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Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé Introduction Le syndrome de Cushing paranéoplasique est une cause rare d’hypercorticisme endogène. Il est dû à une sécrétion ectopique d’ACTH par une tumeur endocrine non hypophysaire. Les données biologiques et radiologiques à visée étiologique sont souvent non concluantes posant un problème de diagnostic différentiel avec la maladie de Cushing. En outre, ces tumeurs sont souvent de petite taille et leur siège est extrêmement variable d’où les difficultés de localisation imposant le recours à des techniques d’imagerie moderne notamment la tomographie par émission de positons au 18-fluoro-désoxyglucose (TEP- 18 FDG) ou au 18-fluoro-dihydroxyphénylalanine (TEP au 18 FDOPA). Observation Nous rapportons l’observation d’un homme âgé de 50 ans présentant un syndrome de cushing sévère et rapidement évolutif, en rapport avec un hypercorticisme par sécrétion ectopique d’ACTH. Devant la sévérité du tableau clinique, la résistance au traitement par kétoconazole et l’impossibilité de localiser la tumeur causale par les techniques d’imagerie conventionnelle, une surrénalectomie bilatérale de sauvetage était réalisée. Deux ans plus tard, la tomodensitométrie thoracique objectivait un nodule de 11 mm isolé au niveau du lobe inférieur gauche, la TEP au 18 FDG retrouvait un hypermétabolisme discret du nodule pulmonaire sans spécificité, et la TEP au 18 FDOPA confirmait la nature hyperfixante de ce nodule en faveur d’un carcinome endocrine. L’examen anatomopathologique était en faveur d’une tumeur carcinoïde typique et le complément immuno-histochimique montrait une positivité des cellules tumorales pour l’ACTH, le CD56, la chromogranine et la synaptophysine. Conclusion Cette observation illustre le dilemme entre la nécessité de localiser la sécrétion ectopique de l’ACTH et le contrôle d’un syndrome de Cushing agressif et menaçant. Le recours précoce à la TEP au 18 FDG ou au 18 FDOPA doit être envisagé si le diagnostic topographique de la tumeur causale ne peut être fait par les techniques d’imageries conventionnelles. Introduction Paraneoplastic Cushing's syndrome is a rare cause of endogenous hypercortisolism attributable to ectopic ACTH secretion by non-pituitary tumors. Imaging and biochemical results are often inconclusive and differential diagnosis with Cushing's disease can then be challenging. Moreover, these tumors may be occult and difficult to find and thus the need of new imaging tools such as 18 FDG-PET scan and 18 DOPA-PET scan. Case report We report a 50-year-old man who presented with very aggressive clinical features related to Cushing's syndrome. Biological work-up confirmed the hypercortisolism and was consistent with an ectopic ACTH secretion. Conventional localization techniques failed to show any tumor and bilateral adrenalectomy was performed because of life-threatening complications. Two years later, thoracic computed tomography reveals an 11 mm mass in the left lower pulmonary lobe, 18 FDG-PET scan found a non-specific mild hypermetabolism of the lung nodule, and the 18 DOPA-PET scan confirmed the high uptake of this nodule suggesting an endocrine carcinoma. Histology confirmed a typical carcinoid tumor. The tumor cells stained positive for ACTH, CD56, chromogranin and synaptophysin. Conclusion This case illustrates the dilemma between the need for morphological diagnosis of the ectopic ACTH source and control of the life-threatening hypercortisolism. 18 FDG-PET scan and 18 DOPA-PET scan should be considered early as a secondary diagnostic tool when conventional imagery fails to show any tumor. [ABSTRACT FROM AUTHOR]

Abstract: Introduction. – Oncogenic osteomalacia (OO) is a rare paraneoplastic syndrome characterized by severe hypophosphatemia induced by phosphaturic factors which are secreted by some tumors of mesenchymal origin. Fibroblast Growth Factor 23 (FGF-23) belongs to this family. Measurement of FGF-23 might improve the diagnosis of OO. Exegesis. – We report the case of 71-year-old Caucasian man who had a history of severe osteomalacia with multiples fractures and extreme hypophosphatemia with hyperphosphaturia and normal serum calcium level. Serum FGF-23 was 199 RU/ml (N<100 RU/ml). The tumor, detected by F-18 FDG PET/CT SCAN was localized in the mandible. Surgical removal of the tumor relieved all symptoms with normalization of serum phosphate levels within 3 days after surgery. Conclusion. – We conclude that FGF-23 measurement is likely to be of considerable importance for facilitating early diagnosis of OO. [Copyright &y& Elsevier]

