ABSTRACT
The 2021 World Health Organization classification of CNS tumours was greeted with enthusiasm as well as an initial potential overwhelm. However, with time and experience, our understanding of its key aspects has notably improved. Using our collective expertise gained in neuro-oncology units in hospitals in different countries, we have compiled a practical guide for radiologists that clarifies the classification criteria for diffuse gliomas in adults. Its format is clear and concise to facilitate its incorporation into everyday clinical practice. The document includes a historical overview of the classifications and highlights the most important recent additions. It describes the main types in detail with an emphasis on their appearance on imaging. The authors also address the most debated issues in recent years. It will better prepare radiologists to conduct accurate presurgical diagnoses and collaborate effectively in clinical decision making, thus impacting decisions on treatment, prognosis, and overall patient care.
Subject(s)
Brain Neoplasms , Glioma , Humans , Glioma/diagnostic imaging , Brain Neoplasms/diagnostic imaging , Adult , World Health Organization , Preoperative CareABSTRACT
Introducción La tomografía por emisión de positrones (PET) con aminoácidos es una herramienta recomendada por las principales sociedades de neuroimagen, en el diagnóstico diferencial entre radionecrosis (RNC) y recurrencia tumoral (RT) en los tumores cerebrales, sin embargo, su uso en nuestro pais aún es limitado. El objetivo de este trabajo es presentar nuestra experiencia con 6-[18F]FDOPA PET/TC (FDOPA) en tumores cerebrales (primarios y M1), comparando estos resultados con otros publicados. Material y métodos Estudio retrospectivo de 62 pacientes con sospecha de RT: 42 metástasis cerebrales (M1) y 20 primarios, a los que se les realizó una FDOPA. Las imágenes fueron analizadas visual y semicuantitativamente, obteniendo el SUVmax y los ratios SUVmaxlesión/SUVmaxestriado (L/E) y SUVmaxlesión/SUVmaxcortex (L/C). Se analizó la validez diagnóstica de la PET y se calcularon los puntos de corte con mayor rendimiento. Los resultados de la PET se compararon con la evolución clínico-radiológica y/o con la histopatología. Resultados Se identificó RT en el 49% de las M1 y en el 76% de los primarios cerebrales. La interpretación de la FDOPA con mejores resultados fue la conjunta; visual y semicuantitativa, con una sensibilidad y especificidad en los primarios del 94 y 80% y en las M1 del 96 y 72%, respectivamente. Los puntos de corte con mejor rendimiento diagnóstico fueron L/C 1,44 en M1 y L/C 1,55 en primarios. Existen resultados discrepantes con otros publicados. Conclusión La FDOPA PET/TC es una herramienta útil en el diagnóstico diferencial entre RT y RNC en tumores cerebrales. Es necesario una estandarización que contribuya a homogeneizar los resultados de la FDOPA a nivel intercentro (AU)
Introduction Amino acid PET is a tool recommended by the main neuroimaging societies in the differential diagnosis between radionecrosis (RNC) and tumour recurrence (TR) in brain tumours, but its use in our country is still limited. The aim of this work is to present our experience with 6-[18F]FDOPA PET/CT (FDOPA) in brain tumours (primary and M1), comparing these results with other published results. Material and methods Retrospective study of 62 patients with suspected tumour recurrence (TR): 42 brain metastases (M1) and 20 primary, who underwent FDOPA. Images were analysed visually and semi-quantitatively, obtaining SUVmax and SUVmaxlesion/SUVmaxstriatum (L/S) and SUVmaxlesion/SUVmaxcortex (L/C) ratios. The diagnostic validity of PET was analysed and the best performing cut-off points were calculated. PET results were compared with clinical-radiological follow-up and/or histopathology. Results TR was identified in 49% of M1 and 76% of brain primaries. The best performing FDOPA interpretation was visual and semi-quantitative, with a sensitivity and specificity in primaries of 94% and 80% and in M1s of 96% and 72% respectively. The cut-off points with the best diagnostic performance were L/C1.44 in M1 and L/C1.55 in primaries. There are discrepant results with other published results. Conclusion FDOPA PET/CT is a useful tool in the differential diagnosis between recurrence and RNC in brain tumours. It is needed a standardization to contribute to homogenise FDOPA results a inter-centre level (AU)
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Aged , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/radiotherapy , Dihydroxyphenylalanine , Retrospective Studies , Neoplasm Recurrence, Local , Positron Emission Tomography Computed TomographyABSTRACT
INTRODUCTION: Amino acid PET is a tool recommended by the main neuroimaging societies in the differential diagnosis between radionecrosis (RNC) and umour recurrence (TR) in brain tumours, but its use in our country is still limited. The aim of this work is to present our experience with 6-[18F]FDOPA PET/CT (FDOPA) in brain tumours (primary and M1), comparing these results with other published results. MATERIAL AND METHODS: Retrospective study of 62 patients with suspected tumour recurrence (TR): 42 brain metastases (M1) and 20 primary, who underwent FDOPA. Images were analysed visually and semi-quantitatively, obtaining SUVmax and SUVmaxlesion/SUVmaxstriatum (L/S) and SUVmaxlesion/SUVmaxcortex (L/C) ratios. The diagnostic validity of PET was analysed and the best performing cut-off points were calculated. PET results were compared with clinical-radiological follow-up and/or histopathology. RESULTS: TR was identified in 49% of M1 and 76% of brain primaries. The best performing FDOPA interpretation was visual and semi-quantitative, with a sensitivity and specificity in primaries of 94% and 80% and in M1s of 96% and 72% respectively. The cut-off points with the best diagnostic performance were L/C1.44 in M1 and L/C1.55 in primaries. There are discrepant results with other published results. CONCLUSION: FDOPA PET/CT is a useful tool in the differential diagnosis between recurrence and RNC in brain tumours. It is needed a standardization to contribute to homogenise FDOPA results a inter-centre level.
Subject(s)
Brain Neoplasms , Positron Emission Tomography Computed Tomography , Humans , Neoplasm Recurrence, Local/diagnostic imaging , Retrospective Studies , Positron-Emission Tomography/methods , Dihydroxyphenylalanine , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/radiotherapyABSTRACT
Lymphomas of the CNS are the second most frequent primary brain malignancy in adults after gliomas. Presurgical suspicion of lymphoma greatly impacts patient management. The radiologic features of this tumor have been widely covered in the literature for decades, but under current classifications, mainly corresponding to the most common presentations of the most frequent type: primary diffuse large B-cell lymphoma of the CNS. Nevertheless, rarer presentations of this specific lymphoma and of other World Health Organization lymphoma subtypes with different imaging features are rarely treated. Moreover, important advances in imaging techniques, changing epidemiologic factors with relevant impact on these tumors (eg, immunodeficiency/dysregulation), and recent updates of the World Health Organization Classification of CNS Tumors 2021 and Hematolymphoid Tumors 2022 may have rendered some accepted concepts outdated. In this article, the authors aim to fulfill a critical need by providing a complete update-review, emphasizing the latest clinical-radiologic features of the full spectrum of lymphomas involving the CNS.
Subject(s)
Brain Neoplasms , Central Nervous System Neoplasms , Lymphoma , Neoplasms, Second Primary , Adult , Humans , Lymphoma/diagnostic imaging , Lymphoma/pathology , Central Nervous System Neoplasms/diagnostic imaging , Central Nervous System Neoplasms/pathology , Diagnostic Imaging , World Health OrganizationABSTRACT
BACKGROUND AND PURPOSE: Immunodeficiency-associated CNS lymphoma may occur in different clinical scenarios beyond AIDS. This subtype of CNS lymphoma is diffuse large B-cell and Epstein-Barr virus-positive. Its accurate presurgical diagnosis is often unfeasible because it appears as ring-enhancing lesions mimicking glioblastoma or metastasis. In this article, we describe clinicoradiologic features and test the performance of DSC-PWI metrics for presurgical identification. MATERIALS AND METHODS: Patients without AIDS with histologically confirmed diffuse large B-cell Epstein-Barr virus-positive primary CNS lymphoma (December 2010 to January 2022) and diagnostic MR imaging without onco-specific treatment were retrospectively studied. Clinical, demographic, and conventional imaging data were reviewed. Previously published DSC-PWI time-intensity curve analysis methodology, to presurgically identify primary CNS lymphoma, was used in this particular lymphoma subtype and compared with a prior cohort of 33 patients with Epstein-Barr virus-negative CNS lymphoma, 35 with glioblastoma, and 36 with metastasis data. Normalized curves were analyzed and compared on a point-by-point basis, and previously published classifiers were tested. The standard percentage of signal recovery and CBV values were also evaluated. RESULTS: Seven patients with Epstein-Barr virus-positive primary CNS lymphoma were included in the study. DSC-PWI normalized time-intensity curve analysis performed the best for presurgical identification of Epstein-Barr virus-positive CNS lymphoma (area under the receiver operating characteristic curve of 0.984 for glioblastoma and 0.898 for metastasis), followed by the percentage of signal recovery (0.833 and 0.873) and CBV (0.855 and 0.687). CONCLUSIONS: When a necrotic tumor is found in a potentially immunocompromised host, neuroradiologists should consider Epstein-Barr virus-positive CNS lymphoma. DSC-PWI could be very useful for presurgical characterization, with especially strong performance of normalized time-intensity curves.
Subject(s)
Epstein-Barr Virus Infections , Glioblastoma , Lymphoma, Large B-Cell, Diffuse , Humans , Herpesvirus 4, Human , Epstein-Barr Virus Infections/complications , Epstein-Barr Virus Infections/diagnostic imaging , Retrospective Studies , Lymphoma, Large B-Cell, Diffuse/diagnostic imaging , Lymphoma, Large B-Cell, Diffuse/pathology , PerfusionABSTRACT
BACKGROUND AND PURPOSE: DSC-PWI has demonstrated promising results in the presurgical diagnosis of brain tumors. While most studies analyze specific parameters derived from time-intensity curves, very few have directly analyzed the whole curves. The aims of this study were the following: 1) to design a new method of postprocessing time-intensity curves, which renders normalized curves, and 2) to test its feasibility and performance on the diagnosis of primary central nervous system lymphoma. MATERIALS AND METHODS: Diagnostic MR imaging of patients with histologically confirmed primary central nervous system lymphoma were retrospectively reviewed. Correlative cases of glioblastoma, anaplastic astrocytoma, metastasis, and meningioma, matched by date and number, were retrieved for comparison. Time-intensity curves of enhancing tumor and normal-appearing white matter were obtained for each case. Enhancing tumor curves were normalized relative to normal-appearing white matter. We performed pair-wise comparisons for primary central nervous system lymphoma against the other tumor type. The best discriminatory time points of the curves were obtained through a stepwise selection. Logistic binary regression was applied to obtain prediction models. The generated algorithms were applied in a test subset. RESULTS: A total of 233 patients were included in the study: 47 primary central nervous system lymphomas, 48 glioblastomas, 39 anaplastic astrocytomas, 49 metastases, and 50 meningiomas. The classifiers satisfactorily performed all bilateral comparisons in the test subset (primary central nervous system lymphoma versus glioblastoma, area under the curve = 0.96 and accuracy = 93%; versus anaplastic astrocytoma, 0.83 and 71%; versus metastases, 0.95 and 93%; versus meningioma, 0.93 and 96%). CONCLUSIONS: The proposed method for DSC-PWI time-intensity curve normalization renders comparable curves beyond technical and patient variability. Normalized time-intensity curves performed satisfactorily for the presurgical identification of primary central nervous system lymphoma.
Subject(s)
Brain Neoplasms/diagnostic imaging , Central Nervous System Neoplasms/diagnostic imaging , Image Interpretation, Computer-Assisted/methods , Neuroimaging/methods , Adolescent , Adult , Aged , Aged, 80 and over , Algorithms , Brain Neoplasms/pathology , Central Nervous System Neoplasms/pathology , Female , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Pilot Projects , Retrospective Studies , Young AdultABSTRACT
The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic has shaken hospitals worldwide. Some authors suggest that neurologic involvement could further complicate the disease. This descriptive study is a cross-sectional review of 103 patients diagnosed with COVID-19 who underwent neuroimaging (of a total of 2249 patients with COVID-19 in our center). Analyzed variables were neurologic symptoms and acute imaging findings. The most frequent symptoms that motivated neuroimaging examinations were mild nonfocal neurologic symptoms, code stroke (refers to patients presenting with signs and symptoms of stroke whose hyperacute assessment and care is prioritized), focal neurologic symptoms, postsedation encephalopathy, and seizures. No cases of encephalitis or direct central nervous system involvement were detected. Thirteen patients presented with acute ischemic events, and 7, with hemorrhagic events; however, most reported multiple vascular risk factors. Despite the large cohort of patients with COVID-19, we found a large number of symptomatic patients with negative neuroimaging findings, and no conclusions can be drawn concerning concrete associations between neuroimaging and COVID-19.
Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Neuroimaging , Pneumonia, Viral/complications , Stroke/etiology , Adult , Aged , Aged, 80 and over , COVID-19 , Cross-Sectional Studies , Encephalitis , Female , Humans , Male , Middle Aged , Pandemics , Risk Factors , SARS-CoV-2ABSTRACT
No disponible
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Humans , Male , Middle Aged , Hemangioma/diagnostic imaging , Orbital Neoplasms/diagnostic imaging , Exophthalmos/etiology , Hemangioma/classification , Diagnosis, Differential , Neoplasms, Nerve Tissue/diagnostic imagingABSTRACT
No disponible
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Humans , Male , Adult , Neurofibroma/complications , Neurofibroma , Tomography, Emission-Computed/methods , Earache/etiology , Diagnosis, Differential , Otoscopy , Glomus Jugulare Tumor/pathology , Glomus Jugulare Tumor , Ear, Middle/pathology , Ear, Middle , Hearing Loss/complications , Paraganglioma/pathology , ParagangliomaSubject(s)
Ear Neoplasms/pathology , Ear, Middle , Neurofibroma/pathology , Skull Base Neoplasms/pathology , Adult , Humans , Jugular Veins , Male , Neoplasm InvasivenessSubject(s)
Humans , Male , Young Adult , Carcinoma, Medullary/complications , Carcinoma, Medullary , Diagnosis, Differential , Hematuria/complications , Hematuria , Tomography, Emission-Computed/methods , Tomography, Emission-Computed , Tomography, X-Ray Computed , Kidney Neoplasms/complications , Kidney Neoplasms , Rhabdoid Tumor/complications , Rhabdoid TumorABSTRACT
No disponible
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Humans , Female , Middle Aged , Esophageal Fistula/diagnosis , Pericardium/injuries , Echocardiography, Transesophageal/adverse effects , Hematemesis/etiology , Iatrogenic Disease , Aneurysm, False/diagnosisABSTRACT
Non-ossifying fibromas (NOF) are a benign entity of the developing bone, relatively common in children and young adults. Their location is most frequently metaphyseal. They are usually asymptomatic (unless associated to a fracture) and have a self-limited behavior, with spontaneous regression through a sclerotic consolidation. Plain X-ray is the main imaging tool for its diagnosis. However, an unclear X-ray may lead to further imaging studies. We present the case of a 17-year-old male with back pain and lower limb dysmetria referred for a bone scintigraphy to complete the diagnostic and assess disease extension and the subsequent MRI evaluation
Los fibromas no osificantes (NOF) son entidades benignas del hueso en desarrollo, relativamente frecuentes en niños y adultos jóvenes. Su localización más habitual es la metáfisis de los huesos largos, suelen ser asintomáticos (excepto si se asocian a una fractura) y normalmente se autolimitan, regresando espontáneamente mediante una consolidación esclerosante. La radiografía simple es la principal herramienta para su diagnóstico. Sin embargo, una radiografía dudosa puede llevar a la realización de otras pruebas de imagen. Presentamos el caso de un chico de 17 años con dolor de espalda y dismetría de miembros inferiores, remitido para la realización de una gammagrafía ósea con la finalidad de completar el diagnóstico y evaluar la extensión de la afectación, y la posterior valoración mediante RM
Subject(s)
Humans , Male , Adolescent , Bone Neoplasms/diagnostic imaging , Fibroma/diagnostic imaging , Neoplasms, Multiple Primary/diagnostic imaging , Single Photon Emission Computed Tomography Computed Tomography , Tibia/diagnostic imaging , Magnetic Resonance ImagingABSTRACT
Non-ossifying fibromas (NOF) are a benign entity of the developing bone, relatively common in children and young adults. Their location is most frequently metaphyseal. They are usually asymptomatic (unless associated to a fracture) and have a self-limited behavior, with spontaneous regression through a sclerotic consolidation. Plain X-ray is the main imaging tool for its diagnosis. However, an unclear X-ray may lead to further imaging studies. We present the case of a 17-year-old male with back pain and lower limb dysmetria referred for a bone scintigraphy to complete the diagnostic and assess disease extension and the subsequent MRI evaluation.
Subject(s)
Bone Neoplasms/diagnostic imaging , Fibroma/diagnostic imaging , Neoplasms, Multiple Primary/diagnostic imaging , Single Photon Emission Computed Tomography Computed Tomography , Tibia/diagnostic imaging , Adolescent , Humans , Magnetic Resonance Imaging , MaleSubject(s)
Echinococcosis , Thoracic Wall/parasitology , Adult , Echinococcosis/diagnostic imaging , Echinococcosis/therapy , Humans , MaleABSTRACT
No disponible