David Morland

Incremental Value of 18F-Fluorocholine PET/CT in the Localization of Double Parathyroid Adenomas

A 73-year-old man displaying primary hyperparathyroidism with severe hypercalcemia (Ca: 4.1 mmol/l, PTH > 600 pmol/l) was referred for preoperative localization of a parathyroid adenoma. Tc-pertechnetate and Tc-sestaMIBI dual tracer scintigraphy displayed a mild focal uptake in the projection of the right thyroid lobe with negative ultrasonography. F-Fluorocholine PET/CT was quickly performed considering this discrepancy and not only confirmed the scintigraphic findings but also revealed a second contralateral focus of increased uptake, both later confirmed by operative consideration (the two other parathyroid glands are considered normal by the surgeon), pathology, and intraoperative parathyroid hormone assessment.

Infection of Ventricular Assist Device Detected and Monitored by 18F-FDG PET/CT

We report a case of a 59-year-old man who presented with fever, sepsis, and left cervicothoracic cutaneous inflammation 13 months after implantation of Jarvik 2000 device. Device infection was suspected and F-FDG PET/CT showed an intense and homogeneous uptake along driveline cable. Bacteriological local sample showed Staphylococcus aureus. After adapted antibiotherapy, control F-FDG PET/CT displays treatment efficacy with no residual uptake in driveline. F-FDG PET/CT could be an important tool for early noninvasive detection of left ventricular assist device infection and monitoring antibiotherapy response.

Hierarchical forest attributes for multimodal tumor segmentation on FDG-PET/contrast-enhanced CT

Accurate tumor volume delineation is a crucial step for disease assessment, treatment planning and monitoring of several kinds of cancers. However, this process is complex due to variations in tumors properties. Recently, some methods have been proposed for taking advantage of the spatial and spectral information carried by coupled modalities (e.g., PET-CT, MRI-PET). Simultaneously, the development of attributebased approaches has contributed to improve PET image analysis. In this work, we aim at developing a coupled multimodal / attribute-based approach for image segmentation. Our proposal is to take advantage of hierarchical image models for determining relevant and specific attribute from each modality. These attributes then allow us to define a unique, semantic vectorial image. Sequentially, this image can be processed by a standard segmentation method, in our case a random-walker approach, for segmenting tumors based on their intrinsic attribute-based properties. Experimental results emphasize the relevance of computing region-based attributes from both modalities.

Usefulness of Hepatobiliary Scintigraphy in the Evaluation of Hepatic Cystic Lesions in Children.

A 4-year-old girl was referred for a cystic hepatic lesion discovered incidentally during ultrasound exploration.Hepaticmagnetic resonance imaging (MRI) demonstrated a T1-hypointense and T2-hyperintense lesion of 18 × 15 × 13 mm compatible with a hepatic cyst or a ductal dilatation. Tcmebrofenin hepatobiliary scintigraphywas performed.Dynamic acquisition and single-photon emission computed tomography (SPECT) fused with MRI showed a focal accumulation of Tcmebrofenin in the knownhepatic lesion, indicating a communication with the biliary tree. A diagnosis of intrahepatic bile duct dilatationwasmade (Figure 1).Figure 2 (available atwww.jpeds.com) shows the case of a secondpatient, aged 5 years, who was also referred for an incidentally discovered hepatic lesion. The lack of activity in the cyst at the end of the examination was suggestive of a hepatic cyst. Congenital intrahepatic bile duct dilatation (CIHBD), including Caroli disease, is rare, with an estimated incidence of 1 in 1 000 000 persons. Differential diagnosis between CIHBD and simple hepatic cyst may sometimes be challenging but is crucial, given the differing prognosis of the 2 lesions. Differential diagnosis between these 2 pathological lesions is based on the existence of a communication with bile ducts in CIHBD, which is not found in hepatic cysts. Patients with CIHBD are predisposed to developing cholangiocarcinoma, with an estimated 100-fold greater risk than that of the general population. Biliary stasis in abnormal ducts also predisposes to stone formation, leading to cholangitis. Septic and carcinogenic complications justify close clinical and radiologic follow-up of these patients, in whom the sole treatment is surgical excision. In contrast, complications of hepatic cysts are rare and do not justify a systematic follow-up in asymptomatic patients. ■

18F-FDG PET/CT Evaluation of Ceritinib Therapy in Metastatic ALK-Positive Non-small Cell Lung Cancer.

Anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancers (NSCLC) account for 3% to 7% of all NSCLC and require a standard treatment by crizotinib. However, crizotinib resistance is frequent within the first 12 months of treatment. Ceritinib is a novel tyrosine kinase inhibitor of ALK recently introduced in France for metastatic or locally advanced crizotinib-resistant ALK NSCLC. We report the first use of ceritinib in our institution with a spectacular tumoral response after only 3 months of treatment. This case demonstrates the major role of F-FDG PET/CT for monitoring the effectiveness of this new treatment.