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction Les complications hémorragiques du traitement par AVK constituent 13 % des admissions à l’hôpital pour des événements indésirables liés aux médicaments, soit environ 17 000 admissions par an. Parmi ces hémorragies, les hématomes musculaires profonds sont classés comme des hémorragies sévères. Ils sont classiquement traités par un traitement conservateur avec l’arrêt du médicament et la réversion spécifique, et dans de rares cas, par évacuation chirurgicale. Cependant, la diffusion ou la réapparition de saignement, bien que l’effet des AVK ait été annulé, doit suggérer une étiologie supplémentaire. Observation Une femme âgée de 56 ans est admise aux urgences pour une douleur du flanc droit avec parésie de la jambe droite depuis 4 jours. Dans ses antécédents, on retient une fibrillation auriculaire traitée par warfarine 5 mg/jour, un tabagisme à 36 paquets-année. À son admission, elle est hémodynamiquement stable. L’hémoglobine est à 122 g/L, les plaquettes à 395 G/L et l’INR à 2,62. Le scanner abdominal révèle un hématome du psoas-iliaque droit. Sous vitamine K et perfusion de concentré de complexe prothrombinique, l’INR tombe à 1,2. En raison d’une monoparésie sévère du crural droit, elle bénéficie le même jour d’une évacuation chirurgicale. Huit jours plus tard, le taux d’hémoglobine est de 67 g/L. On retrouve une aggravation du déficit neurologique de la jambe droite et le scanner de contrôle révélé une récidive de l’hématome conduisant à un nouveau drainage chirurgical. Après l’amélioration postopératoire, le patient est transféré en service de médecine. À l’entrée, le taux d’hémoglobine était de 79 g/L, l’INR normal. Le bilan complémentaire ne montre pas d’anticoagulant circulant ni d’Ac antiphospholipides. Devant la persistance d’un saignement justifiant des transfusions rapprochées et répétées, le patient est transférée en soins intensifs. La relecture des différents examens TDM antérieurs montre, outre l’hématome du psoas-iliaque, une hémorragie surrénalienne bilatérale ainsi qu’un hématome périrénal gauche. Un complément de TDM thoracique met en évidence alors une lésion suspecte de malignité du culmen. La tomographie avec émission de positons (FDG PET scan) révèle une lésion hypermétabolique du culmen, mais aussi des glandes surrénales et dans les muscles psoas-iliaque, deltoïde, rectus abdominis, muscles fessiers, en faveur de métastases multiples. La biopsie des lésions suspectes confirme des métastases d’un cancer non à petites cellules du poumon. Une radiothérapie hémostatique est réalisée sur les psoas-iliaque, mais la chimiothérapie restera inefficace et la patiente décédera quelques semaines plus tard. Discussion Les hématomes du psoas sous AVK peuvent survenir même en l’absence de surdosage. Bien que généralement unilatéraux, de rares cas d’hématomes bilatéraux ont été rapportés et nécessiter une réversion de l’effet anticoagulant. Comme dans notre cas, le traitement chirurgical est réservé aux hématomes avec signes neurologiques. La récurrence, alors que l’hémostase est contrôlée, ainsi que la diffusion des saignements, doivent attirer l’attention sur un diagnostic alternatif notamment un anticoagulant acquis ou une pathologie tumorale. Les métastases tumorales impliquant le muscle squelettique sont rares, impliquant souvent le diaphragme, les muscles grand droit, deltoïde, intercostaux et les psoas-iliaques. Plusieurs cas de métastases du muscle psoas ont déjà été décrits mais 2 seulement dans les cancers bronchiques. La présentation clinique est un syndrome du psoas classique, en particulier la douleur, mais il n’est pas rapporté d’observation d’hémorragies récurrentes connexes. Le diagnostic tomodensitométrique est souvent difficile, en particulier dans la différenciation des