regulatory annual threshold by using simple means of radioprotection. The point of puncture was carried out at the level of left femoral artery, the preparation and injection of the therapeutic dose was carried out extemporaneously by the nuclear medicine specialist using a 10 ml syringe (for an injected volume of 4 ml) fitted with an adapted syringe protector. The injection was carried out as rapidly as possible under scopic control while avoiding reflux, with compression carried out by the radiologist. This study comprises 52 intra-arterial injections of 131I-lipiodol (2016+/-92 MBq). For the nuclear medicine specialists, 52 measurements were carried out at the level of the thorax and 41 on the fingers. For the radiologists, 22 measurements were carried out at the level of the thorax and six on their index fingers; nine measurements were carried out at the level of the thorax for the technologist and four at the level of the thorax for the stretcher bearer. For the nuclear medicine specialists, the average dose received at the level of the fingers varies between 140 and 443 microSv (according to the fingers) and the average dose at the thorax is 17 microSv. For the radiologists, the average dose received is 215 microSv at the level of the fingers and 15 microSv at the thorax. These results show that the administration of high therapeutic activities of 131I-lipiodol can be carried out for the exposed personnel with a dose at the level of the fingers much lower than the European regulatory limit of 500 mSv.

[Positron emission tomography (PET) and (F-18)-fluorodeoxyglucose in (FDG) in cancerology]. / Tomographie par émission de positons (TEP) et [F-18]-fluorodésoxyglucose (FDG) en cancérologie.

Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) is a scintigraphic imaging technique undergoing a rapid growth in the field of oncology. The constant progress of the detectors, either CDET or PET dedicated cameras, allows to obtain in routine conditions images with a 5 mm spatial resolution. Absolute tracer uptake quantification is also possible, which allows to evaluate objectively therapy efficacy. The mechanisms of FDG tissular accumulation are now better understood. Increase of glycolysis and of transmembrane transport of glucose seems to be at the origin of the high tumorous accumulation of FDG. The main current oncologic application of FDG PET is the diagnosis of malignancy of the isolated pulmonary nodules, with a sensitivity of more than 95%, and in the staging of lung cancer where PET shows higher performances than conventional imaging. The same stands in cutaneous melanoma and for malignancies of the digestive tract, either in colorectal, pancreatic or esophageal localizations. In colorectal cancers, the role of PET has for long being recognized in the differential diagnosis between recurrence and postoperative fibrosis. In the head and neck tumors, FDG also allows to differentiate between recurrence and postradiation necrosis. In lymphoma, the most suitable site for biopsy can be identified on a PET scan and therapy efficacy can also be assessed. In breast cancer, the detection of metastases seems to be possible with FDG. In brain and thyroid cancers, the role of FDG PET remains to be further determined. The low uptake of FDG in prostate cancer metastasis is not in favor of its use in this indication. In conclusion, the indications of FDG PET in oncology are now becoming more precise and it can be expected that clinical PET centers will soon appear in France.

[Diagnosis of coronary artery disease by thallium 201 myocardial scintigraphy during atrial pacing]. / Diagnostic de l'insuffisance coronaire par tomoscintigraphie myocardique au thallium 201 sous stimulation auriculaire.

Rapid atrial pacing may reveal myocardial ischemia but the sensitivity for the diagnosis of coronary artery disease is not high enough for routine use. Therefore, the value of atrial pacing coupled with Thallium 201 scintigraphy was evaluated. Sixty-two patients (53 men and 9 women) referred for investigation of angina or chest pain were divided into two groups: a control group of 13 patients (9 men and 4 women, average age: 57.1 years) with insignificant coronary lesions (less than 50%) (N = 5) or normal coronary angiography (N = 8), and a group of 49 patients (44 men and 5 women, average age: 55.5 years) 27 of whom had a history of myocardial infarction (17 posterior, 10 anterior). Coronary angiography showed single vessel disease in 44.9% of cases, double vessel disease in 34.7% and triple vessel disease in 18.4% of cases, and 1 patient with left main stem disease. All 62 patients underwent the same study protocol which comprised: incremental atrial pacing (to the calculated maximal heart rate), Thallium 201 myocardial scintigraphy immediately after pacing and during the redistribution phase, and coronary angiography. The sensitivities of anginal pain (36.7%) and ECG changes during atrial pacing (57.1%) were too low for the diagnosis of myocardial ischemia. On the other hand, Thallium 201 scintigraphy with atrial pacing was more sensitive (87.8%) and specific (84.6%) for coronary artery disease. Stenosis of the left anterior descending artery was diagnosed with a sensitivity of 96.4% and that of the right coronary artery with a sensitivity of 90.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Assessment of portal blood flow by isotope splenoportography. Methodology and 1st results in cirrhosis]. / Estimation du débit portal par splénoportographie isotopique. Méthodologie et premiers résultats au cours des cirrhoses.

