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Coly M, Adams D, Attarian S, Bouhour F, Camdessanché JP, Carey G, Cauquil C, Chanson JB, Chrétien P, Créange A, Delmont E, Fargeot G, Frachet S, Gendre T, Kuntzer T, Labeyrie C, Maisonobe T, Michaud M, Moulin M, Nicolas G, Noury JB, Péréon Y, Puma A, Sole G, Taithe F, Tard C, Théaudin M, Timsit S, Venditti L, Echaniz-Laguna A. Clinical, paraclinical and outcome features of 166 patients with acute anti-GQ1b antibody syndrome. J Neurol 2024; 271:4982-4990. [PMID: 38767661 DOI: 10.1007/s00415-024-12410-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND & PURPOSE In this retrospective study, we aimed at defining the clinical, paraclinical and outcome features of acute neurological syndromes associated with anti-GQ1b antibodies. RESULTS We identified 166 patients with neurological symptoms appearing in less than 1 month and anti-GQ1b antibodies in serum between 2012 and 2022. Half were female (51%), mean age was 50 years (4-90), and the most frequent clinical features were areflexia (80% of patients), distal upper and lower limbs sensory symptoms (78%), ophthalmoplegia (68%), sensory ataxia (67%), limb muscle weakness (45%) and bulbar weakness (45%). Fifty-three patients (32%) presented with complete (21%) and incomplete (11%) Miller Fisher syndrome (MFS), thirty-six (22%) with Guillain-Barre syndrome (GBS), one (0.6%) with Bickerstaff encephalitis (BE), and seventy-three (44%) with mixed MFS, GBS & BE clinical features. Nerve conduction studies were normal in 46% of cases, showed demyelination in 28%, and axonal loss in 23%. Anti-GT1a antibodies were found in 56% of cases, increased cerebrospinal fluid protein content in 24%, and Campylobacter jejuni infection in 7%. Most patients (83%) were treated with intravenous immunoglobulins, and neurological recovery was complete in 69% of cases at 1 year follow-up. One patient died, and 15% of patients relapsed. Age > 70 years, initial Intensive Care Unit (ICU) admission, and absent anti-GQ1b IgG antibodies were predictors of incomplete recovery at 12 months. No predictors of relapse were identified. CONCLUSION This study from Western Europe shows acute anti-GQ1b antibody syndrome presents with a large clinical phenotype, a good outcome in 2/3 of cases, and frequent relapses.
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Bouvet A, Pla R, Delhaye E, Nicolas G, Bideau N. Profiling biomechanical abilities during sprint front-crawl swimming using IMU and functional clustering of variabilities. Sports Biomech 2024:1-21. [PMID: 38889362 DOI: 10.1080/14763141.2024.2368064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/10/2024] [Indexed: 06/20/2024]
Abstract
This study aims to profile biomechanical abilities during sprint front crawl by identifying technical stroke characteristics, in light of performance level. Ninety-one recreational to world-class swimmers equipped with a sacrum-worn IMU performed 25 m all-out. Intra and inter-cyclic 3D kinematical variabilities were clustered using a functional double partition model. Clusters were analysed according to (1) swimming technique using continuous visualisation and discrete features (standard deviation and jerk cost) and (2) performance regarding speed and competition calibre using respectively one-way ANOVA and Chi-squared test as well as Gamma statistics. Swimmers displayed specific technical profiles of intra-cyclic (smoothy and jerky) and inter-cyclic stroke regulation (low, moderate and high repeatability) significantly discriminated by speed (p < 0.001, η2 = 0.62) and performance calibre (p < 0.001, V = 0.53). We showed that combining high levels of both kinds of variability (jerky + low repeatability) are associated with highest speed (1.86 ± 0.12 m/s) and competition calibre (ℽ = 0.75, p < 0.001). It highlights the crucial importance of variabilities combination. Technical skills might be driven by a specific alignment of stroke pattern and its associated dispersion according to the task constraints. This data-driven approach can assist eyes-based technical evaluation. Targeting the development of an explosive swimming style with a high level of body stability should be considered during training of sprinters.
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Nicolas G. Lessons from genetic studies in Alzheimer disease. Rev Neurol (Paris) 2024; 180:368-377. [PMID: 38429159 DOI: 10.1016/j.neurol.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/27/2023] [Indexed: 03/03/2024]
Abstract
Research on Alzheimer disease (AD) genetics has provided critical advances to the knowledge of AD pathophysiological mechanisms. The etiology of AD can be divided into monogenic (autosomal dominant inheritance) and complex (multifactorial determinism). In monogenic AD, recent advances mainly concern mutation-associated mechanisms, presymptomatic clinical studies, and the search for modifiers of ages of onset that are still ongoing. In complex AD, genetic factors can be further categorized into three classes: (i) the APOE-ɛ4 and ɛ2 common alleles that represent a category by themselves as they are both common and with a strong impact on AD risk; (ii) common variants with a modest effect, identified in genome-wide association studies (GWAS); and (iii) rare variants with a moderate-to-strong effect, identified in case-control sequencing studies. Regarding APOE, odds ratios, available in multiple ethnicities, can now be converted into penetrance curves, although such curves remain to be performed in diverse ethnicities. In addition, advances in the understanding of mechanisms have been recently reported and rare APOE variants add to the complexity. In the GWAS category, novel loci have been discovered thanks to larger studies, doubling the number of hits as compared to the previous reference meta-analysis. However, such modest risk factors cannot be used in the clinic, neither individually, nor in genetic risk scores. In the category of rare variants, two novel genes, ABCA1 and ATP8B4 now add to the three main ones, TREM2, SORL1, and ABCA7. The study of such rare variants suggests oligogenic inheritance in some families, as also suggested by digenic penetrance curves for SORL1 loss-of-function variants with APOE-ɛ4. Cumulate frequencies of definite (so-called) rare risk factors are 2.3% to 3.6% (depending on thresholds on odds ratios) in control databases and many more remain to be classified and identified, showing how important these risk factors may be as part of the complex determinism of AD. A better understanding of these rare risk factors and their combined effects on each other, with common variants, and with environmental factors, should allow for a prediction of AD risk and, eventually, preventive medicine. Taken together, most genetic determinants of AD, in monogenic and in complex forms, point toward the aggregation of Aβ as a pivotal triggering factor, such that targeting it may be efficient as prevention in at-risk individuals. The role of neuroinflammation, microglia, and Tau pathology modulation are important sources of research for disease modification.
