[Isolated tracheobronchial involvement by atrophic polychondritis: role of PET scanning]. / Atteinte trachéobronchique isolée de la polychondrite atrophiante: intérêt du TEP-scanner.

INTRODUCTION: Atrophic polychondritis is a rare and serious disease characterised by multifocal inflammatory lesions of cartilage. The diagnosis, though urgent, is difficult when there is isolated tracheal involvement. CASE REPORT: We report the case of a woman of 55 with recent, non-infectious febrile episodes accompanied by a steroid sensitive inflammatory syndrome. Auscultation, lung function tests and a thoracic CT scan suggested tracheobronchomalacia. Atrophic polychondritis was suspected without being confirmed on the basis of histological or biological tests; particularly as no other cartilaginous involvement was discovered. Laryngeal and tracheal hypermetabolism on a PET scan, performed in the absence of corticosteroid treatment, was also in favour of this diagnosis. One month after resumption of steroid treatment at increased dosage, this examination was normal. Secondarily, after careful reduction of steroids, the patient developed nasal chondritis, confirming the diagnosis of atrophic polychondritis. CONCLUSION: The PET scanner could be useful in the diagnosis of atrophic polychondritis in its isolated tracheobronchial form. Its place in the follow-up of this disease remains to be evaluated and should take account of the irradiation dose of this examination.

Long-term follow-up of patients with papillary and follicular thyroid cancer: a prospective study on 715 patients.

PURPOSE: This prospective study evaluated the recurrence rate in 715 patients with differentiated thyroid cancer who had no evidence of persistent disease after total thyroidectomy and lymph node dissection in 94% of them followed up by radioiodine ablation (30-100 mCi) and assessed the predictive value of the initial thyroglobulin (Tg) levels for detecting recurrence, both during levothyroxine (LT4) treatment and after TSH stimulation. PATIENTS AND METHODS: Patients had Tg determinations performed at 3 months on LT4 treatment (Tg1) and at 9-12 months after stimulation by either thyroid hormone withdrawal or recombinant human TSH (Tg2); the Access kit was used (functional sensitivity of 0.11 ng/ml); they had undetectable anti-Tg antibodies. Patients were followed up annually. Predictive values were calculated by comparing Tg levels (Tg1 and Tg2) and the outcome in terms of recurrence. RESULTS: During the median follow-up of 6.2 yr, 32 patients had a recurrence. Assuming a cutoff level for Tg1 at 0.27 ng/ml, Tg1 sensitivity and specificity reached 72 and 86%, respectively, whereas predictive positive and negative values were 20 and 99%, respectively. With a cutoff level for Tg2 at 1.4 ng/ml, sensitivity and specificity reached 78 and 90%, respectively, whereas positive and negative predictive values were 26 and 99%, respectively. CONCLUSION: This large prospective cohort of patients presented a low rate of recurrence. Initial Tg measurements allow to predict long-term recurrence with an excellent specificity. Stimulated Tg determination presented a slightly higher sensitivity than Tg determination on LT4. TSH stimulation may be avoided when Tg measured 3 months after ablation is less than 0.27 ng/ml during LT4 treatment.

Comparison of seven serum thyroglobulin assays in the follow-up of papillary and follicular thyroid cancer patients.

