Imaging of melanoma: usefulness of ultrasonography before and after contrast injection for diagnosis and early evaluation of treatment

High-frequency ultrasound (8–14 MHz) is routinely used to display cutaneous melanomas. Maximum thickness measurement (Breslow index) has been shown to be well correlated to histologic findings for lesions of more than 0.75 mm. Some morphological criteria (strong delineation, hypoechoic texture, homogeneity) have been reported to help differentiate between malignant and benign pigmented blue lesions, but remain insufficient. Vascular ultrasound analysis using Doppler mode provides additional information and showed good specificity for malignancy (90%–100%), but variable sensitivity (34%–100%). Recent advances in ultrasound imaging allow functional evaluation. Likewise, dynamic contrast-enhanced ultrasound using contrast medium injection and specific perfusion and quantification software showed promising results in clinical and preclinical trials for early prediction of tumor response to target treatments

Molecular Magnetic Resonance and Ultrasound Imaging of Tumor Angiogenesis

International audienc

Age-related impairment of declarative memory: linking memorization of temporal associations to GluN2B redistribution in dorsal CA1

GluN2B subunits of NMDA receptors have been proposed as a target for treating age‐related memory decline. They are indeed considered as crucial for hippocampal synaptic plasticity and hippocampus‐dependent memory formation, which are both altered in aging. Because a synaptic enrichment in GluN2B is associated with hippocampal LTP in vitro, a similar mechanism is expected to occur during memory formation. We show instead that a reduction of GluN2B synaptic localization induced by a single‐session learning in dorsal CA1 apical dendrites is predictive of efficient memorization of a temporal association. Furthermore, synaptic accumulation of GluN2B, rather than insufficient synaptic localization of these subunits, is causally involved in the age‐related impairment of memory. These challenging data identify extra‐synaptic redistribution of GluN2B‐containing NMDAR induced by learning as a molecular signature of memory formation and indicate that modulating GluN2B synaptic localization might represent a useful therapeutic strategy in cognitive aging

How to perform Contrast-Enhanced Ultrasound (CEUS)

"How to perform contrast-enhanced ultrasound (CEUS)" provides general advice on the use of ultrasound contrast agents (UCAs) for clinical decision-making and reviews technical parameters for optimal CEUS performance. CEUS techniques vary between centers, therefore, experts from EFSUMB, WFUMB and from the CEUS LI-RADS working group created a discussion forum to standardize the CEUS examination technique according to published evidence and best personal experience. The goal is to standardise the use and administration of UCAs to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients

Virtual Patients and Sensitivity Analysis of the Guyton Model of Blood Pressure Regulation: Towards Individualized Models of Whole-Body Physiology

Mathematical models that integrate multi-scale physiological data can offer insight into physiological and pathophysiological function, and may eventually assist in individualized predictive medicine. We present a methodology for performing systematic analyses of multi-parameter interactions in such complex, multi-scale models. Human physiology models are often based on or inspired by Arthur Guyton's whole-body circulatory regulation model. Despite the significance of this model, it has not been the subject of a systematic and comprehensive sensitivity study. Therefore, we use this model as a case study for our methodology. Our analysis of the Guyton model reveals how the multitude of model parameters combine to affect the model dynamics, and how interesting combinations of parameters may be identified. It also includes a “virtual population” from which “virtual individuals” can be chosen, on the basis of exhibiting conditions similar to those of a real-world patient. This lays the groundwork for using the Guyton model for in silico exploration of pathophysiological states and treatment strategies. The results presented here illustrate several potential uses for the entire dataset of sensitivity results and the “virtual individuals” that we have generated, which are included in the supplementary material. More generally, the presented methodology is applicable to modern, more complex multi-scale physiological models

Imaging biomarker roadmap for cancer studies.

Imaging biomarkers (IBs) are integral to the routine management of patients with cancer. IBs used daily in oncology include clinical TNM stage, objective response and left ventricular ejection fraction. Other CT, MRI, PET and ultrasonography biomarkers are used extensively in cancer research and drug development. New IBs need to be established either as useful tools for testing research hypotheses in clinical trials and research studies, or as clinical decision-making tools for use in healthcare, by crossing 'translational gaps' through validation and qualification. Important differences exist between IBs and biospecimen-derived biomarkers and, therefore, the development of IBs requires a tailored 'roadmap'. Recognizing this need, Cancer Research UK (CRUK) and the European Organisation for Research and Treatment of Cancer (EORTC) assembled experts to review, debate and summarize the challenges of IB validation and qualification. This consensus group has produced 14 key recommendations for accelerating the clinical translation of IBs, which highlight the role of parallel (rather than sequential) tracks of technical (assay) validation, biological/clinical validation and assessment of cost-effectiveness; the need for IB standardization and accreditation systems; the need to continually revisit IB precision; an alternative framework for biological/clinical validation of IBs; and the essential requirements for multicentre studies to qualify IBs for clinical use.Development of this roadmap received support from Cancer Research UK and the Engineering and Physical Sciences Research Council (grant references A/15267, A/16463, A/16464, A/16465, A/16466 and A/18097), the EORTC Cancer Research Fund, and the Innovative Medicines Initiative Joint Undertaking (grant agreement number 115151), resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and European Federation of Pharmaceutical Industries and Associations (EFPIA) companies' in kind contribution

Imaging biomarker roadmap for cancer studies.