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Eigler C, McDougall L, Bauman A, Bernhardt P, Hentschel M, Blackham KA, Nicolas G, Fani M, Wild D, Cordier D. Radiolabeled Somatostatin Receptor Antagonist Versus Agonist for Peptide Receptor Radionuclide Therapy in Patients with Therapy-Resistant Meningioma: PROMENADE Phase 0 Study. J Nucl Med 2024; 65:573-579. [PMID: 38423782 DOI: 10.2967/jnumed.123.266817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/05/2024] [Indexed: 03/02/2024] Open
Abstract
Our primary aim was to compare the therapeutic index (tumor-to-bone marrow and tumor-to-kidney absorbed-dose ratios) of the new radiolabeled somatostatin receptor antagonist [177Lu]Lu-DOTA-JR11 with the established radiolabeled somatostatin receptor agonist [177Lu]Lu-DOTATOC in the same patients with progressive, standard therapy-refractory meningioma. Methods: In this prospective, single-center, open-label phase 0 study (NCT04997317), 6 consecutive patients were included: 3 men and 3 women (mean age, 63.5 y). Patients received 6.9-7.3 GBq (standard injected radioactivity) of [177Lu]Lu-DOTATOC followed by 3.3-4.9 GBq (2 GBq/m2 × body surface area) of [177Lu]Lu-DOTA-JR11 at an interval of 10 ± 1 wk. In total, 1 [177Lu]Lu-DOTATOC and 2-3 [177Lu]Lu-DOTA-JR11 treatment cycles were performed. Quantitative SPECT/CT was done at approximately 24, 48, and 168 h after injection of both radiopharmaceuticals to calculate meningioma and organ absorbed doses as well as tumor-to-organ absorbed-dose ratios (3-dimensional segmentation approach for meningioma, kidneys, liver, bone marrow, and spleen). Results: The median of the meningioma absorbed dose of 1 treatment cycle was 3.4 Gy (range, 0.8-10.2 Gy) for [177Lu]Lu-DOTATOC and 11.5 Gy (range, 4.7-22.7 Gy) for [177Lu]Lu-DOTA-JR11. The median bone marrow and kidney absorbed doses after 1 treatment cycle were 0.11 Gy (range, 0.05-0.17 Gy) and 2.7 Gy (range, 1.3-5.3 Gy) for [177Lu]Lu-DOTATOC and 0.29 Gy (range, 0.16-0.39 Gy) and 3.3 Gy (range, 1.6-5.9 Gy) for [177Lu]Lu-DOTA-JR11, resulting in a 1.4 (range, 0.9-1.9) times higher median tumor-to-bone marrow absorbed-dose ratio and a 2.9 (range, 2.0-4.8) times higher median tumor-to-kidney absorbed-dose ratio with [177Lu]Lu-DOTA-JR11. According to the Common Terminology Criteria for Adverse Events version 5.0, 2 patients developed reversible grade 2 lymphopenia after 1 cycle of [177Lu]Lu-DOTATOC. Afterward, 2 patients developed reversible grade 3 lymphopenia and 1 patient developed reversible grade 3 lymphopenia and neutropenia after 2-3 cycles of [177Lu]Lu-DOTA-JR11. No grade 4 or 5 adverse events were observed at 15 mo or more after the start of therapy. The disease control rate was 83% (95% CI, 53%-100%) at 12 mo or more after inclusion. Conclusion: Treatment with 1 cycle of [177Lu]Lu-DOTA-JR11 showed 2.2-5.7 times higher meningioma absorbed doses and a favorable therapeutic index compared with [177Lu]Lu-DOTATOC after injection of 1.4-2.1 times lower activities. The first efficacy results demonstrated a high disease control rate with an acceptable safety profile in the standard therapy for refractory meningioma patients. Therefore, larger studies with [177Lu]Lu-DOTA-JR11 are warranted in meningioma patients.
