Validation of the standardization framework SSTR-RADS 1.0 for neuroendocrine tumors using the novel SSTR­targeting peptide [18F]SiTATE.

OBJECTIVES: Somatostatin receptor positron emission tomography/computed tomography (SSTR-PET/CT) using [68Ga]-labeled tracers is a widely used imaging modality for neuroendocrine tumors (NET). Recently, [18F]SiTATE, a SiFAlin tagged [Tyr3]-octreotate (TATE) PET tracer, has shown great potential due to favorable clinical characteristics. We aimed to evaluate the reproducibility of Somatostatin Receptor-Reporting and Data System 1.0 (SSTR-RADS 1.0) for structured interpretation and treatment planning of NET using [18F]SiTATE. METHODS: Four readers assessed [18F]SiTATE-PET/CT of 95 patients according to the SSTR-RADS 1.0 criteria at two different time points. Each reader evaluated up to five target lesions per scan. The overall scan score and the decision on peptide receptor radionuclide therapy (PRRT) were considered. Inter- and intra-reader agreement was determined using the intraclass correlation coefficient (ICC). RESULTS: The ICC analysis on the inter-reader agreement using SSTR-RADS 1.0 for identical target lesions (ICC ≥ 85%), overall scan score (ICC ≥ 90%), and the decision to recommend PRRT (ICC ≥ 85%) showed excellent agreement. However, significant differences were observed in recommending PRRT among experienced readers (ER) (p = 0.020) and inexperienced readers (IR) (p = 0.004). Compartment-based analysis demonstrated good to excellent inter-reader agreement for most organs (ICC ≥ 74%), except for lymph nodes (ICC ≥ 53%). CONCLUSION: SSTR-RADS 1.0 represents a highly reproducible and consistent framework system for stratifying SSTR-targeted PET/CT scans, even using the novel SSTR-ligand [18F]SiTATE. Some inter-reader variability was observed regarding the evaluation of uptake intensity prior to PRRT as well as compartment scoring of lymph nodes, indicating that those categories require special attention during further clinical validation and might be refined in a future SSTR-RADS version 1.1. CLINICAL RELEVANCE STATEMENT: SSTR-RADS 1.0 is a consistent framework for categorizing somatostatin receptor-targeted PET/CT scans when using [18F]SiTATE. The framework serves as a valuable tool for facilitating and improving the management of patients with NET. KEY POINTS: SSTR-RADS 1.0 is a valuable tool for managing patients with NET. SSTR-RADS 1.0 categorizes patients with showing strong agreement across diverse reader expertise. As an alternative to [68Ga]-labeled PET/CT in neuroendocrine tumor imaging, SSTR-RADS 1.0 reliably classifies [18F]SiTATE-PET/CT.

Nasal airway ion transport is linked to the cystic fibrosis phenotype in adult patients.

BACKGROUND: This study was conducted to determine whether the major nasal airway ion transport abnormalities in cystic fibrosis (that is, defective cAMP regulated chloride secretion and basal sodium hyperabsorption) are related to the clinical expression of cystic fibrosis and/or to the genotype. METHODS: Nasal potential difference was measured in 79 adult patients with cystic fibrosis for whom clinical status, respiratory function, and CFTR genotype were determined. RESULTS: In univariate and multivariate analysis, patients with pancreatic insufficiency were more likely to have low responses to low chloride (odds ratio (OR) 8.6 (95% CI 1.3 to 58.5), p = 0.03) and isoproterenol (OR 11.2 (95% CI 1.3 to 93.9), p = 0.03) solutions. Similarly, in univariate and multivariate analysis, patients with poor respiratory function (forced expiratory volume in 1 second <50% of predicted value) were more likely to have an enhanced response to amiloride solution (OR 3.7 (95% CI 1.3 to 11.0), p = 0.02). However, there was no significant relationship between nasal potential difference and the severity of the genotype. CONCLUSIONS: Nasal epithelial ion transport in cystic fibrosis is linked to the clinical expression of the disease. The pancreatic status appears to be mostly related to the defect in epithelial chloride secretion whereas the respiratory status is mostly related to abnormal sodium transport and the regulatory function of the CFTR protein.

Gastroesophageal reflux: conventional surgical treatment versus laparoscopy. A prospective study of 61 cases.

Sixty-one patients with gastroesophageal reflux who did not respond to conventional medical treatment were treated in a prospective study, 29 by conventional surgery and 32 by laparoscopic methods. All underwent manometry and pH measurement preoperatively and at a follow-up of four months. There was no mortality, and the morbidity of the two groups was not significantly different at 3% and 5%. Hospital stay was significantly reduced (5.4 versus 8.9 days; p = 0.02) following laparoscopic treatment, and time off from work was 21.3 days versus 38.2 days (p = 0.02). The satisfaction index expressed by the patients was 65% at 1 month and 95% at 3 months. Dysphagia was observed in 30% of the patients at 1 month and in 3% at 4 months in both groups. The results of manometry and pH measurements at 4 months are comparable between open surgery and laparoscopy. There was one failure (3%) in the laparoscopic group caused by disruption of the valve. The mean pressure in the esophageal segment (expressed in mm Hg) changed in the two groups from 3.6 to 18.1 (p = 0.001). The results of this series show laparoscopic management of gastroesophageal reflux to be justified.

[Gastroesophageal reflux. Conventional surgery versus laparoscopic treatment. Prospective study (61 cases). Mano-Ph-metric evaluation at 4 months]. / Reflux gastro-oesophagien. Chirurgie conventionnelle versus traitement laparoscopique. Etude prospective (61 cas). Evaluation mano-Ph-métrique à 4 mois.

