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BACKGROUND: This study aimed to assess the validity and pathophysiology of the T2/FLAIR-mismatch sign for noninvasive identification of isocitrate dehydrogenase (IDH)-mutant 1p/19q non-codeleted glioma. METHODS: Magnetic resonance imaging scans from 408 consecutive patients with newly diagnosed glioma (113 lower-grade gliomas and 295 glioblastomas) were evaluated for the presence of T2/FLAIR-mismatch sign by 2 independent reviewers. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the performance of the T2/FLAIR-mismatch sign for identifying IDH-mutant 1p/19q non-codeleted tumors. An exploratory analysis of differences in contrast-enhancing tumor volumes, apparent diffusion coefficient (ADC) values, and relative cerebral blood volume (rCBV) values in IDH-mutant gliomas with versus without the presence of a T2/FLAIR-mismatch sign (as well as analysis of spatial differences within tumors with the presence of a T2/FLAIR-mismatch sign) was performed. RESULTS: The T2/FLAIR-mismatch sign was present in 12 cases with lower-grade glioma (10.6%), all of them being IDH-mutant 1p/19q non-codeleted tumors (sensitivity = 10.9%, specificity = 100%, PPV = 100%, NPV = 3.0%, accuracy = 13.3%). There was a substantial interrater agreement to identify the T2/FLAIR-mismatch sign (Cohen's kappa = 0.75 [95% CI, 0.57-0.93]). The T2/FLAIR-mismatch sign was not identified in any other molecular subgroup, including IDH-mutant glioblastoma cases (n = 5). IDH-mutant gliomas with a T2/FLAIR-mismatch sign showed significantly higher ADC (P < .0001) and lower rCBV values (P = .0123) as compared to IDH-mutant gliomas without a T2/FLAIR-mismatch sign. Moreover, in IDH-mutant gliomas with T2/FLAIR-mismatch sign the ADC values were significantly lower in the FLAIR-hyperintense rim as compared to the FLAIR-hypointense core of the tumor (P = .0005). CONCLUSIONS: This study confirms the high specificity of the T2/FLAIR-mismatch sign for noninvasive identification of IDH-mutant 1p/19q non-codeleted gliomas; however, sensitivity is low and applicability is limited to lower-grade gliomas. Whether the higher ADC and lower rCBV values in IDH-mutant gliomas with a T2/FLAIR-mismatch sign (as compared to those without) translate into a measurable prognostic effect requires investigation in future studies. Moreover, spatial differences in ADC values between the core and rim of tumors with a T2/FLAIR-mismatch sign potentially reflect specific distinctions in tumor cellularity and microenvironment.
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Objetivo: Detectar las alteraciones estructurales de los músculos peniformes proximales en pacientes con diagnóstico de lupus eritematoso sistémico (LES) y describir su relación con la actividad de la enfermedad y tiempo de tratamiento. Métodos: Pacientes > 18 años con diagnóstico confirmado de LES atendidos durante el periodo comprendido entre enero de 2016 y septiembre de 2018. Se extrajeron de las historias clínicas datos demográficos, clínicos y serológicos previa realización de una ecografía musculoesquelética de los músculos peniformes proximales, tríceps y vasto lateral, para evaluar parámetros cualitativos y cuantitativos de la arquitectura muscular (grosor muscular, longitud del fascículo, ángulo de penación, ecogenicidad, atrofia y edema muscular). Resultados: Se incluyeron 21 pacientes de los cuales 18 eran mujeres (85,7 %), 19 de ellos en el rango de 18-50 años de edad (90,4 %), 15 refirieron mialgia en la entrevista (71 %) y 7 mostraron leve pérdida de la fuerza según la escala Medical Research Council (MRC) (33 %). La mayoría de pacientes recibió tratamiento a base de esteroides (95 %) más un medicamento modificador de la enfermedad. Diez pacientes tenían índice de actividad de la enfermedad leve a moderado (81,2 %). En cuanto a las medidas ecográficas, se encontró una relación significativa entre un ángulo de penación menor a 11,4 grados y atrofia muscular con valores de p = 0,035. Conclusiones: La ecografía musculoesquelética es un método no invasivo útil para la detección de cambios estructurales en la arquitectura muscular del músculo vasto lateral en pacientes con diagnóstico de LES
Objective: To detect muscle structure alterations related to patients diagnosed with Systemic Lupus Erythematosus (SLE) and to describe their relationship with disease activity and time of treatment. Methods: patients > 18 years with diagnosis of SLE affiliated to Sanitas Health System and treated during the period from January 2016 to September 2018. The demographic, clinical and serological information were obtained from the patient's medical records, prior to ultrasound examination from the proximal pennate triceps and vastus lateralis muscles. The qualitative and quantitative variables of the muscular architecture were evaluated (muscle thickness, fascicle length, angle of pennation, echogenicity, atrophy and muscular edema). Results: 21 patients were included of which 18 were women (85.7%), 19 of them in the age range of 18-50 years (90.4%), 15 patients reported myalgia in the interview (71%) and 7 presented loss of their strength in the MRC scale (33%). The majority of patients received a steroid-based treatment (95%) plus a disease-modifying medication. Ten patients presented a mild to moderate disease activity index (81.2%). Regarding ultrasound measurements, we found a relationship between a pennation angle of less than 11.4 degrees and the presence of atrophy with a value of p = 0.035. Conclusions: Musculoskeletal ultrasound is a useful non-invasive method for detecting changes in the muscle architecture of the vastus lateralis muscle in patients diagnosed with SLE.