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Fortanier E, Berling E, Zanin A, Le Guillou A, Micaleff J, Nicolas G, Lozeron P, Attarian S. Reply to letter on What biological markers could be used for diagnosis and monitoring of nitrous oxide abuse. Eur J Neurol 2024; 31:e16187. [PMID: 38124455 PMCID: PMC11235966 DOI: 10.1111/ene.16187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
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Rouyer A, Tard C, Dessein A, Spinazzi M, Bédat‐Millet A, Dimitri‐Boulos D, Nadaj‐Pakleza A, Chanson J, Nicolas G, Douillard C, Laforêt P. Long-term prognosis of fatty-acid oxidation disorders in adults: Optimism despite the limited effective therapies available. Eur J Neurol 2024; 31:e16138. [PMID: 38015438 PMCID: PMC11235989 DOI: 10.1111/ene.16138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/25/2023] [Accepted: 10/21/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Fatty-acid oxidation disorders (FAODs) are recessive genetic diseases. MATERIALS AND METHODS We report here clinical and paraclinical data from a retrospective study of 44 adults with muscular FAODs from six French reference centers for neuromuscular or metabolic diseases. RESULTS The study cohort consisted of 44 adult patients: 14 with carnitine palmitoyl transferase 2 deficiency (32%), nine with multiple acyl-CoA deficiency (20%), 13 with very long-chain acyl-CoA dehydrogenase deficiency (30%), three with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (7%), and five with short-chain acyl-CoA dehydrogenase deficiency (11%). Disease onset occurred during childhood in the majority of patients (59%), with a mean age at onset of 15 years (range = 0.5-35) and a mean of 12.6 years (range = 0-58) from disease onset to diagnosis. The principal symptoms were acute muscle manifestations (rhabdomyolysis, exercise intolerance, myalgia), sometimes associated with permanent muscle weakness. Episodes of rhabdomyolysis were frequent (84%), with a mean creatinine kinase level of 68,958 U/L (range = 660-300,000). General metabolic complications were observed in 58% of patients, respiratory manifestations in 18% of cases, and cardiological manifestations in 9% of cases. Fasting acylcarnitine profile was used to orient genetic explorations in 65% of cases. After a mean follow-up of 10 years, 33% of patients were asymptomatic and 56% continued to display symptoms after exercise. The frequency of rhabdomyolysis decreased after diagnosis in 64% of cases. CONCLUSION A standardized register would complete this cohort description of muscular forms of FAODs with exhaustive data, making it possible to assess the efficacy of therapeutic protocols in real-life conditions and during the long-term follow-up of patients.
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Friebe L, Freitag MT, Braun M, Nicolas G, Bauman A, Bushnell D, Christ E, Wild D. Peptide Receptor Radionuclide Therapy Is Effective for Clinical Control of Symptomatic Metastatic Insulinoma: A Long-Term Retrospective Analysis. J Nucl Med 2024; 65:228-235. [PMID: 38164592 DOI: 10.2967/jnumed.123.265894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/25/2023] [Indexed: 01/03/2024] Open
Abstract
Metastatic insulinoma is a rare malignant neuroendocrine tumor characterized by inappropriate insulin secretion, resulting in life-threatening hypoglycemia, which is often difficult to treat. There is currently very limited information about the efficacy of peptide receptor radionuclide therapy (PRRT) for clinical control of hypoglycemia. The aim of this long-term retrospective study was to evaluate the therapeutic efficacy of PRRT for improving hypoglycemia, to evaluate the change of medication after PRRT, and to calculate progression-free survival (PFS) and overall survival (OS). Methods: Inclusion criteria were histologically proven somatostatin receptor-positive metastatic malignant insulinoma and at least 2 cycles of [90Y]Y-DOTATOC or [177Lu]Lu-DOTATOC therapy from early 2000 to early 2022. A semiquantitative scoring system was used to quantify the severity and frequency of hypoglycemic episodes under background antihypoglycemic therapy (somatostatin analog, diazoxide, everolimus, corticosteroids): score 0, no hypoglycemic episodes; score 1, hypoglycemic events requiring additional conservative treatment with optimization of nutrition; score 2, severe hypoglycemia necessitating hospitalization and combined medication or history of hypoglycemic coma. Hypoglycemic score before and after PRRT was analyzed. Time of benefit was defined as a time range of fewer hypoglycemic episodes in the observation period than at baseline. Information on antihypoglycemic medication before and after therapy, PFS, and OS was recorded. Results: Twenty-six of 32 patients with a total of 106 [90Y]Y-DOTATOC/[177Lu]Lu-DOTATOC cycles were included. The average observation period was 21.5 mo (range, 2.3-107.4 mo). Before therapy, 81% (n = 21) of the patients had a hypoglycemia score of 2 and 19% (n = 5) had a score of 1. After PRRT, 81% of patients (n = 21) had a decreased score, and the remaining 5 patients showed a stable situation. There was temporary worsening of hypoglycemia just after injection of [90Y]Y-DOTATOC/[177Lu]Lu-DOTATOC in 19% of patients. The average time of benefit in the observation period was 17.2 mo (range, 0-70.2 mo). Antihypoglycemic medication reduction was achieved in 58% (n = 15) of patients. The median OS and PFS after the start of PRRT were 19.7 mo (95% CI, 6.5-32.9 mo) and 11.7 mo (95% CI, 4.9-18.5 mo), respectively. Conclusion: To our knowledge, our study included the largest cohort of patients with malignant insulinoma to be evaluated. Long-lasting symptom control and reduction of antihypoglycemic medications were shown in most patients after late-line PRRT.
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Raineteau Y, Pla R, Bideau B, Bideau N, Nicolas G. From dry-land to the water: training and testing practices of strength and conditioning coaches in high level French sprint swimmers. Front Sports Act Living 2024; 5:1338856. [PMID: 38283120 PMCID: PMC10811196 DOI: 10.3389/fspor.2023.1338856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction The aim of this study was to explore training and testing practices from Strength & Conditioning (S&C) coaches who manage groups of high-level French swimmers in elite training centers. The transfer of abilities from dry-land to in situ condition was also investigated. Methods 24 French S&C coaches completed a survey via an online platform. Frequency analyses were made for quantitative and qualitative responses, the level of significance set for this study was p ≤ 0.05. Results Core stability, Strength & Power were the three most targeted qualities. Core strengthening in all its forms, Bench Press & Squat were the three most prescribed exercises. 79% of S&C coaches adapted exercises according to different parameters. Most of the coaches indicated that dry-land S&C sessions were preferentially placed before in-water sessions. Very varied exercises were used in-water to make the transfer from dry-land more effective. 87% of participants monitored the training load and 38% assessed the force and velocity parameters for some S&C exercises. Discussion Dry-land training practices of S&C coaches were mostly in line with scientific recommendations. In the light of results of the questionnaire, it would appear that testing procedures might be a key issue for transferring qualities from dry-land to in situ.