61 patients with aggressive gastro-esophageal reflux have been prospectively treated, 29 by open surgery and 32 by laparoscopy. There is no mortality and the morbidity is not significantly different (3 per cent vs 5 per cent). Hospital stay is strongly reduced in the laparoscopic group (5.4 days vs 8.9 days p = 0.02). Either the period of no professional activity (21.3 days vs 38.2 days p = 0.02). In both group, dysphagia is noted in 30% of the patients at 1 month and 3% at 4 months. All patients have had pre-operatively a mano-Ph-metry evaluation. At 4 months, the follow-up rate is 100% and all patient have been controlled with a 24 hours mano-Ph-metry. There is no difference between open and laparoscopic surgery. The mean SIO pressure had increased in both group from 3.6 mmHg to 18.1 mmHg (p = 0.001). There is only one failure in the beginning of the learning curve (4th patients in the "laparoscopy group" (3.1%). These study suggest that laparoscopic treatment could be proposed in the majority of failures of medical treatment in gastro-oesophageal reflux.

Is P50 the most representative P(SO2) to evaluate HbO2 affinity?

Off-line computer assistance allowed a correct visualization of the actual data included in any experimental whole oxygen-hemoglobin association curve. The affinity of hemoglobin for oxygen (characterized by the successive PO2 corresponding to any saturation value: P(SO2)), the shape of the association curve (Hill's curve and Hill's numbers) and the Bohr coefficients all along the oxygenation process, were determined with great accuracy. Results agreed with literature values obtained for successive steps of oxygenation. A batch of 78 computerized curves was divided into 3 groups (normal: NL, right deviated: RD and left deviated: LD) to which the principal component (P.C.) method was applied. It was therefore possible not only to study correlations between any curve summarized by its P.C. and any external variable but also to define for any association curve, whatever its eventual shift, the most representative value of P(SO2). For all mixed groups, the most significant parameter would be P44. If the characterization of the HbO2 dissociation curve is to be represented by a single point, then it should be P48 for the NL curves, P52 for the LD group, and P24 for the RD group. Then, the common use of P50 appeared to be illegitimate and inadequate for the right shifted curves, a very frequent circumstance in clinical practice.

Application of new calculation algorithms to oxygenation parameters of cirrhotic patients. A comparison between calculated and measured data.

Oxygen status from both arterial and mixed venous blood was analyzed by reliable methods in 39 cirrhotic patients. These measured data were checked with computed oxygen parameters by new calculation algorithms. Calculated oxygen contents were higher than directly measured values but there was a highly significant correlation between them. Calculated and measured 2,3-DPG mean values were not significantly different but there was no correlation between them. A large difference was observed between measured and computed evaluation of oxygen-hemoglobin affinity without correlation between P50. In hyperkinetic patients, no correlation was observed between 'compensation factor' and the increase of cardiac index. So, in these patients the new iterative equations were not valid to determine traditional oxygen parameters from only Po2 and So2 arterial measurements. Moreover the new oxygenation parameters appeared frankly inadequate.

[Bronchiolitis obliterans with cryptogenetic-like organizing pneumonia. Demonstration of gastro-esophageal reflux in 5 cases]. / Bronchiolite oblitérante avec pneumonie en voie d'organisation en apparence cryptogénétique. Mise en évidence d'un reflux gastro-oesophagien dans 5 cas.

Gastro-oesophageal reflux was demonstrated in 5 cases of bronchiolitis obliterans with apparently cryptogenetic organizing pneumonia. In addition, one patient had hiatus hernia and another, oesophageal diverticulum. In 4 patients, after failure of prolonged antibiotic therapy, medical or surgical treatment of the gastro-oesophageal reflux resulted in regression of the clinical and radiological signs of pulmonary lesions. The cure thus obtained persisted throughout a follow-up period of 2 months to 8 years. Gastro-oesophageal reflux therefore could be one of the causes of apparently cryptogenetic bronchiolitis obliterans with organizing pneumonia, and all patients with this respiratory disease should be investigated for gastro-oesophageal reflux.

[Drepanocytosis and diffuse interstitial pulmonary fibrosis (author's transl)]. / Drépanocytose et fibrose pulmonaire interstitielle diffuse.

Respiratory disorders in homozygous drepanocytosis and double SC heterozygosis are mainly dependent on two factors : repeated infections with, more particularly, pneumococcus or mycoplasma, and epidoses of occlusion of the pulmonary circulation. Mutual reinforcement of these two factors occurs, in so far as the relative hypoxia of an infected lung increases the risk of falciform and thrombosis formation in the pulmonary arterioles. The particular physical and chemical properties of the drepanocyte red cell, and the anaemia, themselves lead to parallel disturbances in pulmonary circulation function and gas exchanges. Possible development of respiratory insufficiency is generally, therefore, the result of chronic pulmonary arterial hypertension. However, the results of respiratory function tests are often fairly analogous to those observed in moderate interstitial fibrosis : reduction in vital capacity, alveolo-capillary block, reduction in CO diffusion space, a shunt effect, and diminished pulmonary compliance. This problem is discussed in relation to findings of diffuse interstitial fibrosis in a 34-year-old man with double SC heterozygosis, who had numerous episodes of bone, abdominal, and pulmonary microinfarcts. The presence of a diffuse interstitial pulmonary fibrosis, evoked by radiological criteria and respiratory function tests and confirmed by transbronchial biopsy, no other aetiology being established, raises the question of the possible genesis of the fibrosis from repeated episodes of microvascular occlusion. Many factors may therefore be involved in the formation of fibrosis of this type, not only the pulmonary artery obstruction from the microthrombi but also the macrophagic perivascular inflammatory response related to the presence of foci of infarction and precipitation of pathological intravascular material.