néoplasmes psoas-iliaque, des abcès et des hématomes. Les glandes surrénales sont un site commun de métastases de carcinome du poumon non à petites cellules, mais l’hémorragie rétropéritonéale de lésions métastatiques surrénaliennes secondaires au cancer du poumon est extrêmement rare. Le scanner est sensible et spécifique pour le diagnostic d’hémorragie surrénale, mais peut échouer à distinguer un hématome d’une masse tissulaire. Comme dans notre cas, la TEP-FDG peut permettre de mieux caractériser le processus métastatique, probablement à rapporter à des lésions hypervascularisées. Conclusion Un hématome est le premier diagnostic à évoquer devant un syndrome du psoas chez un patient sous AVK. Cependant, après un traitement spécifique et après avoir écarté un inhibiteur acquis de la coagulation, une pathologie tumorale doit être recherchée, particulièrement en cas de récidive ou d’hémorragies diffuses associées. [ABSTRACT FROM AUTHOR]

Copyright of Oncologie (Tech Science Press) is the property of Tech Science Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Cancer / Journal Africain du Cancer is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objective: [18F]fluoro-deoxy-glucose positron-emission tomography combined with integrated computed tomography (FDG-PET/CT) is commonly used for advanced stage cervical cancer but its efficiency is discussed in early stage. The aim of this study was to evaluate false negative rate of FDG-PET/CT in early-stage cervical and vaginal cancer. Patients and methods: Patients treated between 2005 and 2008 for stage IB1 cervical cancer and stage I vaginal cancer who underwent a FDG-PET/CT followed by a pelvic lymphadenectomy were studied. Results: Eighteen patients were included with bilateral pelvic lymphadenectomy (16 cervical cancer, two vaginal cancer). The median age of patients was 41years. Radical hysterectomy was performed for 16 patients, by a laparoscopic approach in 15 cases and by a laparotomic approach in one case. One patient had a simple hysterectomy and one had exclusive radiotherapy. No patient had pelvic or para-aortic fixation on FDG-PET/CT. Three patients have proven pelvic involvement and one had para-aortic metastases. The false-negative rate and negative predictive value of FDG-PET/CT were 17% and 83% respectively. Discussion and conclusion: The accuracy of FDG-PET/CT imaging in predicting the pelvic nodal status is very low in patients with early-stage cervical and vaginal cancer and is not able to replace surgical exploration. [Copyright &y& Elsevier]

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Oncologie (Tech Science Press) is the property of Tech Science Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Lymphoma is the most common orbital malignancy in adults. Among the types of lymphoma, mantle cell lymphoma is a particularly aggressive form, often discovered through systemic involvement, with a dismal prognosis due to frequent recurrences. It is secondary to a t (11 ; 14) (q13; q32) chromosomal translocation resulting in an anti-apoptotic signal via overexpression of Bcl-2. Treatment is based on R-CHOP poly-chemotherapy. We describe the case of a patient with an orbital recurrence of mantle cell lymphoma successfully treated with oral Bcl-2 inhibitor monotherapy. A 58-year-old man who was treated with R-CHOP 8 years ago for mantle cell lymphoma, in remission for 5 years, presented with progressive decreased visual acuity in the left eye, along with binocular diplopia. Clinical examination revealed a decrease in visual acuity in the left eye to 1/20 Parinaud 20 and a relative afferent pupillary defect on the left. External examination revealed a left cranial nerve VI palsy, 2mm of painless proptosis, and hypesthesia of the left V1 territory, leading to a diagnosis of left orbital apex syndrome. The disc and macular OCT were normal. The visual field showed enlargement of the left blind spot. An emergency CT scan and MRI revealed an apical extraconal tissue mass infiltrating the medial rectus muscle, extending to the superior orbital fissure, optic canal and left cavernous sinus, hyperintense on T2 weighted images and isointense on T1. The morphological appearance was strongly suggestive