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Objectif: There are no guidelines regarding the content of information to be delivered in nuclear medicine. This study aimed at describing practices of French nuclear medicine physicians concerning results communication to patients undergoing PETs for oncological indications. Methodes: A survey was performed among French nuclear medicine physicians using an electronic questionnaire. Resultats: The study included 250 nuclear medicine physicians. Their practices regarding communication of PET results to patients were heterogeneous: (1) pre- and/or post-PET consultations were systematic for 56%, adapted on a case-to-case basis for 35%, and never performed for 9% of respondents; (2) oral communication of results was systematic for 13%, adapted on a case-to-case basis for 63%, and never performed for 24% of respondents. Working in a private center, presence of post-PET consultations, being older and more years of experience were significantly associated with more oral communication of results. Finally, 80% of physicians admit that current recommendations are not clear enough. Conclusion: The heterogeneity of practices among French nuclear medicine physicians concerning communication of PET results to patients probably results from lack of clear recommendations. An inter-collegial, ethical, and multi-disciplinary reflection is needed to better guide nuclear medicine physicians in relation to the communication of results to patients suffering from serious disease., SCOPUS: sh.j, info:eu-repo/semantics/published

Objectives The estimation of fracture risk using clinical risk factors (CRFs) is of primary concern in osteoporosis management, but only some risk factors have been thoroughly evaluated and incorporated in predictive models. We have launched a large prospective study, the ‘Fracture Risk Brussels Epidemiological Enquiry’ (FRISBEE), to develop a new predictive model for osteoporotic fractures. The aims of this report are to describe the methodology of the FRISBEE study and to compare the distribution of CRFs in our cohort with those reported in other large studies. Study design FRISBEE is a new study that prospectively evaluates a cohort of 3560 post-menopausal women (aged 60–85 years) followed yearly for the occurrence of fragility fractures. Multiple validated CRFs, densitometry (DXA) values and intake of medication were systematically registered at baseline. The distribution of the FRISBEE CRFs has been compared with the distributions of CRFs in the cohorts used to develop the FRAX® model as well as in more recent cohorts. For these recent cohorts, we focused on CRFs not included in FRAX®. Results The most frequently encountered CRFs used in FRAX® were a prior fragility fracture (27.1%) and a parental history of hip fracture (13.4%). The prevalence of some CRFs not integrated in FRAX® was relatively high, such as the use of proton pump inhibitors (20.8%) and a history of fall(s) (19.7%). The prevalence of many CRFs was quite variable between cohorts; for example, the prevalence of ‘personal prior fragility fracture’ ranged from 9% to 51%. Conclusion We found considerable heterogeneity in the prevalence of CRFs between cohort studies. The impact of these differences on the predictive value of a particular CRF is unknown. We will construct a predictive model calibrated to the Belgian population. More importantly, the FRISBEE study should allow us to determine the predictive value of newly recognized CRFs in addition to the FRAX® algorithm to reliably estimate fractur, SCOPUS: ar.j, info:eu-repo/semantics/inPress

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Background The treatment of complicated urinary tract infection in children is still a matter of debate. In our hospital, antimicrobial treatment is initiated intravenously, and the duration of this treatment is adapted according to the results of a Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy. Aim This study was conducted to evaluate retrospectively the frequency and the importance of late renal sequelae when treating intravenously for 7 days those patients with an abnormal acute DMSA. Methods A review was conducted of the medical charts of all patients consecutively admitted between 2005 and 2008 with positive urine culture and clinical and biological evidence of complicated urinary tract infection (UTI). Results There were 144 patients (59 %) with abnormal early DMSA scintigraphy and 98 (41 %) with normal scintigraphy. The median duration of intravenous treatment was 7.0 days in the children with DMSA lesions and 5.0 days in those without lesions. Obvious renal sequelae were observed on late DMSA scintigraphy in 4 (6 %) out of the 65 patients with an abnormal early DMSA who came back for control scintigraphy. Conclusion Sequelae of acute DMSA lesions observed during complicated UTI treated 7 days intravenously were infrequent. Whether the mode and duration of antimicrobial treatment might explain the low rate of sequelae remains to be demonstrated., SCOPUS: ar.j, info:eu-repo/semantics/published