Assuntos
Humanos , Ultrassonografia , Lúpus Eritematoso Sistêmico , Sistema Musculoesquelético , MiositeRESUMO
El blastoma pleuropulmonar es una neoplasia mesenquimal rara que se debe considerar siempre en el escenario de una masa pulmonar sólida o quística en niños menores de 5 años. Se localiza usualmente en la periferia del pulmón; sin embargo, puede existir compromiso extrapulmonar de mediastino, diafragma y pleura. Se clasifica según su patrón histológico e imagenológico en tres tipos: quístico, mixto (sólido-quístico) y sólido. La cirugía radical es el tratamiento de elección y la única que ha demostrado disminución en la tasa de recurrencia. Se indica el uso de la quimioterapia neoadyuvante y la radioterapia según el tipo histológico y las márgenes libres de tumor. Se estudia el caso de una niña de 3 años con hallazgos, en radiografía convencional y tomografía de tórax, de masa sólida con diagnóstico histopatológico de blastoma pleuropulmonar.
Pleuropulmonary blastoma is a rare mesenchymal neoplasm that should always be considered in the setting of a solid or cystic lung mass in children under 5 years old. It is usually located in the periphery of the lung. However extra pulmonary involvement of the mediastinum, diaphragm, and pleura can exist. It is classified according to its histological and imaging pattern in three types: cystic, mixed (solidcystic) and solid. Radical surgery is the treatment of choice and the only one that has demonstrated a decrease in the rate of recurrence. The use of neoadjuvant chemotherapy and radiotherapy are defined according to the histological type and presence of tumor-free margins. We present the case of a 3-year-old female patient with findings on conventional radiography and thoracic tomography of a solid mass with histopathological diagnosis of pleuropulmonary blastoma.
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Humanos , Blastoma Pulmonar , Cirurgia Torácica , Pulmão , NeoplasiasRESUMO
Las calcificaciones intracraneales son un hallazgo frecuente en los estudios de tomografía y resonancia magnética cerebral. Su etiología es ampliamente variada y comprende procesos tanto fisiológicos como patológicos. Esta revisión busca describir las calcificaciones intracraneales dentro de un algoritmo diagnóstico fácil de realizar por el radiólogo, en el cual su localización, morfología y patrón pueden ayudar a reducir los diagnósticos diferenciales y a disminuir los errores por mala interpretación.
Intracranial calcifications are an occasional finding in computed tomography and cerebral magnetic resonance imaging. Their aetiology is widely diverse and comprises physiological and pathological processes. This review pretends to describe the intracranial calcifications by an easy diagnostic algorithm, using the location, morphology and pattern in order to narrow the differential diagnosis and reduce the interpretation mistakes.
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Humanos , Encefalopatias , Neoplasias Encefálicas , Doenças do Sistema Nervoso Central , Tomografia Computadorizada MultidetectoresRESUMO
La disección espontánea de las arterias coronarias es una rara causa de síndrome coronario agudo, su presentación clínica varía desde un síndrome coronario agudo hasta la muerte súbita, dependiendo de la extensión de la disección. En las publicaciones se evidencia que la mayoría aparecen en mujeres de edad media. A continuación presentamos un caso de disección espontánea de la arteria coronaria izquierda con extensión a la rama descendente anterior y circunfleja, en una mujer de 31 años de edad.
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation is variable, from acute coronary syndrome to sudden death, depending on the extent of the dissection; case reports and case series shows evidence that most cases present in middle-aged women. We present a case of spontaneous dissection of the left coronary artery extending to the left anterior and circumflex descending branch in a 31 years old woman