BACKGROUND: Serum thyroglobulin (Tg) is the marker of differentiated thyroid cancer after initial treatment and TSH stimulation increases its sensitivity for the diagnosis of recurrent disease. AIM: The goal of the study is to compare the diagnostic values of seven methods for serum Tg measurement for detecting recurrent disease both during L-T4 treatment and after TSH stimulation. METHODS: Thyroid cancer patients who had no evidence of persistent disease after initial treatment (total thyroidectomy and radioiodine ablation) were studied at 3 months on L-T4 treatment (Tg1) and then at 9-12 months after withdrawal or recombinant human TSH stimulation (Tg2). Sera with anti-Tg antibodies or with an abnormal recovery test result were excluded from Tg analysis with the corresponding assay. The results of serum Tg determination were compared to the clinical status of the patient at the end of follow-up. RESULTS: Thirty recurrences were detected among 944 patients. A control 131I total body scan had a low sensitivity, a low specificity, and a low clinical impact. Assuming a common cutoff for all Tg assays at 0.9 ng/ml, sensitivity ranged from 19-40% and 68-76% and specificity ranged from 92-97% and 81-91% for Tg 1 and Tg2, respectively. Using assays with a functional sensitivity at 0.2-0.3 ng/ml, sensitivity was 54-63% and specificity was 89% for Tg1. Using the two methods with a lowest functional sensitivity at 0.02 and 0.11 ng/ml resulted in a higher sensitivity for Tg1 (81% and 78%), but at the expense of a loss of specificity (42% and 63%); finally, for these two methods, using an optimized functional sensitivity according to receiver operating characteristic curves at 0.22 and 0.27 ng/ml resulted in a sensitivity at 65% and specificity at 85-87% for Tg1. CONCLUSION: Using an assay with a lower functional sensitivity may give an earlier indication of the presence of Tg in the serum on L-T4 treatment and may be used to study the trend in serum Tg without performing any TSH stimulation. Serum Tg determination obtained after TSH stimulation still permits a more reliable assessment of cure and patient's reassurance.

Correlation between inter-ictal regional cerebral blood flow and sphenoidal electrodes--recorded inter-ictal spikes in mesial temporal lobe epilepsy.

The objective of this study was to assess the reliability of the diagnosis of mesial temporal lobe epilepsy using EEG and sphenoidal electrodes. Inter-ictal 99 m Tc-HMPAO SPECT scans were registered in 21 patients with confirmed mesial temporal lobe epilepsy identified by scalp EEG and sphenoidal electrodes. Visual and quantitative SPECT analysis was performed blind to EEG data. An asymmetry index (AI) was measured from the ratio of two symmetrical regions of interest. A temporal lobe hypoperfusion was defined as an uptake reduced by 5% with respect to the contralateral region. Inter-ictal SPECT abnormalities were observed in 12 out of 21 patients (57%) from both visual and quantitative analysis (focal hypoperfusion in 11 cases, focal hyperperfusion in one case). In seven patients (33%) both visual and quantitative scintigraphy were normal. Abnormal AI was found in 11/15 patients with a high frequency of seizures and in 1/6 patients with a low frequency of seizures. The major data is that the probability to have an abnormal SPECT is statistically correlated to the frequency of the epileptic fits. The couple EEG recordings with sphenoidal electrodes and SPECT is sensitive and reliable in the diagnosis of mesial temporal lobe epilepsy.

[Dermoid cyst of the ovary. False positive diagnosis in iodine 131 scintigraphy of differentiated thyroid cancers]. / Kyste dermoïde de l'ovaire. Faux positif à reconnaître lors de la surveillance scintigraphique à l'iode 131 des cancers différenciés thyroïdiens.

BACKGROUND: Total body 131-iodine labeled scintiscan is used to screen for residual tumoral tissue after ablation of differentiated thyroid carcinoma. At therapeutic doses, radioactive iodine can also be used for treatment. Thyroglobulin level, usually undetectable a few months after total thyroidectomy and metabolic irradiation with 131-iodine in patients without initial metastases, is absolutely necessary for interpreting the scintiscans. Iodine uptake occur in dermoid cysts which usually contain thyroid tissue. CASE REPORT: A 44-year old woman underwent total thyroidectomy with node dissection for papillary carcinoma of the thyroid with a vesicular architecture. Four months later, the total body 131-iodine scintiscan demonstrated a round zone of uptake in the pelvic area. The lesion was found to be a typical dermoid cyst. No thyroid or tumoral tissue could be demonstrated. DISCUSSION: Dermoid cysts can be the cause of false positive 131-scintiscans in patients followed after resection of differentiated thyroid carcinoma. Unlike previously reported cases, the dermoid cyst in this patient was totally devoid of thyroid tissue.

Comparison of epirubicin and doxorubicin cardiotoxicity induced by low doses: evolution of the diastolic and systolic parameters studied by radionuclide angiography.

