The Impact of First Complete Remission by PET-CT and Time to Next Treatment on Survival of Follicular Lymphoma Patients.

We retrospectively analyzed the impact of initial positron emission tomography and computed tomography (PET-CT) complete remission (CR) and time to next treatment (TTNT) on patient outcome in follicular lymphoma. Between 2002 and 2014, 150 patients could be evaluated for treatment response and long-term outcome. The CR after first line treatment with either rituximab-cyclophosphamide, oncovin, and prednisolone (R-COP) or rituximab-cyclophosphamide, doxorubicin, oncovin, and prednisolone (R-CHOP) was 89% and partial response (PR) was 7%. The 5- and 10-year survival rates were 86.0% and 62.6%, respectively. In five years, 11% of patients had died of lymphoma and 3% from other causes. Forty-seven patients (31%) underwent a second line of treatment comprising 19 (40%) with a TTNT shorter than 24 months and 28 (60%) longer than 24 months. There was no difference in overall survival (OS) between R-COP (86%) and R-CHOP (77%) at 5 years, but there were more next treatment events in the R-COP compared with the R-CHOP group on longer follow-up (60% versus 35% at 8 years). For PET-CT response, there was a significant OS difference between initial CR and PR patients (88% versus 70%, p < 0.01), and a longer TTNT was seen in initial CR patients. Patients with a TTNT longer than 24 months had better OS compared with patients with a shorter TTNT (93% versus 54% at 5 years, p < 0.01). In conclusion, patients with initial PET-CT CR and TTNT longer than 24 months had better OS compared with those achieving only PR and shorter TTNT. PET-CT CR should be considered the treatment goal during initial treatment, and more aggressive treatment should be considered for patients with a TTNT of less than 24 months.

Prevertebral muscle involvement in nasopharyngeal carcinoma.

PURPOSE: The purpose of this study is to evaluate the prevalence and prognostic significance of prevertebral muscle involvement in patients with nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: Between July 1990 and December 2001, 521 newly diagnosed patients with NPC treated at Koo Foundation Sun Yat-Sen Cancer Center (KF-SYSCC) were examined with magnetic resonance imaging (MRI) for evidence of prevertebral muscle involvement before treatment. Patients were staged according to the 1997 American Joint Committee on Cancer staging classification of NPC based on the physical exams and MRI findings. All patients received radiotherapy with or without chemotherapy. The association between clinical prevertebral muscle involvement and posttreatment outcomes (overall survival, locoregional recurrence, and distant metastasis) were evaluated using Cox regression model to adjust for other prognostic factors. RESULTS: Of 521 patients treated at KF-SYSCC, 181 (35%) patients were found to have prevertebral muscle involvement, one-third in those with Stage II/III tumors and two-thirds in those with Stage IV tumor. In multivariate analysis accounting for all previously known prognostic factors, prevertebral muscle invasion was associated with an increased risk for any recurrence (adjusted relative risk, 2.01; p<0.001), locoregional recurrence (adjusted relative risk, 2.69; p<0.001), and distant metastasis (adjusted relative risk, 2.25; p<0.001), and with a borderline significant increased risk for overall survival (adjusted relative risk, 1.44; p=0.10). CONCLUSIONS: Prevertebral muscle involvement is an independent prognostic factor for NPC recurrence.

Radiological manifestations of cryptococcal infection in central nervous system.

BACKGROUND: Cryptococcus neoformans is one of the most common infectious agents causing central nervous system (CNS) infections in immunocompromised patients. Patients with CNS cryptococcosis commonly present with non-specific manifestations such as headache, fever, seizure and conscious disturbance. This article presents the computerized tomography scans (CT) and magnetic resonance images (MRI) findings of cryptococcal infection in CNS and displays the image difference between immunocompromised and non-immunocompromised patients. METHODS: CNS cryptococcal infection was found in 26 cases over the past 14 years in Taipei Veterans General Hospital, including 18 males and 8 females. Ten patients were immunocompromised. In all cases, the CNS cryptococcosis was diagnosed by positive cryptococcal antigen titer and India ink stain from cerebral spinal fluid (CSF). Their clinical data and findings from CT and MRI were retrospectively studied. RESULTS: The most common CT manifestation is ventricular dilatation; other common findings include leptomeningeal enhancement, infarction (half of them revealed dilatation of Virchow-Robin spaces in subsequent MRI study) and normal appearance. Less common findings are ventriculitis and abscess formation. The most common MRI pattern is Virchow-Robin space dilatation and leptomeningeal enhancement. Other common appearance includes ventricular dilatation. Less common manifestations include cryptococcoma, hemorrhagic infarction and pontine abscess. There is no significant difference in image patterns between immunocompromised and non-immunocompromised patients (p > 0.05). CONCLUSIONS: The most common pattern ofCNS cryptococcosis is ventricular dilatation in CT and Virchow-Robin space dilatation in MRI. MRI is more sensitive in detecting CNS cryptococcal infection like Virchow-Robin space dilatation and leptomeningeal enhancement. There is no significant pattern difference between immunocompromised and non-immunocompromised patients with CNS cryptococcosis.

Magnetic resonance imaging as a guide in the diagnosis and follow-up of spinal cord infarction.

BACKGROUND: Spinal cord infarction (SCI) is a dynamic process; it can present wide-spectrum images simulating a variety of entities. The purpose of this study is to characterize the typical magnetic resonance (MR) findings and to describe evolutions and contrast-enhanced patterns of SCIs at different stages. METHODS: MR examinations of 15 patients (10 men and 5 women) with clinical diagnosis of SCIs were reviewed respectively. MR was performed from 3 hours to 178 days after onset of symptoms. The images studies were reviewed with special attention to the location, cord size and sequential signal changes of affected spinal cord, as well as contrast-enhanced patterns at different stages of SCIs. According to the onset time, the evolutions of SCIs were divided into 5 categories; onset within 6 hours (hyperacute), between 6 hours to 24 hours (acute), 1 day to 7 days (subacute), 7 days to 28 days and beyond 28 days (chronic stage). RESULTS: Four patients had SCIs involving the cervical, one at the cervicothoracic region, eight at the thoracic, and two at the thoracolumbar region. Twelve out of 15 patients had abnormal signal intensity at the MR studies. Three patients showed normal MR study of clinically suspicious affected level at the age of ictus less than 2 days. The SCI was apparently demonstrated on T2WIs with hyperintensity since 1 day after onset and T1WIs with hypointensity from day 5-7. Contrast enhancement of affected cord simulating other entities was obvious on day 5-7 and peaked on day 14-21 after ictus. CONCLUSIONS: MR is a useful means to detect and follow SCIs. Serial MR studies with contrast showed sequential changes of enhancement similar to those seen in cerebral infarcts. Knowledge of characteristic MR findings and evolutional changes at different stages of SCIs should perhaps lead to early diagnosis and, therefore, more effective management of patients.

Contrast enhancement patterns of acute spinal epidural hematomas: a report of two cases.

The MR finding of an acute spinal epidural hematoma (SEH) can mimic epidural neoplastic or inflammatory lesions, because acute SEH appears hypointense on T1-weighted images and hyperintense on T2-weighted images. We report on two cases of acute SEH with unusual contrast enhancement patterns on MR images. Contrast enhancement can be an MR finding of acute SEH, especially in bleeding diathesis, which indicates an active lesion that needs early diagnosis and management.