Thymic lesions and myasthenia gravis. Diagnosis based on mediastinal imaging and pathological findings

Pirronti, Tommaso; Rinaldi, Pierluigi; Batocchi, A. P.; Evoli, Amelia; Schino, C. Di; Marano, Paul

doi:10.1034/j.1600-0455.2002.430407.x

Cited by 45 publications

(23 citation statements)

References 23 publications

(27 reference statements)

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“…In spite of the technical development in CT, regarding qualitative assessment, similar accuracy data were obtained to the study of Pirronti et al 15 (86.7% versus 83%), suggesting limitations in qualitative analysis of CT. More-over, although Batra et al 14 demonstrated that MRI added no significant information to results obtained with CT, in the present study at qualitative assessment, MRI (with the addition of chemical-shift imaging) was more reliable than CT in discriminating THY from non-thymomatous condi-tions, with an overall accuracy of 96.4%. In the present cohort, most of cases in which CT failed (7/11, 64%) were TLH with a focal appearance and soft-tissue attenuation, a condition that was reported in 20% of patients with MG by Nicolau et al 8 and which is indistinguishable from THY if no obvious fat infiltration is seen.…”

Section: Qualitative Assessmentsupporting

confidence: 68%

“…8,14,15 Furthermore, although two recent studies have demonstrated chemical-shift MRI as an effective technique for MG patients, no studies have compared the accuracy of CT and chemical-shift MRI in differentiating THY from TLH and NT by using both qualitative assessment and quantitative data. 16,17 The aim of the present study was to compare the reli-ability of CT and chemical-shift MRI in patients with gener-alised MG for distinguishing THY from TLH and NT using morphological criteria and quantitative data (radiodensity [HU] for CT, SII for chemical-shift MRI), with the proposal of optimal cut-off point values for each quantitative parameter, and to determine which technique is more accurate.…”

Section: E12mentioning

confidence: 99%

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Comparison of CT and chemical-shift MRI for differentiating thymoma from non-thymomatous conditions in myasthenia gravis: value of qualitative and quantitative assessment

Priola

Gned

et al. 2016

Clinical Radiology

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Comparison of CT and chemical-shift MRI for differentiating thymoma from nonthymomatous conditions in myasthenia gravis: value of qualitative and quantitative assessment AIM: To evaluate the usefulness of computed tomography (CT) and chemical-shift magnetic resonance imaging (MRI) in patients with myasthenia gravis (MG) for differentiating thymoma (THY) from thymic lymphoid hyperplasia (TLH) and normal thymus (NT), and to determine which technique is more accurate. MATERIALS AND METHODS:Eighty-three patients with generalised MG who underwent surgery were divided into the TLH/NT group (A; 65 patients) and THY group (B; 24 patients). Differences in qualitative characteristics and quantitative data (CT: radiodensity in Hounsfield units; MRI: signal intensity index [SII]) between groups were tested using Fisher's exact test and Student's t-test. Logistic regression models were estimated for both qualitative and quantitative analyses. At quantitative analysis, discrimination abilities were determined according to the area under the receiver operating characteristic (ROC) curve (AUROC) with computation of optimal cutoff points. The diagnostic accuracies of CT and MRI were compared using McNemar's test. RESULTS: At qualitative assessment, MRI had higher accuracy than CT (96.4%, 80/83 and 86.7%, 72/83, respectively). At quantitative analysis, both the radiodensity and SII were significantly different between groups (p<0.0001). For CT, at quantitative assessment, the AUROC of the radiodensity in discriminating between groups was 0.904 (optimal cut-off point, 20 HU) with an accuracy of 77.1% (64/83). For MRI, the AUROC of the SII was 0.989 (optimal cut-off point, 7.766%) with an accuracy of 96.4% (80/83), which was significantly higher than CT (p<0.0001). By using optimal cut-off points for cases with an erroneous diagnosis at qualitative assessment, accuracy improved both for CT (89.2%, 74/83) and MRI (97.6%, 81/83).