of an infiltrative lymphomatous process. An 18 FDG PET-scan identified the orbital lesion as well as enhancing lesions in the axilla and colon; given the clinical features and test results, the diagnosis of recurrent mantle cell lymphoma was made without biopsy. Treatment with Venetoclax (Bcl-2 inhibitor) was initiated. At one month of treatment, the orbital apex syndrome had entirely resolved, with visual acuity increased to 8/10 Parinaud 4 and a metabolic return to normal on PET scan. The PET scanner and clinical examination at 3 months were entirely normal. At the one-year follow-up visit, the patient was still on Venetoclax, the clinical examination was unchanged, and the PET-scan still showed a complete metabolic response., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: Aortic involvement that occurs in temporal arteritis is probably underestimated because it is usually asymptomatic. The characteristics of giant cell arteritis with aortic involvement are still poorly described and the relationship between aortitis and vascular outcome of the disease has not been clearly delineated. The objective of this retrospective study of 63 patients with giant cell arteritis, including 26 with aortic involvement, was to compare the features of patients with and without aortitis, and to assess the contribution of CT-scan and FDG-PET-scan in screening for vascular disease, monitoring, and therapeutic management of patients., Methods: This retrospective study was conducted in the internal medicine department of the university hospital in Marseille, France, from January 1, 2005 to September 30, 2011. Patients had at least three out of the five American College of Rheumatology criteria for temporal arteritis and aortic involvement was investigated in all patients using CT-scan. Aortic wall thickness greater or equal to 3mm was considered to be abnormal., Results: Of 63 patients diagnosed with giant cell arteritis, 26 (41.3%) had aortic involvement diagnosed by aortic CT-scan. Age at diagnosis was significantly younger (66.8 vs 73.8 years; P=0.002) in the group with aortitis. Inflammatory dorsal and low back pain, signs of vascular disease of the upper limbs (P=0.009), and higher level of acute phase reactants were associated with aortitis. Aneurysmal lesions of the aorta were significantly more frequent in the group with aortitis. Twenty patients had both aortic CT-scan and FDG-PET-scan. For patients in whom aortic involvement was not demonstrated with CT-scan, FDG-PET-scan was always non-contributive. With corticosteroids, aortitis resolved within 6 months in all patients as evaluated by aortic CT-scan. However, aortitis persisted in 80% of cases at 6 months when evaluated with FDG-PET-scan, and in 66% of cases at 12 months, without influencing the treatment., Conclusion: This case series shows no specific features of aorta and its main roots involvement in giant cell arteritis, justifying a systematic screening by CT-scan. The high frequency of this arterial involvement could help physicians in the diagnosis of giant cell arteritis. Aortitis seems to be associated with vascular complications as highlighted by the frequency of aortic aneurysm and a case of early aortic dissection. Finally, the role of PET-CT-scan for screening vascular disease and therapeutic monitoring remains to be clarified., (Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Purpose: Recent clinical results of dose escalation with stereotactic body radiation therapy to increase local tumour control for patients with stage I non-small-cell lung cancer who either refuse surgery or are medically inoperable resulted in making it a standard treatment in this setting. This treatment technique was implemented at the Paul-Strauss Centre, Strasbourg, in 2010. The objective of this study is to describe and analyze the data of the first 20 treated patients., Patients and Methods: From October 2010 to May 2012, 20 patients were treated with this technique for T1N0M0 or T2N0M0 lung tumour. The indication was proposed by the multidisciplinary thoracic oncology team meeting, and approved by the technical committee of the Department of Radiotherapy. After the realization of a dosimetric CT Scan (4DCT