Capacidad predictiva de la TC para evaluar las adenopatías cervicales en los tumores de cabeza y cuello / Predictive ability of the CT to evaluate cervical lymph nodes in head and neck tumours

Objetivo: Este estudio tiene como objetivo determinar el valor predictivo de la tomografía computarizada (TC), es decir, su sensibilidad y especificidad, en la detección de adenopatías metastásicas de tumores de cabeza y cuello. Además, se estudia la capacidad de la TC para estadificar correctamente la afectación ganglionar. Pacientes y método: La TC se efectuó a 95 pacientes diagnosticados de neoplasia de faringe y/o laringe que posteriormente fueron intervenidos de vaciamientos cervicales ganglionares. En el estudio de imagen se consideraron los siguientes parámetros radiológicos para sospechar afección ganglionar: diámetro de la adenopatía superior a 10mm, márgenes de la lesión mal definidos, realce de la cápsula tras la administración de contraste y adenopatías que independientemente del tamaño tuviesen signos de necrosis central. Resultados: El 70,53% de los vaciamientos resultó N+ en el estudio histopatológico. La sensibilidad de la TC fue del 82,09% y la especificidad del 85,71%. De los 67 vaciamientos histológicamente patológicos, la TC detectó positividad en 55, mientras que de los 28 vaciamientos histológicamente negativos, la TC detectó como negativos 24. El valor índice Kappa ponderado fue de 0,6408 que indica limitada capacidad para la correcta estadificación de las adenopatías. Conclusiones: Si bien la capacidad de la TC para detectar adenopatías metastásicas en los tumores de cabeza y cuello es aceptable, no lo es tanto para realizar una correcta estadificación de las mismas. Por tanto, es necesaria la búsqueda de otras pruebas de imagen que nos aporten una mayor precisión para así evitar vaciamientos electivos innecesarios y reducir la morbimortalidad de los mismos, debiendo actualmente prestar atención en las nuevas técnicas de imagen como son la PET y la PET/TC (AU)

Objective: The aim of this study was to determine the predictive value of computed tomography (CT) i.e., its sensitivity and specificity in detecting metastatic lymph nodes of head and neck tumors. We also studied the capacity of CT in correct nodal lymph staging. Patients and methods: A CT was performed on 95 patients diagnosed with neoplastic disease of the pharynx and/or larynx. All patients subsequently underwent cervical lymph node dissections. In the imaging study, the following parameters were considered for suspected radiological nodal involvement: lymph node diameter greater than 10mm, lesion margins poorly defined, capsule enhancement after contrast administration and lymph nodes that, despite their size, had signs of central necrosis. Results: In the dissections, 70.53% resulted N+ in the histological study. The sensitivity of CT was 82.09% and the specificity, 85.71%. The CT detected positivity in 55 of the 67 histologically pathological dissections, while the CT detected negativity in 24 of the 28 dissections histologically negative. The weighted kappa index value was 0.6408, indicating limited capacity for appropriate staging of the lymph nodes. Conclusions: While the ability of CT to detect metastatic lymph nodes in head and neck tumors is quite acceptable, it is less so for correctly staging them. It is therefore necessary to look for other imaging tests that provide greater accuracy to avoid unnecessary elective neck dissections and to reduce morbidity and mortality from them. We must now pay attention to new imaging techniques such as PET and PET/CT (AU)

[Predictive ability of the CT to evaluate cervical lymph nodes in head and neck tumours]. / Capacidad predictiva de la TC para evaluar las adenopatías cervicales en los tumores de cabeza y cuello.

OBJECTIVE: The aim of this study was to determine the predictive value of computed tomography (CT) i.e., its sensitivity and specificity in detecting metastatic lymph nodes of head and neck tumours. We also studied the capacity of CT in correct nodal staging. PATIENTS AND METHODS: A CT was performed on 95 patients diagnosed with neoplastic disease of the pharynx and/or larynx. All patients subsequently underwent cervical lymph node dissections. In the imaging study, the following parameters were considered for suspected radiological nodal involvement: lymph node diameter greater than 10mm, lesion margins poorly defined, capsule enhancement after contrast administration and lymph nodes that, despite their size, had signs of central necrosis. RESULTS: In the dissections, 70.53% resulted N+ in the histological study. The sensitivity of CT was 82.09% and the specificity, 85.71%. The CT detected positivity in 55 of the 67 histologically pathological dissections, while the CT detected negativity in 24 of the 28 dissections histologically negative. The weighted kappa index value was 0.6408, indicating limited capacity for appropriate staging of the lymph nodes. CONCLUSIONS: While the ability of CT to detect metastatic lymph nodes in head and neck tumours is quite acceptable, it is less so for correctly staging them. It is therefore necessary to look for other imaging tests that provide greater accuracy to avoid unnecessary elective neck dissections and to reduce morbidity and mortality from them. We must now pay attention to new imaging techniques such as PET and PET/CT.

Radiological aid to clinical diagnosis of Schnitzler's syndrome: multimodality imaging approach.

Schnitzler's syndrome is a rare combination of chronic urticaria, fever of unknown origin, disabling bone pain, and monoclonal gammopathy. We report a case with an unusual radiological manifestation as a solitary sclerotic lesion of the right iliac bone. Its main features on conventional radiography, computed tomography, and magnetic resonance imaging are described, and the main radiological differential diagnoses are discussed to help with the characterization of this syndrome, which requires a combination of clinical, laboratory, and radiological data. On the other hand, although our patient had an excellent clinical response to anakinra, the sclerotic lesion remained unchanged on follow-up X-ray examinations.