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von Niederhäusern PA, Seppi C, Sandkühler R, Nicolas G, Haerle SK, Cattin PC. Augmented reality for sentinel lymph node biopsy. Int J Comput Assist Radiol Surg 2024; 19:171-180. [PMID: 37747574 PMCID: PMC10770201 DOI: 10.1007/s11548-023-03014-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Sentinel lymph node biopsy for oral and oropharyngeal squamous cell carcinoma is a well-established staging method. One variation is to inject a radioactive tracer near the primary tumor of the patient. After a few minutes, audio feedback from an external hand-held [Formula: see text]-detection probe can monitor the uptake into the lymphatic system. Such probes place a high cognitive load on the surgeon during the biopsy, as they require the simultaneous use of both hands and the skills necessary to correlate the audio signal with the location of tracer accumulation in the lymph nodes. Therefore, an augmented reality (AR) approach to directly visualize and thus discriminate nearby lymph nodes would greatly reduce the surgeons' cognitive load. MATERIALS AND METHODS We present a proof of concept of an AR approach for sentinel lymph node biopsy by ex vivo experiments. The 3D position of the radioactive [Formula: see text]-sources is reconstructed from a single [Formula: see text]-image, acquired by a stationary table-attached multi-pinhole [Formula: see text]-detector. The position of the sources is then visualized using Microsoft's HoloLens. We further investigate the performance of our SLNF algorithm for a single source, two sources, and two sources with a hot background. RESULTS In our ex vivo experiments, a single [Formula: see text]-source and its AR representation show good correlation with known locations, with a maximum error of 4.47 mm. The SLNF algorithm performs well when only one source is reconstructed, with a maximum error of 7.77 mm. For the more challenging case to reconstruct two sources, the errors vary between 2.23 mm and 75.92 mm. CONCLUSION This proof of concept shows promising results in reconstructing and displaying one [Formula: see text]-source. Two simultaneously recorded sources are more challenging and require further algorithmic optimization.
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Raineteau Y, Nicolas G, Bideau B, Bideau N, Pla R. Associations between load-velocity profiling and race parameters of elite swimmers in the 100 and 200m freestyle events. Front Sports Act Living 2023; 5:1326106. [PMID: 38162699 PMCID: PMC10757606 DOI: 10.3389/fspor.2023.1326106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Improving swimming performance involves assessments of biomechanical variables of the stroke, and it can be achieved using semi-tethered swimming tests. The aim of this study was thus to investigate the associations between load-velocity (L-V) profiles, from a semi-tethered swimming protocol and race variables in the 100 m and 200 m freestyle events. Methods Eight swimmers completed a L-V profiling protocol consisting of four sprints (25 m, 25 m, 20 m, 15 m) against increasing loads (0.1, 2.0, 4.0, 6.0 kg respectively) with complete recovery between repetitions (>5 min). The L-V linear regression was used to estimate maximal velocity (V0) and body mass normalized load (rL0). Race variables such as clean swimming speed (V), stroke rate (SR), distance per cycle (SL) and stroke index (SI) were assessed from video analysis of 100 m and 200 m freestyle events taking place 3-4 days after the L-V protocol. Results L-V results showed high levels of speed (mean ± SD: 1.87 ± 0.04 m/s) and heavy maximal relative loads (mean ± SD: 38.5 ± 6.51 as % of body mass). Swimmers also achieved high-level performances in the 100 m (mean ± SD time: 51.95 ± 0.75 s) and the 200 m (mean ± SD time: 113.85 ± 2.67 s). For the 100 m events, the maximal relative load showed strong correlation with performance (r = 0.63) whereas trivial correlation was observed for the 200 m events (r = 0.12). SR on the 100 m and the 200 m also showed very strong association with rL0 (r = 0.83) and a strong association with V0 (r = 0.68) respectively. Conclusion The relationships between L-V variables and race variables depend on the distance of the event. However, L-V variables seem to be less related to SR and SL evolutions for the 100 m than in the 200 m event. Moreover, L-V profiles tend to be more related to the 100 m than 200 m freestyle performance. L-V profile should be interpreted taking into consideration the specific physiological and biomechanical constraints of the main events of the swimmer.