or three phases-free breathing and deep breath-hold inspiration and expiration) and after performing a ((18)F)-FDG PET scan in the treatment position, all patients were treated on Novalis Tx(®) linear accelerator, with arctherapy or modulated intensity radiotherapy (IMRT). A protocol has been defined for the prescribed dose, depending on the size and location of the tumor, central or peripheral. The patients underwent follow-up during treatment and at 1 month, 3-4 months, 6 and 9 months to assess outcomes and toxicities., Results: The mean age was 72.6 years (52-89). Seventeen patients had one or more pulmonary comorbidities. The mean delivered dose was 59.9 Gy (40-70) in 4 Gy to 17.5 Gy fractions. The mean gross tumour volume was 14.9 mL (median 7.2, 0.9 to 73.5) and the mean planning target volume was 77.8 mL (median 49.5; 17-300). The mean initial SUV max was 7.7 (1.8 to 16.7). Dose constraints and planning target volume coverage recommended by the protocol were achieved in the majority of cases. The mean lung V20 was 7.63% (1.2 to 17.7) and the mean dose delivered to the planning target volume was 94.6% (88-99). The duration of treatment was 21 days (median: 23; 8-27), and no change or interruption of prescribed treatment has occurred. Median follow-up was 6.6 months, and crude rates of objective response for patients evaluated were 85% (11/13 patients) at 3 months and 100% at 6 and 9 months. The complete response rate at 3 and 6 months were 0 (0/13 patients) and 50% (5/10 patients). Two patients had metastatic disease in the 6 months following treatment. Concerning pulmonary toxicity at 3 months, 6 patients developed G2 radiation pneumonitis and three patients G3, with positive evolution., Conclusion: The analysis of the results of this series, comparable with those described in literature, shows that lung stereotactic radiotherapy is an effective and well-tolerated treatment for inoperable patients. The extension of the indications could be envisaged based on the results of ongoing trials., (Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

A solitary pulmonary nodule is a common clinical problem. It is usually detected incidentally. The prevalence of solitary pulmonary nodule (SPN) in the lung cancer screening study varies from 8 to 50% (with a prevalence of malignant nodule from 1 to 13%). The bayesian approach can help us to identify promptly malignant nodule in order to treat them surgically and to avoid surgery for benign nodules. Therefore, it is needed to estimate the probability of cancer (Pca) in the SPN. Likelihood ratio (LR) for overall prevalence of malignancy and for different clinical and radiological information (age, smoking exposure, symptoms, cancer history, nodule size, spiculation, calcification, location, growth...) can be obtained from the literature. The odds of cancer-malignancy (odds ca) can be calculated by multiplying all of these LRs together. The Pca = odds ca/1+odds ca. Using this bayeasian approach, the probability of cancer based on an abnormal or normal fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) scan has been estimated. Sensitivity, specificity, positive predictive value and negative predictive value of PET scan are respectively about 90%, 83%, 92% and 90%. Moreover, the LR for malignancy are higher with an abnormal PET scan when compared to most clinical and radiological LRs. Today, the Bayesian approach of SPN must include PET scan.

Primary adrenal lymphoma is a rare condition. Only 70 cases were described in the literature. Adrenal lymphoma is often bilateral and in most of the cases of B-cell type. T-cell lymphoma is exceptional. The prognosis is bad and patient can die early because of acute adrenal insufficiency. We report a case of a 70-year-old man who was admitted for acute adrenal insufficiency due to primary bilateral adrenal T-cell lymphoma. He had corticotherapy and surgical exploration for intra-abdominal sepsis. He died because of multivisceral deficiency. Clinical features and imaging are not specific. (18)F-FDG PET Scan is an excellent mean to detect malignant tumor of adrenal gland. Percutaneous needle biopsy is useful to determine histology. The standard treatment is chemotherapy.