The authors report a new non-invasive method of portal blood flow (PBF) measurement, after injection of a radiotracer into the spleen. PBF was equal to the product of the radiotracer bolus velocity and the cross-section area of the portal vein as measured by ultrasonography. In 16 patients with cirrhosis, the velocity of the portal blood flow (V) and PBF were determined in 11 cases. In the remaining 5 patients, failures were explained by either a total extrahepatic shunt (3 cases) or difficulties of scanning view analysis (2 cases). Mean values of V and PBF were 8.8 +/- 2.5 cm/s and 579 +/- 193 ml/min respectively, which represent a reduction of 50 p. 100 compared to estimated normal values. This method was also useful to appreciate the fraction of PBF which is supposed to reach the liver cells called the "actual portal blood flow" (APBF). APBF was equal to PBF minus the fraction of blood flowing through intrahepatic shunts and/or the recanalized umbilical vein. In the 16 cases, mean values were 528 +/- 184 ml/min for APBF, 11.9 +/- 1.7 cm for the portal vein diameter, and 53 +/- 34 p. 100 for spleen blood flow fraction going through porto-systemic collateral veins. Significant intrahepatic shunt was observed in one patient only out of 13 without total extrahepatic shunt, i. e., in 8 p. 100 of the cases. The impossibility of measuring PBF when a total extrahepatic shunt is present is a drawback in the use of this new technique.(ABSTRACT TRUNCATED AT 250 WORDS)

[Scintigraphy with indium 111-labeled polynuclears: correlation with the extensiveness and activity of cryptogenetic enterocolitis]. / Scintigraphie aux polynucléaires marqués à l'indium 111: corrélation avec l'extension et l'activité des entérocolites cryptogénétiques.

We have studied prospectively the usefulness of indium 111 granulocytes scanning in patients with Crohn's disease and ulcerative colitis. Abdominal scans were performed 1 h, 3 h and 20 h after the injection of a pure autologous granulocyte preparation containing 3.7-5.5 MBq of radioindium. The extent of bowel involvement, evaluated on the 3-hour scan, was compared to the X-rays and endoscopic findings. The disease activity was assessed by the intensity of intestinal radionuclide uptake (IRU), the fecal indium 111 measurement (FIM) after a 4-day fecal collection, the decrease of the hepatic and splenic uptake (DHSU). It was compared to clinical and biological data as CDAI, sedimentation rate, albumin and alpha-2-globulin levels. Thirty-three examinations were performed in 26 patients, 16 with Crohn's disease and 10 with ulcerative colitis. The correlation of disease location between indium scan and other diagnosis procedures was good in 81 p. 100 of cases. CDAI was significantly correlated with radionuclide indexes: IRU, FIM, DHSU. FIM was not significantly different between mild and moderates diseases (respectively 1.5 +/- 1.0 p. 100 and 3.6 +/- 3.2 p. 100), but was different between moderate and moderately severe diseases (respectively 3.6 +/- 3.2 p. 100 and 23.6 +/- 16.7 p. 100, p less than 0.001). DHSU was significantly different between mild and moderate diseases (respectively 10.9 +/- 7.2 p. 100 and 22.5 +/- 10.7 p. 100, p less than 0.05) and between moderate and moderately severe diseases (respectively 22.7 +/- 10.7 and 42.4 +/- 7.3 p. 100, p less than 0.001). The radionuclide activity indexes were significantly correlated between themselves.(ABSTRACT TRUNCATED AT 250 WORDS)

[Contribution of 131I MIBG scintigraphy in the diagnosis of carcinoid tumors of the digestive tract. Experience of 14 cases]. / Apport de la scintigraphie à la 131I MIBG dans le diagnostic des tumeurs carcinoïdes digestives. Expérience de 14 cas.

131I MIBG scintigraphy is of great value in the diagnosis and the treatment of several tumors derived from the neural crest. But, its role in the assessment of carcinoid tumors remains to be evaluated. It was the aim of this prospective study. Between 1987 and 1989, 14 consecutive patients with carcinoid tumors were studied. Planar scintigrams were obtained 24 and 48 hours after the intravenous injection of 74 MBq of 131I MIBG. At least one scintigraphy was performed in every patient; at that time one or several abdominal tumor sites (a total of 22 sites) were found and histologically proven. Scintigram was judged as positive in 9 of 14 patients (64 p. 100); 68 percent of the 22 tumor sites and 86 percent of the 14 extra-hepatic tumor sites took up 131I MIBG. Liver metastases were overlooked on scintigrams in 5 of 8 patients. Scintigraphy was the only positive examination in 3 patients. No false positive scintigrams were noticed. These results emphasize the value of 131I MIBG scintigraphy in the assessment of carcinoid value tumors.

[Athlete's pubic pain syndrome or "pubialgia". Comparison of radiological and scintigraphic findings]. / Le syndrome d'algie pubienne du sportif (pubialgie). Intérêts de la confrontation radiologique et scintigraphique.

