Primary Mediastinal Large B-Cell Lymphoma: A Review for Radiologists.

OBJECTIVE. The purpose of this article is to provide a primer for radiologists focused on integrating the radiologic, pathologic, and clinical features of primary mediastinal large B-cell lymphoma (PMLBCL). CONCLUSION. PMLBCL is a unique subtype of lymphoma that poses diagnostic and therapeutic challenges to the fields of radiology and oncology. Knowledge of this distinctive clinical-pathologic entity and its associated imaging and clinical features is critical for radiologists.

A Radiologist's Guide to the Changing Treatment Paradigm of Advanced Non-Small Cell Lung Cancer: The ASCO 2018 Molecular Testing Guidelines and Targeted Therapies.

OBJECTIVE. The purpose of this article is to provide an imaging-based guide of the modern genomic classifications and targeted therapies for advanced non-small cell lung cancer (NSCLC) with an emphasis on the relevance of the 2018 American Society of Clinical Oncology molecular testing guidelines for radiologists. CONCLUSION. Knowledge of the radiologic relevance of lung cancer driver mutations and modern targeted agents is essential for imaging interpretation of advanced NSCLC in the modern age of precision medicine.

Low versus high radioiodine dose in postoperative ablation of residual thyroid tissue in patients with differentiated thyroid carcinoma: a large randomized clinical trial.

OBJECTIVES: Radioiodine ablation of thyroid tissue remains the cornerstone of treatment for patients with differentiated thyroid carcinoma after thyroidectomy. Selecting an optimal dose of radioiodine for successful ablation is a continuous challenge in these patients. METHODS: We compared the treatment response of 341 patients with thyroidectomy randomly allocated to the high-dose group, 3700 MBq (170 patients), versus the low-dose group, 1110 MBq (171 patients), for radioiodine ablation therapy in a double-blind randomized clinical trial. The response to treatment was defined as successful or unsuccessful according to post-therapy ultrasonography of the neck, serum thyroglobulin (Tg), anti-Tg, and functioning residual tissue after 6-month and 12-month intervals. The major criteria of successful ablation were Tg<2 ng/ml, anti-Tg<100 IU/ml, and absent remnant in the off-levothyroxine state. Additional radioiodine doses were administered in cases showing no significant response to the first therapy. Finally, the initial outcome, the total hospitalization time, and the cumulative I-131 doses during the 12-month course of the study were compared between the subgroups. RESULTS: The rate of initial successful ablation was 51.6% in all patients, 39.2% in the low-dose group, and 64.1% in the high-dose group. The corresponding success rates at the end of the 12-month follow-up without additional treatment were 55.1, 41.5, and 68.8%, respectively. The relative risk (RR) of unsuccessful ablation for the low-dose versus the high-dose group was 1.695 [95% confidence interval (CI), 1.34-2.14]. In the low-dose group, more patients needed a second dose of I-131, resulting in a higher cumulative activity (median, 4810 vs. 3700 MBq, P<0.0001) and more inpatient time (median 4 vs. 3 days) in comparison with the high-dose group. The covariate factors predicting the treatment response, in order of significance, were radioiodine dose, baseline Tg, baseline thyroid stimulating hormone (TSH) level, efficiency of TSH suppressive therapy, and sex. CONCLUSION: The higher dose of I-131 (3700 MBq) resulted in successful ablation more often than the low dose (1110 MBq).

Enalapril induced reversible acute renal failure detected by (99m)Tc-DMSA renal scan in a patient with bilateral renal artery stenosis: a case report.

The authors report and discuss a case of bilateral renal artery stenosis in a hypertensive 9 year-old girl that was first suspected with (99m)Technetium-dimercaptosuccinic acid renal scintigraphy. The scintigraphy showed signs of acute renal failure while the patient was on enalapril for controlling her hypertension. Bilateral renal artery stenosis was confirmed with computed tomography angiography. Hypertension resolved after bilateral renal artery angioplasty.

Manifestations of Ollier's disease in a 21-year-old man: a case report.

INTRODUCTION: Ollier's disease is a rare nonhereditary disorder characterized by multiple enchondromas with a predilection for unilateral distribution. Malignant changes in Ollier's disease may occur in adult patients. Radionuclide bone scanning is one method used to assess lesions depicted on radiographs or magnetic resonance images that are presumed to be enchondromas. Also, a bone scan may give a clue to the multifocal nature of the disease and it has been recommended that scintigraphy is useful in the monitoring of lesions and the development of any malignant transformation. CASE PRESENTATION: A 21-year-old man with a history of pathologic fractures of the right tibia and multiple limb surgeries related to Ollier's disease was referred to our nuclear medicine department. Radiographic assessment showed multiple radiolucent expansile lesions, suggestive of multiple enchondromas. A whole-body bone ((99m)Tc-MDP) scan showed multiple foci of increased activity involving the proximal and distal right femur and tibia, proximal right humerus, distal right ulna, right metacarpals, metatarsals and phalyngeal tubular bones, consistent with unilateral distribution of the lesions. The long bones of the left hemi-skeleton were unremarkable, representing unilateral involvement of the skeleton. In this case, the intensity of uptake in the lesions of the lower extremity was high, raising the possibility of malignant degeneration of the enchondromas. Hence, the patient underwent surgical excision of the suspected lesions. Pathology analysis revealed their benign nature. CONCLUSION: Although the malignant transformation of enchondromas is a well known phenomenon, it should be kept in mind that other etiologies can be considered as the cause of intensely increased uptake. Retrospective assessment of our patient revealed that the etiology of increased uptake in the lower limb lesions was due to previous insufficiency fractures and the possibility of malignant transformation was ruled out based on the pathology findings.

High accuracy of myocardial perfusion imaging in patients with left bundle branch block: comparison of four interpretation approaches.

Although myocardial perfusion imaging (MPI) with pharmacologic stress is the standard method for screening coronary artery disease (CAD) in patients with left bundle branch block (LBBB), controversies remain about its correct interpretation. We sought the best interpretation approach in these patients to achieve higher accuracy. Forty-two patients with LBBB underwent MPI with dipyridamole stress and the criteria for positive results with four patterns of interpretation were as follows: Pattern A: any reversible or irreversible perfusion abnormality in the myocardium irrespective of the location or extension was considered positive. Pattern B: any reversible or irreversible perfusion abnormalities except in the septal/anteroseptal region were defined as positive. Pattern C: in the absence of fixed LV cavity dilatation, the scan was interpreted the same as pattern A, while in the presence of fixed LV cavity dilatation, only the abnormalities outside the LAD territory was defined as positive. Pattern D: as in pattern C, except that in the absence of fixed LV cavity dilatation, the scan was read according to pattern B. For all patients, the angiographic results were considered as gold standard of CAD diagnosis. Our results showed that the false positive rate of MPI in patients with fixed LV dilatation was 50%, while in cases with normal LV size or transient dilatation, was 38.5%. This difference was more prominent in the female patients. The accuracy for screening CAD for patterns A, B, C and D were 57%, 62%, 69% and 69%, respectively. Pattern D was the better approach in female cases and patients with fixed septal/anteroseptal defects. In conclusion, a) in the male population without fixed defects in the septal/anteroseptal region, the specificity and accuracy are high in all patterns and the pattern of reading does not significantly influence the diagnostic value of MPI for CAD screening. b) in LBBB patients, fixed defects limited to the septal/anteroseptal region should be considered a significant finding only when LV cavity is not dilated.