Background and Purpose: Taylor-type focal cortical dysplasias (TTFCD) represent a particular pathological entity responsible for severe drug-resistant epilepsy of extratemporal location. Epilepsy can be surgically cured if complete removal of the lesion can be performed. However, identification on imaging may be difficult and negative standard MRIs are not rare. The frequent location of TTFCD in the central region restrains the possibilities of complete resection. We report a series of patients operated on for intractable epilepsy associated with TTFCD in the central area., Patients and Methods: Between 2000 and 2006, of 34 consecutive patients with TTFCD, 17 had a lesion located in the central area. MRI was considered normal in eight, although in five a subtle gyral abnormality was disclosed on further analysis. A (18)FDG PET scan performed in 16 cases demonstrated focal hypometabolism in 15 that correlated with abnormalities on MRI when visible. SEEG performed in 13 cases revealed typical abnormalities for TTFCD in 10 cases. At resection, cortical and subcortical stimulations of the dysplastic cortex did not elicit a motor response., Results: Postoperative motor or sensory deficit was observed in 13 patients--severe in four--which subsequently resolved completely in seven. Six patients had a minor permanent, motor or sensory deficit. Four patients were reoperated for seizure recurrence and residual dysplastic tissue was found at reoperation in three cases. Average postoperative follow-up was 3.7 years. Sixteen patients (94%) were in Engel Class I (65% in Class IA)., Conclusion: This study suggests that surgical resection of central region TTFCD may be associated with favorable seizure outcome and no or minor functional permanent disability. In cases of seizure relapse, reoperation can be performed without further permanent deficit and lead to seizure-free outcome. Future techniques for intraoperative detection of these lesions could optimize their complete resection in functional areas.

Presentation of a 57-year-old female patient with fever of unknown origin, asthenia, and weight loss for I month. History and examination were unremarkable. Blood analysis showed an important inflammatory syndrome. Other paraclinic tests were all normal. Finally, sophisticated exams (CT-scan, and FDG PET-scan) allowed the diagnosis of giant cell arteritis, confirmed by biopsy of the temporal arteries. Differential diagnosis and treatment are discussed.

Introduction: Anti-Hu associated paraneoplastic neurological syndromes are rare and characterized by poor prognosis. The research and treatment of a related cancer, a small-cell lung cancer most of the time, remains the best therapeutic strategy., Case Report: We describe the clinical course of a paraneoplastic subacute sensory neuronopathy associated with anti-Hu antibodies in a male smoker treated by an early chemotherapy active against a small-cell lung cancer although no tumor could be found at repeated evaluations. In spite of this treatment, the neurological state deteriorated with the appearance of a cerebellar degeneration, and limbic encephalitis which resulted in a loss of autonomy. A small-cell lung cancer was found and treated 65 months after the onset of the neurological symptoms. The treatment of the underlying malignancy, when it can be found, is still considered as the optimal treatment for paraneoplastic neurological syndromes. Although no tumor could be found, we treated our patient with an empirical chemotherapy active against the most frequent malignancy associated to anti-Hu syndrome in a smoker man, without any improvement., Conclusion: Active and repeated research for a cancer related to an anti-Hu neurological syndrome and its treatment are undispensable. For our patient without any identified cancer empirical chemotherapy treatment was unable to stop neurological worsening. When no tumor can be identified by conventional imaging techniques, an early FDG-PET scan should be considered and then repeated if normal.

Objective: To evaluate and compare the performances of FDG-PET imaging, MRI and clinical examination in the detection of residual tumour 3 months after treatment of patients with head and neck squamous cell carcinoma., Patients: A consecutive sample of 50 patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx or larynx, or a cervical lymph node metastasis from an unknown primary site excluding T1 lip and T1 vocal cord tumours., Methods: Treatment outcome was assessed after 3 months by clinical examination, MRI, and FDG-PET scan. Sensitivity, specificity and accuracy were calculated relative to proven biopsy of residual tumour or a clinical follow-up of 4 months., Results: Residual cancer was confirmed in 8 patients (16%), while the clinical follow-up was unsuspicious in the remaining 42 patients. PET-FDG had a sensitivity of 100% as compared to MRI (88%) and clinical examination (63%). Specificity was higher for clinical examination (90%), intermediate for MRI (83%) and lowest for PET-FDG (74%)., Conclusions: This study finds very high sensitivity for PET-FDG in the detection of residual tumour. However, its lower specificity, lack of anatomical resolution, and high cost, require further studies to determine its role in routine screening.