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Fortanier E, Berling E, Zanin A, Guillou AL, Micaleff J, Nicolas G, Lozeron P, Attarian S. How to distinguish Guillain-Barré syndrome from nitrous oxide-induced neuropathy: A 2-year, multicentric, retrospective study. Eur J Neurol 2023; 30:3296-3306. [PMID: 37494104 DOI: 10.1111/ene.15998] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Recreational use of nitrous oxide (N2 O) has dramatically increased in recent years, resulting in numerous cases of acute sensorimotor tetraparesis secondary to nitrous oxide-induced neuropathy (N2 On). Challenging clinical features can mimic Guillain-Barré syndrome (GBS), the main differential diagnosis upon admission. The most sensitive biomarkers for distinguishing between these two conditions remain to be determined. METHODS Fifty-eight N2 On patients from three referral centers were retrospectively included over a 2-year period and compared to GBS patients hospitalized during the same timeframe (47 patients). Collected demographic, clinical, biological, and electrophysiological data were compared between the two groups. RESULTS The typical N2 On clinical pattern included distal sensorimotor deficit in lower limbs with absent reflexes, proprioceptive ataxia, and no cranial involvement (56.7% of our cohort). Misleading GBS-like presentations were found in 14 N2 On patients (24.1%), and 13 patients (22.4%) did not report N2 O use during initial interview. Only half the N2 On patients presented with reduced vitamin B12 serum levels upon admission. A slightly increased cut-off (<200 pmol/L) demonstrated 85.1% sensitivity and 84.5% specificity in distinguishing N2 On from GBS. Only 6.9% of N2 On patients met the criteria for primary demyelination (p < 0.01), with only one presenting conduction blocks. A diagnostic algorithm combining these two biomarkers successfully classified all GBS-like N2 On patients. CONCLUSIONS Vitamin B12 serum level < 200 pmol/L cut-off and conduction blocks in initial electrophysiological study are the two most sensitive biomarkers for rapidly distinguishing N2 On from GBS patients. These two parameters are particularly useful in clinically atypical N2 On with GBS-like presentation.
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Cintas P, Bouhour F, Cauquil C, Masingue M, Tard C, Sacconi S, Delmont E, Choumert A, Chanson JB, Michaud M, Solé G, Cassereau J, Noury JB, Nicolas G, Bellance R, Péréon Y, Camdessanché JP, Magy L, Attarian S. Current clinical management of CIDP with immunoglobulins in France: An expert opinion. Rev Neurol (Paris) 2023; 179:914-922. [PMID: 37019741 DOI: 10.1016/j.neurol.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/05/2023] [Accepted: 03/13/2023] [Indexed: 04/05/2023]
Abstract
Treatment strategies in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) must be adapted on a case-to-case basis. Validated and reproducible tools for monitoring treatment response are required at diagnosis, when initiating treatment and throughout follow-up. A task force of French neurologists, experts in neuromuscular disease reference centers, was assembled to provide expert advice on the management of typical CIDP with intravenous immunoglobulins (Ig), and to harmonize treatment practices in public and private hospitals. The task force also referred to the practical experience of treating CIDP with Ig at the diagnostic, induction and follow-up stages, including the assessment and management of Ig dependence, and following the recommendations of the French health agency.
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Bouvet A, Pla R, Delhaye E, Nicolas G, Bideau N. Profiles of stroke regulations discriminate between finishing positions during international open water races. J Sports Sci 2023; 41:1309-1316. [PMID: 37824415 DOI: 10.1080/02640414.2023.2268902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
This study aims to identify stroke regulation profiles and tipping-points in stroke regulation timing during international open water races according to performance level. Twelve elite or world-class swimmers were analysed during 18 international races. Stroke rate and jerk cost were computed cycle-to-cycle using an Inertial Measurement Unit and regulations profiles fitted using polynomials. We performed two-ways mixed-ANOVA to compare stroke kinematics among race segments and performance groups (G1 -fastest- to G3 -slowest-). Swimmers displayed specific regulation profiles (i.e., J-shape with end-spurt, J-shape without end-spurt and reverse L-shape for stroke rate and U-shape, reverse J-shape and reverse L-shape for jerk cost, for respectively G1, G2 and G3) with significant effect of race segment on stroke kinematics for G1 and G2. We highlighted tipping-points in stroke regulations profiles (TP1 and TP2) at respectively 30% and 75% of the race with greater magnitude in G1 than G2. TP1 reflects the end of a stroke economy period (0-30%) and TP2 the end of a progressive increase in stroke kinematics (30-75%) towards end-spurt (75-100%). Open water races follow a high-grading dynamics requiring biomechanical regulations along the race. Targeting stroke rate reserve and management of stroke smoothness should be considered during training of open water swimmers.
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Krief N, Gabriel R, Cauquil C, Adams D, Fargeot G, Maisonobe T, Osman D, Schmidt M, Chanson JB, Bigaut K, Sole G, Tard C, Nicolas G, Pereon Y, Aure K, Lagrange E, Lefilliatre M, Labeyrie MA, Echaniz-Laguna A. Clinical features and maternal and fetal outcomes in women with Guillain-Barré syndrome in pregnancy. J Neurol 2023; 270:4498-4506. [PMID: 37294323 PMCID: PMC10252168 DOI: 10.1007/s00415-023-11808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Guillain-Barre syndrome (GBS) is an acute inflammatory polyradiculoneuropathy rarely observed during pregnancy. METHODS In this retrospective study, we analyzed the characteristics of pregnant women with GBS (pGBS) diagnosed in French University Hospitals in the 2002-2022 period and compared them with a reference group of same-age non-pregnant women with GBS (npGBS) identified in the same institutions & timeframe. RESULTS We identified 16 pGBS cases. Median age was 31 years (28-36), and GBS developed in the 1st, 2nd, and 3rd trimester in 31%, 31% and 38% of cases respectively. A previous infection was identified in six cases (37%), GBS was demyelinating in nine cases (56%), and four patients (25%) needed respiratory assistance. Fifteen patients (94%) were treated with intravenous immunoglobulins, and neurological recovery was complete in all cases (100%). Unscheduled caesarean section was needed in five cases (31%), and two fetuses (12.5%) died because of cytomegalovirus (CMV) infection (1 case) and HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome (1 case). In comparison with a reference group of 18 npGBS women with a median age of 30 years (27-33), pGBS patients more frequently had CMV infection (31% vs 11%), had a prolonged delay between GBS onset and hospital admission (delay > 7 days: 57% vs 12%), more often needed ICU admission (56% vs 33%) and respiratory assistance (25% vs 11%), and more often presented with treatment-related fluctuations (37% vs 0%). CONCLUSIONS This study shows GBS during pregnancy is a severe maternal condition with significant fetal mortality.
