Identification of CT radiomic features robust to acquisition and segmentation variations for improved prediction of radiotherapy-treated lung cancer patient recurrence.

peer reviewedThe primary objective of the present study was to identify a subset of radiomic features extracted from primary tumor imaged by computed tomography of early-stage non-small cell lung cancer patients, which remain unaffected by variations in segmentation quality and in computed tomography image acquisition protocol. The robustness of these features to segmentation variations was assessed by analyzing the correlation of feature values extracted from lesion volumes delineated by two annotators. The robustness to variations in acquisition protocol was evaluated by examining the correlation of features extracted from high-dose and low-dose computed tomography scans, both of which were acquired for each patient as part of the stereotactic body radiotherapy planning process. Among 106 radiomic features considered, 21 were identified as robust. An analysis including univariate and multivariate assessments was subsequently conducted to estimate the predictive performance of these robust features on the outcome of early-stage non-small cell lung cancer patients treated with stereotactic body radiation therapy. The univariate predictive analysis revealed that robust features demonstrated superior predictive potential compared to non-robust features. The multivariate analysis indicated that linear regression models built with robust features displayed greater generalization capabilities by outperforming other models in predicting the outcomes of an external validation dataset

Prise en charge de l'infarctus du myocarde à la phase aiguë en 2008 : analyse à partir de 244 cas Brestois

La prise en charge de l'infarctus du myocarde est un enjeu de santé publique. Le pronostic de cette pathologie a été régulièrement amélioré, notamment grâce aux progrès des techniques de revascularisation coronaire (trombolyse et angioplastie). Après un rappel des principales études ayant conduit aux recommandations actuelles sur la prise en charge de l'infarctus à la phase aiguë, nous avons analysé la cohorte des patients admis pour SCA ST+ au CHU de Brest de juillet 2006 à octobre 2008 et déterminé le circuit et les délais de prise en charge. La comparaison de cette étude brestoise aux registres bretons et nationaux révèle des avancées majeures sur les dix dernières années, avec toutefois des améliorations à apporter notamment sur l'utilisation de la thrombolise préhospitalière, l'entrée dans le circuit thérapeutique par le "15" et la régulation des appels reçus par les médecins généralistes.BREST-BU Médecine-Odontologie (290192102) / SudocSudocFranceF

Suivi à long terme des troubles du rythme auriculaire après valvuloplastie mitrale

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Noninvasive diagnosis of pulmonary embolism.

International audienceBACKGROUND: We designed a simple and integrated diagnostic algorithm for acute pulmonary embolism (PE). Diagnosis was based on clinical probability assessment, plasma D-dimer testing, then sequential testing to include lower limb venous compression ultrasonography, ventilation perfusion lung scan, and chest multidetector CT (MDCT) imaging. METHODS: We included 321 consecutive patients presenting at Brest University Hospital in Brest, France, with clinically suspected PE and positive d-dimer or high clinical probability. Patients in whom VTE was deemed absent were not given anticoagulants and were followed up for 3 months. RESULTS: Detection of DVT by ultrasonography established the diagnosis of PE in 43 (13%). Lung scan associated with clinical probability was diagnostic in 243 (76%) of the remaining patients. MDCT scan was required in only 35 (11%) of the patients. The 3-month thromboembolic risk in patients not given anticoagulants, based on the results of the diagnostic protocol, was 0.53% (95% CI, 0.09-2.94). CONCLUSIONS: A diagnostic strategy combining clinical assessment, d-dimer, ultrasonography, and lung scan gave a noninvasive diagnosis in the majority of outpatients with suspected PE and appeared to be safe

Systemic Artery to Pulmonary Artery Shunt Mimicking Acute Pulmonary Embolism, Unmasked by a Multimodality Imaging Approach

In this report, we describe the functional imaging findings of systemic artery to pulmonary artery shunt in V/Q SPECT CT imaging. A 63-year-old man with small-cell lung cancer underwent CT pulmonary angiography (CTPA) for suspected acute pulmonary embolism (PE). The CTPA showed an isolated segmental filling defect in the right lower lobe, which was initially interpreted as positive for PE but was actually the consequence of a systemic artery to pulmonary artery shunt due to the recruitment of the bronchial arterial network by the adjacent tumor. A V/Q SPECT/CT scan was also performed, demonstrating a matched perfusion/ventilation defect in the right lower lobe

Midterm benefits of left univentricular pacing in patients with congestive heart failure.

