Prognostic value of baseline and early response FDG-PET/CT in patients with refractory and relapsed aggressive B-cell lymphoma undergoing CAR-T cell therapy.

PURPOSE: Chimeric antigen receptor (CAR)-T cells are a viable treatment option for patients with relapsed or refractory (r/r) aggressive B-cell lymphomas. The prognosis of patients who relapse after CAR-T cell treatment is dismal and factors predicting outcomes need to be identified. Our aim was to assess the value of FDG-PET/CT in terms of predicting patient outcomes. METHODS: Twenty-two patients with r/r B-cell lymphoma who received CAR-T cell treatment with tisagenlecleucel (n = 17) or axicabtagene ciloleucel (n = 5) underwent quantitative FDG-PET/CT before (PET-0) and 1 month after infusion of CAR-T cells (PET-1). PET-1 was classified as complete metabolic response (CMR, Deauville score 1-3) or non-CMR (Deauville score 4-5). RESULTS: At the time of PET-1, 12/22 (55%) patients showed CMR, ten (45%) patients non-CMR. 7/12 (58%) CMR patients relapsed after a median of 223 days, three of them (25%) died. 9/10 (90%) non-CMR patients developed relapse or progressive disease after a median of 91 days, eight of them (80%) died. CMR patients demonstrated a significantly lower median total metabolic tumor volume (TMTV) in PET-0 (1 ml) than non-CMR patients (225 ml). CONCLUSION: Our results confirm the prognostic value of PET-1. 42% of all CMR patients are still in remission 1 year after CAR T-cell treatment. 90% of the non-CMR patients relapsed, indicating the need for early intervention. Higher TMTV before CAR-T cell infusion was associated with lower chances of CMR.

Hendidura laríngea: diagnóstico y tratamiento en un caso inusual de presentación en el adulto / Laryngeal cleft: Diagnosis and treatment of an unusual presentation in an adult

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Gadoxetic acid enhanced MRI for differentiation of FNH and HCA: a single centre experience.

OBJECTIVES: Evaluation of enhancement characteristics of histopathologically confirmed focal nodular hyperplasias (FNHs) and hepatocellular adenomas (HCAs) with gadoxetic acid-enhanced MRI. METHODS: Sixty-eight patients with 115 histopathologically proven lesions (FNHs, n=44; HCAs, n=71) examined with gadoxetic acid-enhanced MRI were retrospectively enrolled (standard of reference: surgical resection, n=53 patients (lesions: FNHs, n=37; HCAs, n=53); biopsy, n=15 (lesions: FNHs, n=7; HCAs, n=18)). Two radiologists evaluated all MR images regarding morphological features as well as the vascular and hepatocyte-specific enhancement in consensus. RESULTS: For the hepatobiliary phase, relative enhancement of the lesions and lesion to liver enhancement were significantly lower for HCAs (mean, 48.7 (±48.4)%and 49.4 (±33.9) %) compared to FNHs (159.3 (±92.5) %; and 151.7 (±79) %; accuracy of 89%and 90 %, respectively; P<0.001). Visual strong uptake of FNHs vs. hypointensity of HCAs in the hepatobiliary phase resulted in an accuracy of 92 %. This parameter was superior to all other morphological and dynamic vascular criteria alone and in combination (accuracy, 54­85 %). CONCLUSIONS: For differentiation of FNHs and HCAs by means of MRI, gadoxetic acid uptake in the hepatobiliary phase was found to be superior to all other criteria alone and in combination. KEY POINTS: EOB-MRI is well suited to differentiate FNHs and hepatocellular adenomas. For this purpose hepatobiliary phase is superior to unenhanced and dynamic imaging. Hepatobiliary phase (peripheral) hyper- or isointensity is typical for FNH. Hepatobiliary phase hypointensity is typical for hepatocellular adenomas. EOB-MRI helps to avoid misinterpretations of benign hepatocellular lesions.

Assessment of the cerebellar arteries with multidetector computed tomography angiography benefits from submillimeter slice thickness.