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Templeton AJ, Omlin A, Berthold D, Beyer J, Burger IA, Eberli D, Engeler D, Fankhauser C, Fischer S, Gillessen S, Nicolas G, Kroeze S, Lorch A, Müntener M, Papachristofilou A, Schaefer N, Seiler D, Stenner F, Tsantoulis P, Vlajnic T, Zilli T, Zwahlen D, Cathomas R. Interdisciplinary Swiss consensus recommendations on staging and treatment of advanced prostate cancer. Swiss Med Wkly 2023; 153:40108. [PMID: 37598311 DOI: 10.57187/smw.2023.40108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
The management of prostate cancer is undergoing rapid changes in all disease settings. Novel imaging tools for diagnosis have been introduced, and the treatment of high-risk localized, locally advanced and metastatic disease has changed considerably in recent years. From clinical and health-economic perspectives, a rational and optimal use of the available options is of the utmost importance. While international guidelines list relevant pivotal trials and give recommendations for a variety of clinical scenarios, there is much room for interpretation, and several important questions remain highly debated. The goal of developing a national consensus on the use of these novel diagnostic and therapeutic strategies in order to improve disease management and eventually patient outcomes has prompted a Swiss consensus meeting. Experts from several specialties, including urology, medical oncology, radiation oncology, pathology and nuclear medicine, discussed and voted on questions of the current most important areas of uncertainty, including the staging and treatment of high-risk localized disease, treatment of metastatic hormone-sensitive prostate cancer (mHSPC) and use of new options to treat metastatic castration-resistant prostate cancer (mCRPC).
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Chitimus DM, Berling E, Garderet L, Venturelli N, Malfatti E, Authier FJ, Nicolas G, Laforêt P, Lefeuvre C. Systemic light chain amyloidosis myopathy responsive to daratumumab monotherapy. Eur J Neurol 2023; 30:745-748. [PMID: 36403110 PMCID: PMC10098764 DOI: 10.1111/ene.15640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/09/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE Amyloid myopathy is a rare and severe manifestation of systemic light chain (AL) amyloidosis. Early diagnosis and staging are mandatory for optimal therapy, given the rapid progression of muscle weakness. Despite the efficacy of bortezomib-based treatment regimens, there is a lack of therapeutic alternatives in non-responsive patients. METHOD The case report of a patient with systemic AL amyloidosis myopathy treated with daratumumab is presented. RESULTS A 70-year-old man displayed severe proximal muscle weakness which had developed over a 10-month period. Blood tests revealed an immunoglobulin A lambda monoclonal gammopathy, whilst muscle biopsy showed amyloid deposits within the arteriolar walls, confirming the diagnosis of amyloid myopathy associated with AL amyloidosis. Initial treatment with a bortezomib-based regimen showed no clinical or hematological improvement. After switching to daratumumab monotherapy, our patient achieved a favorable evolution with respect to functional muscle scoring and a complete hematological response. CONCLUSION To our knowledge, this is the first case report of an amyloid myopathy showing a remarkable clinical improvement in response to daratumumab monotherapy. It thereby highlights the potential of daratumumab as a monotherapeutical approach to the treatment of amyloid myopathy complicating AL amyloidosis.
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Guémy C, Durand MC, Brisset M, Nicolas G. Changes in electrophysiological findings suggestive of demyelination following Guillain-Barré syndrome: A retrospective study. Muscle Nerve 2023; 67:394-400. [PMID: 36814082 DOI: 10.1002/mus.27803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION/AIMS Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common form of Guillain-Barré syndrome (GBS) in Western countries. However, electrophysiological descriptions of changes in abnormalities suggestive of demyelination after an AIDP episode are rare. We aimed to describe the clinical and electrophysiological features of AIDP patients after the acute episode, to investigate changes in abnormalities suggestive of demyelination and to compare with electrophysiological features of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS We reviewed the clinical and electrophysiological characteristics of 61 patients followed at regular intervals after the AIDP episode. RESULTS We detected early electrophysiological abnormalities from the first nerve conduction studies (NCS) performed before 3 wk. Abnormalities suggestive of demyelination worsened on subsequent examinations. This worsening continued after more than 3 mo of follow-up for some parameters. We also found the persistence of abnormalities suggestive of demyelination for long periods after the acute episode, beyond 18 mo of follow-up, despite clinical improvement in most patients. DISCUSSION In AIDP, NCS findings continue to worsen several weeks or even months after the onset of symptoms, and "CIDP-like" abnormalities suggestive of demyelination may persist for a long period of time, in contrast to the existing literature and the usually favorable clinical course. Thus, the discovery of conduction abnormalities on NCS performed long after an AIDP should always be interpreted according to the clinical context and not systematically lead to a diagnosis of CIDP.