OBJECTIVES: The aim of the study was to evaluate prospectively the usefulness of fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in investigation of fever of unknown origin (FUO) in HIV-positive patients and to determine whether HIV viraemia impacts on FDG-PET/CT performance. METHODS: The FDG-PET/CT results of 20 HIV-infected patients with FUO were analysed and compared with the FDG-PET/CT results of 10 HIV-infected viraemic patients without FUO. The performance of FDG-PET/CT for identifying the aetiology of FUO was assessed. Final diagnosis for FUO was based on histopathology, microbiological assays, or clinical and imaging follow-up. RESULTS: FDG-PET/CT contributed to the diagnosis or exclusion of a focal aetiology of the febrile state in 80% of patients with FUO. The presence of increased FDG uptake in the central lymph node has 100% specificity for focal aetiology of fever, even in viraemic patients. The absence of hypermetabolic central lymph nodes in FUO patients has 100% negative predictive value for focal disease. Lymph node biopsy in central hypermetabolic areas allowed, in 100% of cases, identification of underlying disease in patients with FUO. Biopsy of peripheral lymph nodes should be performed in lymph nodes with maximum standardized uptake value (SUVmax) ≥ 6-8 (sensitivity 62.5%; specificity 75%) and avoided in lymph nodes with SUVmax = 0-4 (specificity 0%). High HIV viraemia does not prevent correct interpretation of FDG-PET/CT. CONCLUSIONS: As in HIV-negative patients, we confirm the usefulness of FDG-PET/CT in investigation of FUO in HIV-positive patients even if they are viraemic., JOURNAL ARTICLE, FLWIN, SCOPUS: ar.j, info:eu-repo/semantics/published

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BACKGROUND: Output efficiency (OE) and normalized residual activity (NORA) are two parameters that allow quantifying the renal drainage at any moment of renographic acquisition. Although OE is theoretically more accurate than NORA in case of a decreased overall renal function, both parameters present some weaknesses. OBJECTIVES: To compare both parameters and to evaluate whether the clinical information provided by both parameters is identical. METHODS: From a large database of Tc-99m mercaptoacetyltriglycine 3 renographic studies, 450 kidneys were selected covering a large range of ages, overall function, split function, and quality of drainage. NORA and OE were calculated at the end of the 20-min renogram, as well as on the late post erect postmicturition (PM) views. RESULTS: An inverse correlation was observed between NORA 20 and OE 20 (r=-0.926), as well as between NORA PM and OE PM (r=-0.936). Discrepancies were noted in approximately 10% of the kidneys, but main discrepancies, which would result in a different estimation of the quality of drainage, were only observed in 2% of the kidneys. There was no bias in the discordances; OE could reveal a better as well as a worse quality of drainage than NORA. It is likely therefore that imperfections of both parameters might be the cause of the divergences. The stratification of the kidneys according to age, overall renal function, split function, or quality of drainage did not modify the results. CONCLUSION: NORA, being much easier to program, can replace the output efficiency in the evaluation of renal drainage. © 2011 Wolters Kluwer Health, SCOPUS: ar.j, info:eu-repo/semantics/published

INTRODUCTION: Until recently, renogram, performed in children with pelvi-ureteric junction stenosis detected antenatally, has not been able to predict the probability of function improvement after surgery or the risk of function deterioration in case of conservative attitude. Recently, Schlotmann et al. have suggested that cortical transit might have this predictive role. The aim of this study, focused on those kidneys with severely impaired cortical transit, was to verify this statement. METHODS: All renograms performed in children during a 3-year period (n=729) were retrospectively reviewed and 19 pediatric patients were selected based on an antenatally detected unilateral pelvi-ureteric junction syndrome, the existence of at least two renograms during the follow-up and a severe cortical transit impairment, visually defined. Twenty-six pairs of data could be analyzed and allowed comparing preoperative and postoperative differential renal function (DRF), and the DRF changes during the conservative management. RESULTS: Among the 16 patients who underwent pyeloplasty, 10 showed a significant DRF improvement. Among the 10 patients with conservative follow-up, four showed a significant DRF deterioration. CONCLUSION: Severely impaired cortical transit seems to be a valuable marker of those patients who could benefit from a pyeloplasty, either because of the high probability of postoperative DRF improvement, or because of DRF deterioration in case of an conservative approach. However, a normal cortical transit, as defined in this study, does not exclude the risk of DRF deterioration. Alternatively, the design of this study does not allow excluding the fact that DRF might improve after pyeloplasty despite a normal cortical transit. © 2011 Wolters Kluwer Health, SCOPUS: ar.j, info:eu-repo/semantics/published