PURPOSE: To evaluate the accuracy of 64-row-multidetector computed tomography (MDCT) with different slice thickness (0.625 vs. 1.25 mm) in assessing the cerebellar arteries. MATERIALS AND METHODS: A total of 21 consecutive patients who underwent computed tomography angiography (CTA) of the cervicocranial arteries (64-row MDCT; slice thickness, 0.625 mm) because of suspicion of cerebral ischemia were enrolled retrospectively. The MDCT data set was secondarily reconstructed to a slice thickness of 1.25 mm. The examinations were reviewed by three independent blinded observers. Recorded parameters for reconstructed slice thicknesses of 0.625 compared to 1.25 mm were visualization and edge enhancement (based on a developed phantom reference model) of the cerebellar arteries including anterior and posterior inferior cerebellar arteries and the superior cerebellar artery. RESULTS: With 0.625-mm slices, significantly more vessel segments were visualized and edge enhancement was superior compared to 1.25-mm slices by the three readers, and a significant difference for the interaction between vessel segments and the slice thickness was found (P<.001). Furthermore, for a slice thickness of 1.25 mm, there was a significant difference in visualization (P=.0042) and edge enhancement (P=.0015) of vessel segments between the three readers, whereas for thinner slices (0.625 mm), no significant differences were found (P=.412, P=.465). CONCLUSIONS: MDCT with slice thickness of 0.625 mm is superior to 1.25 mm reconstructed slice thickness regarding the visualization of cerebellar arteries, representative for smallest assessable arteries in CTA. This is paralleled by a sharper edge enhancement of the vessel contours resulting from a reduced partial volume effect. Conclusively, cranial CTA protocols should be routinely optimized to generate submillimeter slices for diagnostic purposes and digital storage as additional diagnostic value can be expected.

[Chondromyxoid fibroma of the left maxillary and ethmoid sinuses]. / Fibroma condromixoide de seno maxilar y etmoides izquierdos.

Chondromyxoid fibroma is an infrequent bone tumour in the craniofacial bones and exceptional in the paranasal sinuses. This unusual location, its non-specific clinical manifestation and aggressive behaviour with local destruction and a high recurrence rate can complicate precise diagnosis and treatment.

Epidemiological study of voice disorders among teaching professionals of La Rioja, Spain.

The purpose of the present study was to calculate the prevalence and incidence of voice disorders among teaching staff and find out the associated occupational risk factors. A case-control study was performed with 905 teachers, 579 cases and 326 controls; 492 were randomly selected and 413 volunteered. All teachers were asked to fill out a standard questionnaire. Next, a complete laryngeal exam was performed including a general ear, nose, and throat evaluation and videolaryngostroboscopy. The prevalence of voice disorders among teaching staff was 57%. The most prevalent lesions were vocal overstrain (18%), nodular lesions (14%), and hyperfunctional dysphonia (8%). The incidence rate was 3.87 new cases per year per 1000 teachers. Women had organic lesions three times more than men (odds ratio [OR]: 3.52, confidence interval [CI]: 2.04-6.09). However, men had chronic laryngitis three times more than women (OR: 2.93, CI: 1.50-5.71) and functional dysphonia nearly twice more than women (OR: 1.81, CI: 1.21-2.69). We find a significant risk of suffering voice disorders in teachers who smoke daily (OR: 2.31, CI: 1.58-3.37) and who drink several cups of coffee or tea (OR: 1.87, CI: 1.36-2.56). It is advisable to carry out an annual evaluation of all teaching staff on account of the high prevalence of voice disorders among them.

[Laryngeal leiomyosarcoma]. / Leiomiosarcoma laríngeo.

Laryngeal leiomyosarcoma is a highly infrequent malignancy, with less than fifty reports in the scientific literature world-wide. Diagnosis is based on immunohistochemistry and, occasionally, on electron microscopy techniques, making it difficult to be done preoperatively. We report a new case of laryngeal leiomyosarcoma, with an up-to-date review of the differential diagnosis and the treatment strategy.

Leiomiosarcoma laríngeo / Laryngeal leiomyosarcoma

El leiomiosarcoma laríngeo es un tumor extraordinariamente infrecuente, con menos de 50 casos descritos en la literatura mundial. Su diagnóstico implica la necesidad de técnicas de inmunohistoquímica y ocasionalmente de microscopia elestrónica, que se practica casi siempre postoperatoriamente. Presentamos un nuevo caso de leiomiosarcoma laríngeo, haciendo una revisión actualizada de su diagnóstico diferencial y de la estrategia terapéutica

Laryngeal leiomyosarcoma is a highly infrequent malignancy, with less than fifty reports in the scientific literature world-wide. Diagnosis is based on immunohistochemistry and, occasionally, on electron microscopy techniques, making it difficult to be done preoperatively. We report a new case of laryngeal leiomyosarcoma, with an up-to-date review of the differential diagnosis and the treatment strategy

Laringectomía casi total. Comentarios clínicosy estudio de la voz / Near-total laryngectomy. Clinical observations and voice study

Los autores realizan una valoración clínica de pacientes intervenidos de laringectomía casi total (LCT). Realizando un shunt de un calibre muy pequeño no han encontrado ningún caso con problemas deglutorios por salida de líquido o alimento a través del shunt al traqueostoma. Se consideran aceptables los resultados obtenidos con dicha técnica quirúrgica aunque el estudio de la voz realizado muestra una disminución de la fluidez falta de brillo vocal y un aumento de la frecuencia fundamenta. A pesar del éxito alcanzado por las protésis fonatorias, los autores afirman que se evitarían algunas laringectomías totales aplicando esta técnica (AU)