Imaging biomarkers (IBs) are integral to the routine management of patients with cancer. IBs used daily in oncology include clinical TNM stage, objective response and left ventricular ejection fraction. Other CT, MRI, PET and ultrasonography biomarkers are used extensively in cancer research and drug development. New IBs need to be established either as useful tools for testing research hypotheses in clinical trials and research studies, or as clinical decision-making tools for use in healthcare, by crossing 'translational gaps' through validation and qualification. Important differences exist between IBs and biospecimen-derived biomarkers and, therefore, the development of IBs requires a tailored 'roadmap'. Recognizing this need, Cancer Research UK (CRUK) and the European Organisation for Research and Treatment of Cancer (EORTC) assembled experts to review, debate and summarize the challenges of IB validation and qualification. This consensus group has produced 14 key recommendations for accelerating the clinical translation of IBs, which highlight the role of parallel (rather than sequential) tracks of technical (assay) validation, biological/clinical validation and assessment of cost-effectiveness; the need for IB standardization and accreditation systems; the need to continually revisit IB precision; an alternative framework for biological/clinical validation of IBs; and the essential requirements for multicentre studies to qualify IBs for clinical use.Development of this roadmap received support from Cancer Research UK and the Engineering and Physical Sciences Research Council (grant references A/15267, A/16463, A/16464, A/16465, A/16466 and A/18097), the EORTC Cancer Research Fund, and the Innovative Medicines Initiative Joint Undertaking (grant agreement number 115151), resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and European Federation of Pharmaceutical Industries and Associations (EFPIA) companies' in kind contribution

Etude de l'influence de l'entrée artérielle tumorale par modélisation numérique et in vitro en imagerie de contraste ultrasonore. (application clinique pour l'évaluation des thérapies ciblées en cancérologie.)

L échographie dynamique de contraste (DCE-US) est actuellement proposée comme technique d imagerie fonctionnelle permettant d évaluer les nouvelles thérapies anti-angiogéniques. Dans ce contexte, L'UPRES EA 4040, Université Paris-Sud 11, et le service d'Echographie de l'Institut Gustave Roussy ont développé une méthodologie permettant de calculer automatiquement, à partir de la courbe de prise de contraste moyenne obtenue dans la tumeur après injection en bolus d un agent de contraste, un ensemble de paramètres semi-quantitatifs. Actuellement, l état hémodynamique du patient ou encore les conditions d injection du produit de contraste ne sont pas pris en compte dans le calcul de ces paramètres à l inverse d autres modalités (imagerie par résonance magnétique dynamique de contraste ou scanner de perfusion). L objectif de cette thèse était donc d étendre la méthode de déconvolution utilisée en routine dans les autres modalités d imagerie à l échographie de contraste. Celle-ci permet de s affranchir des conditions citées précédemment en déconvoluant la courbe de prise de contraste issue de la tumeur par la fonction d entrée artérielle, donnant ainsi accès aux paramètres quantitatifs flux sanguin, volume sanguin et temps de transit moyen. Mon travail de recherche s est alors articulé autour de trois axes. Le premier visait à développer la méthode de quantification par déconvolution dédiée à l échographie de contraste, avec l élaboration d un outil méthodologique suivie de l évaluation de son apport sur la variabilité des paramètres de la microvascularisation. Des évaluations comparatives de variabilité intra-opérateur ont alors mis en évidence une diminution drastique des coefficients de variation des paramètres de la microvascularisation de 30% à 13% avec la méthode de déconvolution. Le deuxième axe était centré sur l étude des sources de variabilité influençant les paramètres de la microvascularisation portant à la fois sur les conditions expérimentales et sur les conditions physiologiques de la tumeur. Enfin, le dernier axe a reposé sur une étude rétrospective menée sur 12 patients pour lesquels nous avons évalué l intérêt de la déconvolution en comparant l évolution des paramètres quantitatifs et semi-quantitatifs de la microvascularisation en fonction des réponses des tumeurs obtenues par les critères RECIST à partir d un scan effectué à 2 mois. Cette méthodologie est prometteuse et peut permettre à terme une évaluation plus robuste et précoce des thérapies anti-angiogéniques que les méthodologies actuellement utilisées en routine dans le cadre des examens DCE-US.Dynamic contrast-enhanced ultrasonography (DCE-US) is currently used as a functional imaging technique for evaluating anti-angiogenic therapies. A mathematical model has been developed by the UPRES EA 4040, Paris-Sud university and the Gustave Roussy Institute to evaluate semi-quantitative microvascularization parameters directly from time-intensity curves. But DCE-US evaluation of such parameters does not yet take into account physiological variations of the patient or even the way the contrast agent is injected as opposed to other functional modalities (dynamic magnetic resonance imaging or perfusion scintigraphy). The aim of my PhD was to develop a deconvolution process dedicated to the DCE-US imaging, which is currently used as a routine method in other imaging modalities. Such a process would allow access to quantitatively-defined microvascularization parameters since it would provide absolute evaluation of the tumor blood flow, the tumor blood volume and the mean transit time. This PhD has been led according to three main goals. First, we developed a deconvolution method involving the creation of a quantification tool and validation through studies of the microvascularization parameter variability. Evaluation and comparison of intra-operator variabilities demonstrated a decrease in the coefficients of variation from 30% to 13% when microvascularization parameters were extracted using the deconvolution process. Secondly, we evaluated sources of variation that influence microvascularization parameters concerning both the experimental conditions and the physiological conditions of the tumor. Finally, we performed a retrospective study involving 12 patients for whom we evaluated the benefit of the deconvolution process: we compared the evolution of the quantitative and semi-quantitative microvascularization parameters based on tumor responses evaluated by the RECIST criteria obtained through a scan performed after 2 months. Deconvolution is a promising process that may allow an earlier, more robust evaluation of anti-angiogenic treatments than the DCE-US method in current clinical use.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

Mise au point d'un produit de contraste échographique à visée diagnostique et thérapeutique

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF