Albumin-binding MR blood pool contrast agent improves diagnostic performance in human brain tumour: comparison of two contrast agents for glioblastoma.

OBJECTIVE: We qualitatively and quantitatively compared MRI enhancement obtained with gadofosveset, an albumin-binding blood-pool contrast agent, and with gadobutrol, an extracellular contrast agent, in patients with glioblastoma. METHODS: Thirty-five patients (25 men; 64 ± 14 years) with histologically proven glioblastoma underwent MRI including pre- and post-contrast T1-weighted SE images acquired 5 min after gadobutrol (0.1 mmol/kg) and, 48 h later, images acquired with identical parameters 5 min and 3, 6, and 24 h after gadofosveset (0.03 mmol/kg). Lesion extent, delineation, internal morphology, multifocality, and global diagnostic preference were evaluated quantitatively for the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and contrast enhancement (CE). RESULTS: Mean values of SNR, CNR, and tumour CE were highest 6 h after gadofosveset. Multifocality was seen in 17 (48.6 %) patients; additional lesions had stronger enhancement 6 h after gadofosveset in 12 patients (70.6 %). In 21 (60 %) patients, radiologists' global preference was highest in images acquired 6 h after gadofosveset (kappa = 0.764). In 22 patients (62.8 %), all qualitative endpoints were better at 5 min after gadobutrol than in images acquired 5 min after gadofosveset injection. CONCLUSIONS: Gadobutrol gives significant tumour enhancement in early postcontrast imaging. However, images acquired 6 h after gadofosveset injection have significantly better diagnostic information endpoints and contrast enhancement.

A diagnostic approach to the mediastinal masses.

BACKGROUND: Multiple different types of mediastinal masses may be encountered on imaging techniques in symptomatic or asymptomatic patients. The location and composition of these lesions are critical to narrowing the differential diagnosis. METHODS: Radiological compartmentalisation of the mediastinum helps in focusing the diagnosis of masses on the basis of their site. Some diseases, however, do not occur exclusively in any specific compartment and can spread from one compartment to another. RESULTS: Tissular components of the mass, the degree of vascularisation and the relationships with mediastinal structures assessed by computed tomography (CT) or magnetic resonance imaging (MRI) are a leading edge of the radiological diagnosis. Special applications at MRI have been developed over the recent years in order to identify accurately tissular components of the mediastinal masses. The likelihood of malignancy of the mediastinal masses is influenced by the symptomatology and the age of the patient. This article reviews the most commonly encountered mediastinal masses considering clinical history and manifestations, anatomical position and certain details seen on different imaging modalities that allow correct diagnosis in many cases. CONCLUSION: Familiarity with the radiological features of mediastinal masses facilitates accurate diagnosis, differentiation from other mediastinic processes and, thus, optimal patient treatment. TEACHING POINTS: • CT and MRI are important for the diagnosis of mediastinal masses. • The location and tissue characteristics on imaging studies are critical to narrow down the differential diagnosis of mediastinal masses. • Symptomatology and patient age affect the likelihood of malignancy.

[Population-based incidence of lymphoid neoplasms by histological subtypes in Girona (Spain), 1994-2001]. / Incidencia poblacional de las neoplasias linfoides según el subtipo histológico (Clasificación de la OMS) en Girona, 1994-2001.

BACKGROUND AND OBJECTIVE: We aimed to assess the distribution of the lymphoid neoplasms and their histological subtypes in accordance with the World Health Organization (WHO) classification by calculating their incidences rates in our area. PATIENTS AND METHOD: From January 1994 to December 2001, 1,288 patients diagnosed with lymphoid neoplasms were recruited in the population-based Cancer Registry of Girona. Former pathological and hematological diagnoses were reviewed and some were prospectively reclassified following the latest WHO classification. RESULTS: Following criteria established by WHO classification the distribution of lymphoid neoplasms was as follows: 77.3% B-cell neoplasm, 5.9% T-cell neoplasm, 8.7% Hodgkin lymphoma and 8,2% was unclassifiable. From 1994 TO 2001 the lymphoid neoplasm crude incidence rates was 35.8 per 100,000 men-year, while it was 25.7 new cases per 100,000 women-year. In children (< 15 years old), precursor B-lymphoblastic lymphoma/leukemia (65%) and Hodgkin lymphoma (20%) were the most frequent lymphoid neoplasm, whereas myeloma (17.8%), diffuse large B-cell lymphoma (13.5%) showed the highest incidence rate in adults. CONCLUSIONS: A higher incidence rate of lymphoid neoplasms was found in men in our area compared with other geographical areas in Spain, which could suggested a faster approximation to the pattern observed in industrialized societies. The cause of this geographical distribution is unknown.

Incidencia poblacional de las neoplasias linfoides según el subtipo histológico (Clasificación de la OMS) en Girona, 1994-2001 / Population-based incidence of lymphoid neoplasms by histological subtypes in Girona (Spain), 1994-2001

Fundamento y objetivo: Conocer la incidencia de las neoplasias linfoides y sus variantes histológicas de acuerdo con la clasificación de la Organización Mundial de la Salud. Pacientes y método: Desde enero de 1994 a diciembre de 2001, se registraron 1.288 pacientes con el diagnóstico de neoplasia linfoide en la población cubierta por el Registro de Cáncer Poblacional de Girona. Se revisaron los diagnósticos anatomopatológicos y hematológicos para la reclasificación retrospectiva de los diagnósticos. Resultados: La distribución de las neoplasias linfoides fue: neoplasias de células B (77,3%), neoplasias de células T/citolíticas (5,9%), linfomas de Hodgkin (8,7%) y no clasificables (8,2%). La tasa bruta de incidencia de las neoplasias linfoides fue de 35,8 nuevos casos por 100.000 varones y año y de 25,7 nuevos casos por 100.000 mujeres y año. En los niños (< 15 años) fueron la leucemia/linfoma linfoblástico de células B precursoras (65%) y los linfomas de Hodgkin (20%) las entidades más frecuentes, mientras que en los adultos lo fueron los mielomas (17,8%), los linfomas B difusos de células grandes (13,5%), la leucemia linfática crónica/linfoma linfocítico de células pequeñas (13,3%) y los linfomas foliculares (9,7%). Conclusiones: La incidencia de las neoplasias linfoides en la provincia de Girona es superior al resto del Estado español, lo que indica una aproximación mas acelerada al patrón observado en sociedades industrializadas. Se desconocen las causas de esta variación geográfica

Background and objective: We aimed to assess the distribution of the lymphoid neoplasms and their histological subtypes in accordance with the World Health Organization (WHO) classification by calculating their incidences rates in our area. Patients and method: From January 1994 to December 2001, 1,288 patientes diagnosed with lymphoid neoplasms were recruited in the population- based Cancer Registry of Girona. Former pathological and hematological diagnoses were reviewed and some were prospectively reclassified following the latest WHO classification. Results: Following criteria established by WHO classification the distribution of lymphoid neoplasms was as follows: 77.3% B-cell neoplasm, 5.9% T-cell neoplasm, 8.7% Hodgkin lymphoma and 8,2% was unclassifiable. From 1994 TO 2001 the lymphoid neoplasm crude incidence rates was 35.8 per 100,000 men-year, while it was 25.7 new cases per 100,000 women-year. In children (< 15 years old), precursor B-lymphoblastic lymphoma/leukemia (65%) and Hodgkin lymphoma (20%) were the most frequent lymphoid neoplasm, whereas myeloma (17.8%), diffuse large B-cell lymphoma (13.5%) showed the highest incidence rate in adults. Conclusions: A higher incidence rate of lymphoid neoplasms was found in men in our area compared with other geographical areas in Spain, which could suggested a faster aproximation to the pattern observed in industrialized societies. The cause of this geographical distribution is unknow

Invisible mycosis fungoides: a diagnostic challenge.

We describe a 76-year-old woman who had persistent generalized pruritus as the only cutaneous manifestation of a cutaneous T-cell lymphoma (mycosis fungoides). No cutaneous lesions were observed throughout the patient's course. Skin biopsy specimens obtained from normal-looking pruritic skin revealed a discrete perivascular lymphocytic infiltrate in the upper dermis and focal intraepidermal clusters of atypical lymphoid cells (Pautrier's microabscesses). PCR analysis of TCR-gamma gene disclosed a monoclonal T-cell rearrangement. Sequencing of the PCR monoclonal product identified the J(8)V(2)C(2) TCR gene rearrangement. This observation illustrates the existence of a peculiar and exceedingly rare form of mycosis fungoides characterized only by persistent pruritus unresponsive to several therapeutic approaches. The diagnostic difficulties of this rare variant are stressed.