BACKGROUND: Previous studies have demonstrated that epirubicin (EPI) has a lower propensity to produce cardiotoxic effects than doxorubicin (DXR) at high doses. HYPOTHESIS: The aim of the study was to compare the cardiotoxicity induced by low doses of EPI and DXR in patients before and 1 month after the end of chemotherapy. METHOD: In a prospective study, 99 patients with a mean age of 51 +/- 12 years and without cardiac disease were studied before and 1 month after the end of chemotherapy. Group 1 included 38 patients receiving 246 +/- 96 mg/m2 of DXR and Group 2 included 61 patients receiving EPI with and equivalent dose of 219 +/- 92 mg/m2 of DXR. Ejection fraction (EF) of the left ventricle (LV), peak ejection rate (PER), and peak filling rate (PFR) [expressed in end-diastolic volume/s (EDV/s)] were evaluated by gated radionuclide angiography; PFR/PER were also calculated. RESULTS: Moderate and similar alterations of left ventricular ejection fraction were shown for low doses of anthracyclines. The EF of the LV decreased from 57 +/- 6% to 54 +/- 6% for DXR group (Group 1) (p = 0.005), and from 58 +/- 5% to 55 +/- 5% for the EPI group (Group 2)(p = 0.001). The PER of the left ventricle fell from 3.08 +/- 0.46 EDV/s to 2.79 +/- 0.49 in Group 1 (p = 0.004) and from 2.98 +/- 0.50 to 2.73 +/- 0.34 EDV/s in Group 2 (p = 0.001). In contrast, no significant alteration of PFR appeared in Group 2 (from 2.72 +/- 0.51 to 2.62 +/- 0.41 EDV/s) for the equivalent dose of anthracycline, while PFR of the LV dropped from 2.82 +/- 0.76 (EDV/s) to 2.41 +/- 0.55 after doxorubicin (p = 0.004). No difference was found between 1 and 12 months after the end of the treatment in 25 patients in Group 1 and 28 patients in Group 2. These results confirm the advantage of EPI over DXR in terms of cardiotoxicity and help explain the relationship of cellular damage mechanisms with the functional parameters of nuclear investigation. CONCLUSION: A possible explanation for specific alteration after DXR could be the increased production of semiquinone free radicals, which are known to induce membrane damage and, consequently, myocardial edema and diastolic alteration.

Bone scintigraphy equipped with a pinhole collimator for diagnosis of avascular necrosis of the femoral head.

The objective was to compare the sensitivities for diagnosis of avascular necrosis of the femoral head of bone scintigraphy equipped with a pinhole collimator and with an high resolution parallel collimator. Bone scintigraphy equipped with a pinhole collimator and with an high resolution parallel collimator were performed in 16 patients with bilateral (n=7) or unilateral (n=9) avascular necrosis of the femoral head. Bone scintigraphy equipped with a pinhole collimator documented a photopenic defect in 78.3% of the necrotic hips, while bone scintigraphy equipped with an high resolution parallel collimator documented a defect in 47.8%. There was no false-positive diagnosis of avascular necrosis of the femoral head on either bone scintigraphy equipped with a pinhole or with an high resolution parallel collimator. In conclusion, bone scintigraphy equipped with a pinhole collimator has a greater sensitivity for diagnosis of avascular necrosis of the femoral head than bone scintigraphy equipped with an high resolution parallel collimator.

[False positive scintigraphic images in the surveillance of differentiated thyroid cancers]. / Faux positifs scintigraphiques à l'iode 131 dans la surveillance des cancers thyroïdiens différenciés.

Iodine-131 whole body imaging and serum thyroglobulin are used in the follow-up evaluation of differentiated thyroid carcinomas. Iodine 131 is used to detect and treat functioning lesions. Iodine 131 activity detected outside the normal thyroid bed is usually attributed to metastatic disease. False-positive localization of radioiodine has been described, and may be a potential pitfall. We report here six personal cases of false-positive localisations of radioiodine du to body secretions, pathologic exudate, activity in nonlactating breast, salivary gland inflammation, ovarian teratoma. Some of these false-positive can be ruled out easily by removing of clothes, removing of nozzle in patients with tracheostomy, or by ingestion of water in subjects with abnormal mediastinal hyperfixation. Recognition of false-positive radioiodine images is very important to prevent costly additional investigation and possibly inappropriate therapy.