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Chirindel A, Kidd M, Rentsch CA, Stenner F, Templeton AJ, Nitzsche E, Wild D, Nicolas G, Modlin IM. Evaluation of a novel transcriptomic tumor signature (PROSTest) as response biomarker for 177Lu-PSMA therapy in advanced prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
183 Background: Radionuclide therapy targeting the prostate specific membrane antigen (177Lu-PSMA therapy) has proven to be an effective treatment in men with metastatic castration resistant prostate cancer (mCRPCs). Despite representing a significant therapeutic breakthrough, a critical unmet need in 177Lu-PSMA therapy, is a prognostic biomarker for treatment optimization. Imaging and standard biomarkers have limited value. The PROSTest is a new 27-gene algorithmic signature originally developed for prostate adenocarcinoma diagnosis (0 to 100, positive score ≥20). We hypothesized that PROSTest would be elevated in mCRPCs and could have utility as a biomarker for mCRPC management. Methods: Prospective enrollment of 113 mCRPC for 177Lu-PSMA therapy (KlbB-5338-0302021 study). Pathology, clinical and biomarker data were available as was PSMA-PET/CT. Blood samples were collected for PROSTest prior to therapy. Target genes were isolated and amplified using qPCR. PROSTest scores (0-100) were obtained following algorithmic analysis. Scores were correlated with mCRPC diagnosis and baseline information. Scores and standard clinical measures were evaluated as prognostic factors with survival as endpoint. Mann-Whitney U-test, Kaplan-Meier survival and Cox proportional hazards regression analysis were utilized. All data: median (IQ range). Results: 89 (79%) patients were evaluable. Age was 75 (68-80). Disease characteristics at time of diagnosis included Gleason scores 8-10 (70%) and TMM: T3-T4 tumors (67%), N1 (53%), M1 (45%). At the time of therapy all patients were metastatic and all exhibited PSMA-positive disease. The highest tumor SUVmax was 51 (28-78). PSA levels were 69ng/mL (18-305). The PROSTest score was 89 (81-92). PROSTest scores were weakly correlated with age (r=0.33, p=0.0015) but not with baseline histopathological parameters (e.g., Gleason score, TNM) or pretreatment imaging results (e.g., SUVmax). Twenty-four (27%) patients have perished. Treatment and follow-up (5 months, 3-18) are ongoing. The mOS was 15 months. No factors were associated with death as an outcome except for the PROSTest score. PROSTest scores ≥79 (based on ROC analysis) were associated with significantly increased risk for mortality (HR: 2.9, 95% CI: 1.5-7.4). The mOS was 14 months in patients with pre-therapy PROSTest scores >79 compared to mOS not reached for PROSTest scores <79 ( p=0.02). In the COX model, baseline PROSTest was confirmed to be significantly predictive of death despite therapy (β = 1.51, p=0.01). Conclusions: The PROSTest blood gene expression score is elevated in mCRPCs. Levels are not associated with baseline clinical, histopathological, pretreatment PSA or imaging parameters. Elevated expression (≥79) of this biomarker prior to treatment was associated with a lower survival and could be used to predict survival in patients undergoing 177Lu-PSMA.
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Demestre L, Grange S, Dubois C, Bideau N, Nicolas G, Pontonnier C, Dumont G. Characterization of the dynamic behavior of a diving board using motion capture data. SPORTS ENGINEERING 2022. [DOI: 10.1007/s12283-022-00388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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20
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Wallon D, Nicolas G. Genetica della malattia di Alzheimer. Neurologia 2022. [DOI: 10.1016/s1634-7072(22)47093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Mateo M, Nicolas G. Mapping capability of linear correlation statistics for characterization of complex materials using laser-induced breakdown spectroscopy. Anal Chim Acta 2022; 1227:340260. [DOI: 10.1016/j.aca.2022.340260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/22/2022] [Accepted: 08/11/2022] [Indexed: 11/01/2022]
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22
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Delhaye E, Bouvet A, Nicolas G, Vilas-Boas JP, Bideau B, Bideau N. Automatic Swimming Activity Recognition and Lap Time Assessment Based on a Single IMU: A Deep Learning Approach. SENSORS 2022; 22:s22155786. [PMID: 35957347 PMCID: PMC9371205 DOI: 10.3390/s22155786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 12/10/2022]
Abstract
This study presents a deep learning model devoted to the analysis of swimming using a single Inertial Measurement Unit (IMU) attached to the sacrum. Gyroscope and accelerometer data were collected from 35 swimmers with various expertise levels during a protocol including the four swimming techniques. The proposed methodology took high inter- and intra-swimmer variability into account and was set up for the purpose of predicting eight swimming classes (the four swimming techniques, rest, wallpush, underwater, and turns) at four swimming velocities ranging from low to maximal. The overall F1-score of classification reached 0.96 with a temporal precision of 0.02 s. Lap times were directly computed from the classifier thanks to a high temporal precision and validated against a video gold standard. The mean absolute percentage error (MAPE) for this model against the video was 1.15%, 1%, and 4.07%, respectively, for starting lap times, middle lap times, and ending lap times. This model is a first step toward a powerful training assistant able to analyze swimmers with various levels of expertise in the context of in situ training monitoring.
