[Primary lymphoma of the central nervous system in immunocompetent patients: neuroimaging features]. / Linfoma primario del sistema nervioso central en pacientes inmunocompetentes: características en neuroimagen.

INTRODUCTION: Primary lymphoma of the central nervous system (PLCNS) is a rare tumour whose incidence has increased substantially in immunocompetent patients. AIM. To examine the clinical and neuroimaging features in this risk group, with the aim of establishing a set of characteristics that can lead to a quick and accurate diagnosis. PATIENTS AND METHODS: The study analysed all the cases of diffuse B-cell PLCNS that had been diagnosed histologically over the past 13 years in two neurological, neurosurgical and oncological referral hospitals in the north-east of the country. RESULTS; A total of 38 patients were studied (age: 15-84 years old), 55.3% of whom were males. The most frequent clinical presentation was gait instability, speech disorders and headache. The analysis showed that 94.7% of the lesions are supratentorial, and 68% have deep-structure involvement. In magnetic resonance imaging, 50% show homogeneous lesions, 94.7% were T1 hypo/isointense and 65.8% were T2 hyperintense, the mean size being 2.97 cm. Computerised tomography showed 48% of the lesions to be hyperdense. All the patients displayed enhancement following the administration of contrast. The overall median time of survival is 209 ± 134.85 days. CONCLUSIONS: PLCNS can manifest a number of different features per image, which have gradually changed over time, and we must be familiar with them in order to establish a quick diagnosis. Intensive efforts must be made to improve sensitivity and diagnostic specificity, and to conduct research on the biological mechanisms, the possible risk factors and the prevention of iatrogenic neurotoxicity.

Linfoma primario del sistema nervioso central en pacientes inmunocompetentes: características en neuroimagen / Primary lymphoma of the central nervous system in immunocompetent patients: neuroimaging features

Introducción. El linfoma primario del sistema nervioso central (LPSNC) es un tumor poco frecuente cuya incidencia ha aumentado de forma importante en los pacientes inmunocompetentes. Objetivo. Estudiar las características clínicas y de neuroimagen en este grupo de riesgo, con el fin de establecer unas características que guíen hacia un diagnóstico rápido y preciso. Pacientes y métodos. Se estudiaron todos los casos de LPSNC difuso de células B diagnosticados histológicamente durante los últimos 13 años en dos hospitales de referencia neurológica, neuroquirúrgica y oncológica del noroeste del país. Resultados. Se estudiaron 38 pacientes (edad: 15-84 años) con un 55,3% de varones. La presentación clínica más frecuente fue la inestabilidad de la marcha, la alteración del habla y la cefalea. El 94,7% de las lesiones eran supratentoriales, un 68% tenía afectación de estructuras profundas. En la resonancia magnética, el 50% mostraba lesiones homogéneas, el 94,7% hipoisointensas en secuencia T1 y el 65,8% hiperintensas en secuencia T2, y el tamaño medio era de 2,97 cm. En la tomografía computarizada, el 48% de las lesiones eran hiperdensas. Todos los pacientes mostraban realce tras la administración de contraste. Presentaron una mediana global de supervivencia de 209 ± 134,85 días. Conclusiones. El LPSNC puede manifestar múltiples características por imagen, que han ido cambiando con el tiempo, y que debemos conocer para establecer un diagnóstico rápido. Debe haber un intensivo esfuerzo por mejorar la sensibilidad y especificidad diagnóstica, por investigar los mecanismos biológicos, los posibles factores de riesgo y la prevención de la neurotoxidad yatrogénica (AU)

Introduction. Primary lymphoma of the central nervous system (PLCNS) is a rare tumour whose incidence has increased substantially in immunocompetent patients. Aim. To examine the clinical and neuroimaging features in this risk group, with the aim of establishing a set of characteristics that can lead to a quick and accurate diagnosis. Patients and methods. The study analysed all the cases of diffuse B-cell PLCNS that had been diagnosed histologically over the past 13 years in two neurological, neurosurgical and oncological referral hospitals in the north-east of the country. Results. A total of 38 patients were studied (age: 15-84 years old), 55.3% of whom were males. The most frequent clinical presentation was gait instability, speech disorders and headache. The analysis showed that 94.7% of the lesions are supratentorial, and 68% have deep-structure involvement. In magnetic resonance imaging, 50% show homogeneous lesions, 94.7% were T1 hypo/isointense and 65.8% were T2 hyperintense, the mean size being 2.97 cm. Computerised tomography showed 48% of the lesions to be hyperdense. All the patients displayed enhancement following the administration of contrast. The overall median time of survival is 209 ± 134.85 days. Conclusions. PLCNS can manifest a number of different features per image, which have gradually changed over time, and we must be familiar with them in order to establish a quick diagnosis. Intensive efforts must be made to improve sensitivity and diagnostic specificity, and to conduct research on the biological mechanisms, the possible risk factors and the prevention of iatrogenic neurotoxicity (AU)

CT colonography without cathartic preparation: positive predictive value and patient experience in clinical practice.

OBJECTIVE: To determine the positive predictive value (PPV) for polyps ≥ 6 mm detected at CT colonography (CTC) performed without cathartic preparation, with low-dose iodine faecal tagging regimen and to evaluate patient experience. METHODS: 1920 average-risk patients underwent CTC without cathartic preparation. Faecal tagging was performed by diatrizoate meglumine and diatrizoate sodium at a total dose of 60 ml (22.2 g of iodine).The standard interpretation method was primary 3D with 2D problem solving. We calculated per-patient and per-polyp PPV in relation to size and morphology. All colonic segments were evaluated for image quality (faecal tagging, amount of liquid and solid residual faeces and luminal distension). Patients completed a questionnaire before and after CTC to assess preparation and examination experience. RESULTS: Per-polyp PPV for detected lesions of ≥ 6 mm, 6-9 mm, ≥ 10 mm and ≥ 30 mm were 94.3%, 93.1%, 94.7% and 98%, respectively. Per-polyp PPV, according to lesion morphology, was 94.6%, 97.3% and 85.1% for sessile, pedunculated and flat polyps, respectively. Per-patient PPV was 92.8%. Preparation without frank cathartics was reported to cause minimal discomfort by 78.9% of patients. CONCLUSION: CTC without cathartic preparation and low-dose iodine faecal tagging may yield high PPVs for lesions ≥ 6 mm and is well accepted by patients. KEY POINTS: • Computed tomographic colonography (CTC) without cathartic preparation is well accepted by patients • Cathartic-free faecal tagging CTC yields high positive predictive values • CTC without cathartic preparation could improve uptake of colorectal cancer screening.