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Section: Qualitative Assessmentsupporting

confidence: 68%

Section: E12mentioning

confidence: 99%

Comparison of CT and chemical-shift MRI for differentiating thymoma from non-thymomatous conditions in myasthenia gravis: value of qualitative and quantitative assessment

Priola

Gned

et al. 2016

Clinical Radiology

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“…In a study of 104 patients with MG who underwent thymectomy, CT showed thymoma in 46 of 52 patients (sensitivity 88.5% and specificity 95%) and thymic hyperplasia in 16 of 44 (sensitivity 36% and specificity 95%) (25). A recent report suggested chemical shift MRI to be beneficial in differentiation of thymomas from thymic hyperplasia in non-MG patients (15,16).…”

Section: Thymomamentioning

confidence: 99%

“…MG is commonly associated with thymic pathologies, including lymphofollicular hyperplasia in 65%-77%, and thymoma in 15%-30% (25). It is generally agreed that thymectomy is indicated in patients affected by generalized MG between the age of puberty and 50 to 60 years.…”

Section: Thymomamentioning

confidence: 99%

Computed tomography and magnetic resonance imaging of mediastinal tumors

Takahashi¹,

Al-Janabi²

2010

Magnetic Resonance Imaging

174

131

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We describe the clinical, pathological, and imaging findings of mediastinal tumors with focus on thymic hyperplasia, thymic epithelial tumors, and germ cell tumors, malignant lymphoma, and various cystic masses. Chemical shift magnetic resonance imaging (MRI) is useful in characterization of the normal thymus and differentiation of hyperplastic thymus and thymic tumors. In contrast to noninvasive thymomas, invasive thymomas and thymic carcinomas show a more aggressive growth pattern. Local invasion and pleural spread are characteristic of invasive thymoma and mediastinal lymphadenopathy and distant metastasis suggest thymic carcinomas. Mature teratoma typically shows various computed tomography (CT) attenuation, and MR signal intensity depending on its contents and fat tissue and bone within the lesions are its characteristic findings. Seminomas typically have homogenous internal CT attenuation and MR signal intensity with minimal contrast enhancement. Nonseminomatous malignant germ cell tumors characteristically show prominent internal degenerative changes and invasion to the adjacent structures. In mediastinal lymphomas, a residual mass is common after treatment and MRI provides important information in distinguishing viable tumors from residual benign masses. Some mediastinal cysts may reveal high attenuation similar to solid lesions on CT depending on their contents and MRI can be useful in the differentiation of cystic masses from solid lesions.

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“…The pathological confirmed thymoma is accurate in individual patients, but might lead to selection bias in population-based association studies due to various proportions of MG patients who are not advised by treating neurologists or decline to receive thymectomy. Although CT scan is considered as the main screening tools for thymoma, with high sensitivity and specificity, thymic hyperplasia is sometimes misdiagnosed as thymoma solely on CT imaging, while small thymoma beyond the resolution of imaging might be missed (15). MRI does not add the sensitivity in the screening of thymoma (16).…”

Section: Relative Precision In the Main Domains Of Myasthenia Gravis mentioning

confidence: 99%

Precision medicine in myasthenia graves: begin from the data precision

Hong

Xie

et al. 2016

Ann. Transl. Med.

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Myasthenia gravis (MG) is a prototypic autoimmune disease with overt clinical and immunological heterogeneity. The data of MG is far from individually precise now, partially due to the rarity and heterogeneity of this disease. In this review, we provide the basic insights of MG data precision, including onset age, presenting symptoms, generalization, thymus status, pathogenic autoantibodies, muscle involvement, severity and response to treatment based on references and our previous studies. Subgroups and quantitative traits of MG are discussed in the sense of data precision. The role of disease registries and scientific bases of precise analysis are also discussed to ensure better collection and analysis of MG data.

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Thymic lesions and myasthenia gravis. Diagnosis based on mediastinal imaging and pathological findings

Abstract: In MG patients CT is a sensitive, specific and efficient modality for detecting thymoma, but is less so for detecting thymic hyperplasia. MR was shown to be accurate in detecting invasive thymoma both preoperatively and in postoperative follow-up.

Cited by 45 publications

References 23 publications

Comparison of CT and chemical-shift MRI for differentiating thymoma from non-thymomatous conditions in myasthenia gravis: value of qualitative and quantitative assessment

Comparison of CT and chemical-shift MRI for differentiating thymoma from non-thymomatous conditions in myasthenia gravis: value of qualitative and quantitative assessment

Computed tomography and magnetic resonance imaging of mediastinal tumors

Precision medicine in myasthenia graves: begin from the data precision

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