[Thymic carcinoid tumor causing paraneoplastic Cushing syndrome. Diagnostic value of double-labelled tomoscintigraphy]. / Tumeur carcinoïde thymique responsable d'un syndrome de Cushing paranéoplasique. Intérêt diagnostique de la tomoscintigraphie en double marquage.

Cushing's syndromes caused by ectopic corticotropin secretion represent 10 to 15% in the causes of Cushing's syndrome. Somatostatin receptor scientigraphy can be successful in the localization of ACTH-secreting neuroendocrine tumors. We report a case of Cushing's syndrome caused by ectopic corticotropin secretion from a thymic carcinoid tumor. Conventional localization techniques failed but the tumor was detected by a double binding thoracic scintigraphy using 111Indium-octreotide and 99mTechnetium-albumine macroagregates.

Diastolic or systolic left and right ventricular impairment at moderate doses of anthracycline? A 1-year follow-up study of women.

A prospective study was carried out to assess the early and later alterations in left and right ventricular diastolic and systolic function after the termination of anthracycline therapy. In 33 women without cardiac disease who were treated by anthracycline therapy, cardiac function was evaluated by radionuclide angiography before the treatment (T0) and 1 month (T1) and 12 months (T12) after the end of the treatment. Cardiac function was assessed by radionuclide measurement throughout treatment. Analysis of ejection fraction (EF), peak ejection rate (PER), time to PER (TPER), peak filling rate (PFR) and time to PFR (TPFR) was performed before and after treatment. To normalise radionuclide measurements of the ventricular diastolic function, the ratio of the PFR and the EF and the ratio of the PFR and the PER were calculated. No patient developed symptomatic congestive cardiac failure. One-way analysis of variance showed a significant decrease in the three parameters (EF, PER, PFR) over time only for the left ventricle (LV); no significant alterations appeared for the right ventricle (RV). The EF of the LV decreased from 59%+/-5% at T0 to 57%+/-6% at T1 and 56%+/-5% at T12. The PER of the LV fell from 3.03+/-0.40 end-diastolic volume per second (EDV/s) at T0 to 2.79+/-0.47 at T1 and 2.78+/-0.43 at T12. The PFR of the LV dropped from 2.99+/-0.43 EDV/s at T0 to 2.62+/-0.44 at T1 and 2.56+/-0.42 at T12. For the normalised ratios, no differences were observed. Significant differences were found for EF, PER and PFR between T0 and T1, and between T0 and T12, but no difference was found between T1 and T12. This report shows simultaneous impairment of the systolic and diastolic LV radionuclide parameters at 1 and 12 months after anthracycline therapy without alteration in the RV function.

Impairment of diastolic function during short-term anthracycline chemotherapy.

OBJECTIVE: To assess the early changes in left ventricular diastolic and systolic function due to anthracycline treatment. DESIGN: A prospective study of cardiac function by radionuclide angiography in adults before and one month after the end of anthracycline treatment. PATIENTS: 60 patients without cardiac disease treated with chemotherapy containing anthracycline. METHODS: Cardiac function was assessed by radionuclide measurement throughout treatment. Ejection fraction, peak ejection rate, time to peak ejection rate, filling rate, and time to peak filling rate were measured before and after treatment. To normalise radionuclide measurements of the left ventricular diastolic function the ratio of the filling rate to the ejection fraction and the ratio of the filling rate to the peak ejection rate were calculated. RESULTS: No patient developed symptomatic congestive cardiac failure. The ejection fraction decreased from 58% (5%) to 55% (6%) (P < 0.001), the peak ejection rate fell from 2.99 (0.41) to 2.77 (0.41) of the end diastolic volume per second (P < 0.001), and the peak filling rate from 2.71 (0.47) to 2.55 (0.44) of the end diastolic volume per second (P < 0.01) after treatment. No difference was observed in the normalised ratios. CONCLUSIONS: This report shows simultaneous impairment of left ventricular systolic and diastolic radionuclide parameters. The absence of variation in normalised measurements suggests similar changes in ejection fraction, peak ejection rate, and peak filling rate throughout treatment.