The pubic pain syndrome in athlete's results from two principal mechanisms: muscle insertion tendinitis or dynamic arthropathy of the pubis. Classification of these two entities is established by comparing radiological and scintigraphic findings.

[Lipiodolized angiography in hepatocellular carcinomas. Contribution of iodine-131-labelled lipiodol]. / L'angiographie lipiodolée au cours des carcinomes hépato-cellulaires. Apport du lipiodol marqué à l'iode 131.

Twelve patients with hepatocellular carcinoma and cirrhosis were investigated by Lipiodol injection into the hepatic artery. A CT scan was done 4-6 days later. Lipiodol was retained by hepatic tumors in each case. This method emphasized the extension of the carcinoma and allowed to discover daughter tumors. I131-lipiodol was also injected in 4 of the 12 patients and then its biodistribution was evaluated. At the 6th hour after injection, I131-lipiodol was detected by scintigraphy over the liver (74-91 percent) and over the lungs (9-16 percent) only. The tumor to normal liver pixel count ratio was about 5. These results indicate that there is a preferential arterial blood flow towards the hepatic tumors, and that we can consider a therapeutic use of I131-Lipiodol in hepatocellular-carcinoma.

[Management system for patients requiring stereotactic macrobiopsies of the breast: report on 100 patients]. / Mise en place de la prise en charge des macrobiopsies stéréotaxiques mammaires: évaluation sur 100 patientes.

PURPOSE: The authors describe and evaluate the management system for patients requiring large core vacuum-assisted biopsies at a dedicated breast center. This process includes mandatory review of all requests by a multidisciplinary team. MATERIAL: and method. Patients were provided questionnaires to evaluate their degree of satisfaction with the management process. Results from biopsy and surgery were retrospectively reviewed. RESULTS: From the 100 patients included in the study (106 macrobiopsies), 95,28% of biopsies were informative. The degree of correlation between the histological diagnosis from biopsy and surgery was 86,95% for the 46 operated cases. The degree of acceptability by patients as well as medical and non-medical staff was satisfactory. CONCLUSION: The original feature of this process is the retrospective review of all charts after the histological results becomes available for final validation of the biopsy results and management. The results of the biopsy and the post biopsy management are provided by the initial referring physician, allowing optimal patient care and follow-up.

[Trophoblastic tumor at the site of placental implantation. Apropos of a new case]. / La tumeur trophoblastique du site d'implantation placentaire. A propos d'un nouveau cas.

The authors report a case in which a trophoblastic tumour developed at the implantation site in a 34-year-old woman in her second pregnancy. She had previously had trophoblastic disease that had persisted after a molar pregnancy. Using monoclonal anti-beta-hCG antibodies in order to localise the tumour by clinical radio immunodetection made it possible to cure the patient. The tumour was a secretory tumour and hysterectomy was the cure.

[Contribution of indium-111 labelled polynuclear scintigraphy in the exploration of articular and bone infections]. / Apport de la scintigraphie aux polynucléaires marqués à l'indium 111 dans l'exploration des infections osseuses et articulaires.

Radionuclide imaging with Indium 111-labelled polymorphonuclears was performed on 90 occasions in 84 patients with suspected osteo-articular infection. The sensitivity of this technique was 70% and its specificity 87%. The Indium 111 technique is less sensitive than those using Technetium 99m and/or Gallium 67, but it is much more specific of infection. There are several causes of error when using this method: false-negative results due to the peculiarities of bone infection may occur, but false-positive results are rare, except in inflammatory diseases of peripheral joints. Among the best indications are infected articular prosthesis, spondylodiscitis, osteitis and osteomyelitis.

[Pulmonary metastases with a prolonged development. Two cases of thyroid cancers]. / Métastases pulmonaires d'évolution prolongée. A propos de deux cas de cancers thyroidiens.

The authors report two cases of differentiated carcinoma of the thyroid with pulmonary involvement showing as miliary shadowing radiologically which preceded the diagnosis of the thyroid neoplasm by 35 and 6 years respectively. The two patients had undergone cervical radiotherapy in infancy for lymphadenopathy whose aetiology had not been determined. The scintigraph with iodine 131 showed tht in two cases there was a bilateral and diffuse pulmonary uptake in keeping with pulmonary lesion of metastatic origin. Our observations recall the possibility of a slow evolution of pulmonary metastases and carcinoma of the thyroid and the role of cervical irradiation in the development of such cancers. With miliary shadowing a metastatic origin, in particular that of the thyroid, should be considered and in the majority of cases the proof could be supported using iodine 131 scintigraphy. The delay in appearance of pulmonary metastases during the course of cancer of the thyroid is variable. They occur most often after the initial diagnosis or more rarely preceding the discovery of a primary thyroid cancer. The pulmonary metastases may be asymptomatic. This neoplasm may benefit from a specific effective therapy and prolonged remissions have been described even with metastases.