Role of SPECT/CT compared with MRI in the diagnosis and management of patients with wrist trauma occult fractures.

Background: The diagnosis of wrist fractures, especially scaphoid fractures, remains a challenge because of nonunion risk. Currently, new hybrid technologies are emerging such as SPECT/CT systems, which combine functional and anatomical data sets. So, we wanted to evaluate the utility of SPECT/CT in the management of occult carpal fractures.

Diagnostic accuracy of single-photon emission tomography ventilation/perfusion lung scan in the diagnosis of pulmonary embolism.

Background: Planar ventilation/perfusion (V/Q) lung scintigraphy is a validated tool for the diagnosis of pulmonary embolism (PE). Nevertheless, given the high rate of nonconclusive V/Q, further investigation is often necessary. V/Q single-photon emission CT (SPECT) scan could improve V/Q performance, but sparse data are available on its accuracy.

Noninvasive diagnosis of pulmonary embolism.

Background: 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.

Detection of occult wrist fractures by quantitative radioscintigraphy: a prospective study on selected patients.

Objective: To determine the value of quantitative radioscintigraphy (QRS) in the diagnosis of wrist trauma occult fractures.

Purpose: Because of the risk of non-union, the diagnosis of wrist fractures, including scaphoid fractures, is essential but remains difficult despite many imaging modalities. The aim of the study was to assess the benefits of QRS in the diagnosis of occult post-trauma wrist fractures.

Management of suspected pulmonary embolism patients with low clinical and low V/Q probability.

Objective: To assess whether guidelines for the management of suspected PE, recommending that ventilation/perfusion (V/Q) scintigraphy should be followed by other imaging in case of non-diagnostic result, and interpreted along with the clinical probability, are applied in daily practice.

Design: Two-year audit study.

Setting: Tertiary hospital in France.

Premature atherosclerosis in HIV positive patients and cumulated time of exposure to antiretroviral therapy (SHIVA study).

Background: With the advent of antiretroviral therapy regimens in HIV positive patients, it is crucial to consider their long-term benefits to risk ratios. The responsibility of treatment in premature atherosclerosis is not clear. Thus, the aim of this study is to evaluate the impact of exposure to reverse transcriptase inhibitors (nucleosidic and non-nucleosidic) and to protease inhibitors on the cardiovascular status of an entire hospital based cohort of patients.

Management of suspected venous thromboembolism: the impact of a multifaceted intervention.

Objective: To achieve a common strategy in the event of a suspected venous thromboembolism.

Design: A multifaceted intervention, combining an audit strategy and implementation of local guidelines: phase 1, the first step, consisted of a 6-month audit to identify dysfunction; during phase 2, intervention, local guidelines were formulated by a working group and then implemented; phase 3 consisted of a re-audit over a 6-month period following the intervention.

Setting: A tertiary hospital, France.

Octreotide imaging plus bone scintigrams to optimally localize gastroenteropancreatic neuroendocrine tumors.

Purpose: In-111 pentetreotide (Octreotide) is highly sensitive for detecting gastroenteropancreatic neuroendocrine tumors and their metastases. However, a lack of landmarks makes it difficult to localize them anatomically. To overcome this difficulty, the authors simultaneously obtained Octreotide and bone tomoscintigrams, in addition to standard planar images.