Noninvasive techniques have poor sensitivity and specificity in diagnosing endometriosis, which is often associated with an inflammatory process. In several benign diseases, measurement of hypermetabolism using fluorodeoxyglucose (18F 18FDG) reflects the degree of inflammation and aggressiveness of the disease. This prospective study evaluated the value of (18)FDG positron emission tomography (PET)-computed tomography (CT) in assessing the presence of endometriosis., Evaluation Studies, Journal Article, Research Support, Non-U.S. Gov't, SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives: I-123 ioflupane (FP-CIT) single-photon emission computed tomography is a recognized tool in the diagnosis of Parkinsonian syndromes. In practice, data interpretation relies on visual and semiquantitative analyses. Good interobserver reproducibility is a prerequisite before claiming the robustness of a technique. This study aimed at evaluating interobserver reproducibility of this approach. Methods: Thirty nuclear medicine physicians participated in the study. Data included FP-CIT images and semiquantitative measurements of 12 cases, covering a wide spectrum of scintigraphic patterns and for which a 'true' clinical diagnosis based on long-term follow-up was available. Interobserver agreement was defined, for each case, as the highest percentage reached among the three proposed answers with complete agreement arbitrarily set at 80% or more. Variability in an individual observer's sensitivity to assess data as normal, equivocal or abnormal was scored using a three-point scale. Results: Response rate was 99.7%. Among the three possible answers, 'normal' accounted for 41.2% of the total, 'abnormal' for 49.8% and 'equivocal' for 8.1%. The mean interobserver agreement was 76% (range: 37-100%), with complete agreement being reached only in five cases. The interpretation proposed by most observers accorded to clinical diagnosis in 75% of the cases. Abnormalities of the central nervous system were encountered in all the cases with disagreement between the observer's interpretation and clinical diagnoses. An important variability in the observers sensitivity was seen. Conclusion: In the particular setting of this preliminary study evaluating the reproducibility of FP-CIT single-photon emission computed tomography interpretation in a group of nuclear medicine physicians with various experiences, interobserver agreement was suboptimal. Collegial discussion and standardized interpretation criteria could contribute to an improved reproducibility. © 2010 Wolters Kluwer, SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives: Osteopenia and osteoporosis are more frequent in HIV-infected patients. Whether antiretroviral therapy induces a bone mineral density (BMD) loss remains controversial and few data are available in women. This cross-sectional study of 89 pre-menopausal HIV-infected women evaluates the relationship between BMD and antiretroviral treatment. Methods: Three groups of women were compared: women never treated (n = 37), women treated with nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors and never treated with protease inhibitor (PI) (n = 25) and women treated with a PI-containing regimen (n = 27). Their lumbar spine and hip BMD was measured by dual-energy X-ray absorptiometry. We assessed also demographic parameters, body mass index (BMI), habits, history of HIV infection and treatment, lipodystrophy and metabolic and hormonal parameters. Results: 83% were African women. Mean age was 37 years. Median duration of HIV treatment was 3.5 years. The overall prevalence of osteopenia/porosis was 31.5%. No difference was found between the three groups. Using logistic regression, low BMI was the only factor associated with osteopenia/porosis. Conclusion: Osteopenia/porosis was highly prevalent among these HIV-infected pre-menopausal women, mainly of African origin. BMD loss was not associated with antiretroviral therapy (containing PI or not) but was associated with a low BMI. © 2009 Elsevier Ireland Ltd. All rights reserved., SCOPUS: ar.j, info:eu-repo/semantics/published

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SCOPUS: ar.j, info:eu-repo/semantics/published

We describe the case of a woman with ventriculo-peritoneal drainage who presented, following bilateral breast reparative surgery, an abnormally abundant liquid production in one of the surgical drains. This production was related to unknown rupture of the thoracic portion of the ventriculo-peritoneal drain, having led to the direct passage of the cerebrospinal fluid into the surgical drain. Rupture of the thoracic portion of the ventriculo-peritoneal drain was demonstrated by X-ray. However, the pathway of the cerebrospinal fluid and its direct passage throughout the surgical drain were demonstrated by isotopic procedure. Based upon this observation, we briefly describe and discuss the principle, technical characteristics, advantages and disadvantages of isotopic procedures, allowing to demonstrate permeability of ventricular derivations. © 2007 Elsevier Masson SAS. All rights reserved., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives: Pulmonary embolism is a potentially fatal condition whose diagnosis requires helical CT scan or perfusion/ventilation scan. In emergency situations these techniques may be unavailable. The question was whether lung-perfusion scan alone could still be used as triage in an emergency department? Methods: This prospective study was performed when both helical CT scan and ventilation/perfusion scan were unavailable. During one year, 53 patients admitted to the emergency department and possibly suffering from pulmonary embolism had perfusion scan as first procedure. The referring emergency physician was thereafter asked whether the perfusion scan had an impact on patient's management and decision-making. The results of this examination were also compared to the final diagnosis at hospital's discharge. Results: Perfusion scan had an important impact in 39 patients (74%). Nine out of the 16 patients whose perfusion scan was interpreted as high probability for pulmonary embolism had pulmonary embolism as final diagnosis. None of the 14 patients with normal perfusion scan and none of the 23 patients with abnormal and equivocal perfusion scan had pulmonary embolism as final diagnosis. Conclusion: This study demonstrates that perfusion scintigraphiy used alone remains useful as it will allow the possibility to exclude embolism in more than 20% of the cases and as it will justify the initiation of appropriate treatment in about 30% of the cases. It also shows that perfusion scan has an important impact on patient's management in more than 70% of the cases. © 2007 Elsevier Masson SAS. All rights reserved., SCOPUS: ar.j, info:eu-repo/semantics/published