International audienceBACKGROUND: Resynchronization therapy by simultaneous pacing of the right and left ventricles has gained wide acceptance as a useful treatment for patients with severe congestive heart failure. Several short-term hemodynamic studies in humans and animals failed to demonstrate any benefit of biventricular pacing over left univentricular pacing, but long-term studies on this pacing mode are lacking. The objective of this study was to assess the outcome over a 1-year period of patients paced exclusively in the left ventricle. METHODS AND RESULTS: Clinical, angiographic, echocardiographic, and ergometric data were collected at baseline and after 12 months in 22 patients (age, 69.3+/-6.5 years) with NYHA class III or IV (10 patients), sinus rhythm, left bundle-branch block, and no bradycardia indication for pacing. After 12 months, compared with baseline values, NYHA class improved significantly by 40% (P<0.0001), 6-minute walk distance by 30% (P=0.01), peak VO2 by 26% (P=0.01), left ventricular end-diastolic diameter by 5% (P=0.02), ejection fraction by 22% (P=0.07), mitral regurgitation area by 40% (P=0.01), and norepinephrine level by 37% (P=0.04). CONCLUSIONS: In patients with severe congestive heart failure, sinus rhythm, and left bundle-branch block despite optimal pharmacological treatment, left univentricular pacing is feasible and results in significant midterm benefit in exercise tolerance and left ventricular function

Feasibility of Systematic Respiratory-Gated Acquisition in Unselected Patients Referred for 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

ObjectiveRespiratory motion in 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) induces blurred images, leading to errors in location and quantification for lung and abdominal lesions. Various methods have been developed to correct for these artifacts, and most of current PET/CT scanners are equipped with a respiratory gating system. However, they are not routinely performed because their use is time-consuming. The aim of this study is to assess the feasibility and quantitative impact of a systematic respiratory-gated acquisition in unselected patients referred for FDG PET/CT, without increasing acquisition time.MethodsPatients referred for a FDG PET/CT examination to the nuclear medicine department of Brest University Hospital were consecutively enrolled, during a 3-month period. Cases presenting lung or liver uptakes were analyzed. Two sets of images were reconstructed from data recorded during a unique acquisition with a continuous table speed of 1 mm/s of the used Biograph mCT Flow PET/CT scanner: standard free-breathing images, and respiratory-gated images. Lesion location and quantitative parameters were recorded and compared.ResultsFrom October 1 2015 to December 31 2015, 847 patients were referred for FDG PET/CT, 741 underwent a respiratory-gated acquisition. Out of them, 213 (29%) had one or more lung or liver uptake but 82 (38%) had no usable respiratory-gated signal. Accordingly, 131 (62%) patients with 183 lung or liver uptakes were analyzed. Considering the 183 lesions, 140 and 43 were located in the lungs and the liver, respectively. The median (IQR) difference between respiratory-gated images and non-gated images was 18% (4−32) for SUVmax, increasing to 30% (14−57) in lower lobes for lung lesions, and −18% (−40 to −4) for MTV (p &lt; 0.05). Technologists’ active personal dosimetry and mean total examinations duration were not statistically different between periods with and without respiratory gating.ConclusionThis study showed that a systematic respiratory-gated acquisition without increasing acquisition time is feasible in a daily routine and results in a significant impact on PET quantification. However, clinical impact on patient management remains to be determined