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Grangeon L, Quesney G, Verdalle-Cazes M, Coulette S, Renard D, Wacongne A, Allou T, Olivier N, Boukriche Y, Blanchet-Fourcade G, Labauge P, Arquizan C, Canaple S, Godefroy O, Martinaud O, Verdure P, Quillard-Muraine M, Pariente J, Magnin E, Nicolas G, Charbonnier C, Maltête D, Formaglio M, Raposo N, Ayrignac X, Wallon D. Different clinical outcomes between cerebral amyloid angiopathy-related inflammation and non-inflammatory form. J Neurol 2022; 269:4972-4984. [PMID: 35752990 DOI: 10.1007/s00415-022-11145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a rare manifestation related to CAA, thought to be more severe. We aimed to compare the clinical and radiological outcomes of CAA-ri and non-inflammatory CAA. MATERIALS AND METHODS We retrospectively included all patients with CAA-ri from 13 French centers. We constituted a sex- and age-matched control cohort with non-inflammatory CAA and similar disease duration. Survival, autonomy and cognitive evolution were compared after logistic regression. Cerebral microbleeds (CMB), intracerebral hemorrhage, cortical superficial siderosis and hippocampal atrophy were analyzed as well as CSF biomarker profile and APOE genotype when available. Outcomes were compared using Kaplan-Meier curves and log-rank tests. RESULTS Data from 48 CAA-ri patients including 28 already reported and 20 new patients were analyzed. Over a mean of 3.1 years, 11 patients died (22.9%) and 18 (37.5%) relapsed. CAA-ri patients were more frequently institutionalized than non-inflammatory CAA patients (30% vs 8.3%, p < 0.001); mortality rates remained similar. MMSE and modified Rankin scale scores showed greater severity in CAA-ri at last follow-up. MRI showed a higher number of CMB at baseline and last follow-up in CAA-ri (p < 0.001 and p = 0.004, respectively). CSF showed lower baseline levels of Aß42 in CAA-ri than non-inflammatory CAA (373.3 pg/ml vs 490.8 pg/ml, p = 0.05). CAA-ri patients more likely carried at least one APOE ε4 allele (76% vs 37.5%, adjusted p = 0.05) particularly as homozygous status (56% vs 6.2%, p < 0.001). INTERPRETATION CAA-ri appears to be more severe than non-inflammatory CAA with a significant loss of autonomy and global higher amyloid burden, shown by more CMB and a distinct CSF profile. This burden may be partially promoted by ε4 allele.
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Demestre L, Morin P, May F, Bideau N, Nicolas G, Pontonnier C, Dumont G. Motion-Based Ground Reaction Forces and Moments Prediction Method for Interaction with a Moving And/Or Non-Horizontal Structure. J Biomech Eng 2022; 144:1141730. [PMID: 35722981 DOI: 10.1115/1.4054835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Indexed: 11/08/2022]
Abstract
Inverse dynamics methods are commonly used for the biomechanical analysis of human motion. External forces applied on the subject are required as an input data to solve the dynamic equilibrium of the subject. Force platforms measure ground reactions forces and moments (GRF&Ms) but they limit the ecological aspect of experimental conditions. Motion-based GRF&Ms prediction may circumvent this limitation. The current study aims at evaluating the accuracy of an optimization-based GRF&Ms prediction method modified to be applied to the interaction with a moving and/or non horizontal structure. The main improvement of the method deals with the contact detection in such a moving and/or non horizontal frame. To evaluate the accuracy of the method, 20 subjects performed squats and steps on an instrumented moving structure, measuring both motion and GRF&Ms. The comparison of the root mean square error between the predicted and measured GFR&Ms divided by the subjects mass showed a similar order of magnitude than those from the method without the studied modification (0.14 N/kg for antero-posterior forces, 0.29 N/kg for medio lateral forces, 0.61 N/kg for longitudinal forces, 0.06 Nm/kg for frontal moments, 0.13 Nm/kg for sagittal moments, and 0.03 Nm/kg for transverse moments). The results showed the suitability of the method to study human motions for tasks performed on a moving and/or non-horizontal structure.
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Mallaev M, Chirindel AF, Nicolas G, Tamm M, Hojski A, Wiese M, Stolz D, Lardinois D. 3D-quantitated lung perfusion SPECT/CT: Impact on intended management compared to lung perfusion scan in marginal candidates for lung resection surgery. Br J Surg 2022. [DOI: 10.1093/bjs/znac185.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Based on previous studies, single-photon emission computed tomography/computed tomography (SPECT/CT) has been proven to be more accurate and reproducible than planar lung perfusion scintigraphy. We conducted a study to evaluate the impact of 3D-quantitated lung perfusion SPECT/CT on intended management in candidates for lung resection surgery.
Methods
Retrospective study including candidates for lung resection surgery with lung perfusion imaging. Patients underwent preoperative evaluation according to ERS/ESTS algorithm. The lobar contribution to the total lung perfusion was estimated using planar antero-posterior, posterior oblique and three-dimensional anatomical SPECT/CT method (CT Pulmo 3D and xSPECT- Quant, Siemens). The difference in lobar perfusion with resulting changes in the extent of lung resection were analyzed to reveal possible changes in operability.
Results
120 patients (46 females) with known lung cancer or pulmonary lesion considered for resection with available lung perfusion scintigraphy and SPECT/CT were enrolled. The mean age (±SD) of patients was 68 ±9 years, the target lesions were located in upper lobe in 57.7% and in lower lobe in 33.5%. The median [IQR] FEV1 was 70.5% [52–84] and median DLCO 56.6% [47.1–67.4]. The planar posterior oblique method, compared to 3D-quantitated SPECT/CT, underestimated the perfusion of upper lobes by a median difference of 5% (right [2–9; IQR]; left [2.5–8], p= < 0.0001), while it overestimated the both lower lobes (left by 4% [2–7]; right by 6% [2–9], p= < 0.0001). In contrast to the planar scintigraphy based evaluation, 4(3.3%) patients with upper lobe lesions were classified as inoperable when 3D-quantitated SPECT/CT was used for calculation of predicted postoperative lung function.
Conclusion
In selected patients with upper lobe lesions, 3D-quantitated SPECT/CT would have changed the treatment strategy from operable to inoperable. Importantly, post-operative mortality in this particular subgroup was disproportionally high. 3D-quantitated SPECT/CT shall be further evaluated as it might improve preoperative risk stratification in marginal lung resection candidates.
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