Assessment of Waldeyer’s ring in pediatric and adolescent Hodgkin lymphoma patients—Importance ofmultimodality imaging: Results from the EuroNet-PHL-C1 trial

Background: In the EuroNet Pediatric Hodgkin Lymphoma (EuroNet-PHL) trials, decision onWaldeyer’s ring (WR) involvement is usually based on clinical assessment, that is, physical examination and/or nasopharyngoscopy. However, clinical assessment only evaluates mucosal surface and is prone to interobserver variability. Modern crosssectional imaging technology may provide valuable information beyond mucosal surface, which may lead to a more accurateWRstaging. Patients,materials, and methods: The EuroNet-PHL-C1 trial recruited 2102 patients, of which 1752 underwent central review including reference reading of their crosssectional imaging data. In 14 of 1752 patients, WR was considered involved according to clinical assessment. In these 14 patients, the WR was re-assessed by applying an imaging-based algorithm considering information from 18F-fluorodeoxyglucose positron emission tomography, contrast-enhanced computed tomography, and/or magnetic resonance imaging. For verification purposes, the imaging-based algorithm was applied to 100 consecutive patients whose WR was inconspicuous on clinical assessment. Results: The imaging-based algorithm confirmedWRinvolvement only in four of the 14 patients. Of the remaining 10 patients, four had retropharyngeal lymph node involvement and six an inconspicuous WR. Applying the imaging-based algorithm to 100 consecutive patients with physiological appearance of their WR on clinical assessment, absence of WR involvement could be confirmed in 99. However, suspicion of WR involvement was raised in one patient. Conclusions: The imaging-based algorithm was feasible and easily applicable at initial staging of young patients with Hodgkin lymphoma. It increased the accuracy of WR staging, which may contribute to a more individualized treatment in the future

Optimized Whole-Body PET MRI Sequence Workflow in Pediatric Hodgkin Lymphoma Patients.

18F-FDG PET/MRI might be the diagnostic method of choice for Hodgkin lymphoma patients, as it combines significant metabolic information from PET with excellent soft-tissue contrast from MRI and avoids radiation exposure from CT. However, a major issue is longer examination times than for PET/CT, especially for younger children needing anesthesia. Thus, a targeted selection of suitable whole-body MRI sequences is important to optimize the PET/MRI workflow. Methods: The initial PET/MRI scans of 84 EuroNet-PHL-C2 study patients from 13 international PET centers were evaluated. In each available MRI sequence, 5 PET-positive lymph nodes were assessed. If extranodal involvement occurred, 2 splenic lesions, 2 skeletal lesions, and 2 lung lesions were also assessed. A detection rate was calculated dividing the number of visible, anatomically assignable, and measurable lesions in the respective MRI sequence by the total number of lesions. Results: Relaxation time-weighted (T2w) transverse sequences with fat saturation (fs) yielded the best result, with detection rates of 95% for nodal lesions, 62% for splenic lesions, 94% for skeletal lesions, and 83% for lung lesions, followed by T2w transverse sequences without fs (86%, 49%, 16%, and 59%, respectively) and longitudinal relaxation time-weighted contrast-enhanced transverse sequences with fs (74%, 35%, 57%, and 55%, respectively). Conclusion: T2w transverse sequences with fs yielded the highest detection rates and are well suited for accurate whole-body PET/MRI in lymphoma patients. There is no evidence to recommend the use of contrast agents. Keywords: Hodgkin lymphoma; MRI sequences; PET/MRI; whole-body imagin

Capital Social y gestión de demandas ciudadanas en el Municipio San Francisco. Estado Zulia

El presente artículo tiene como propósito el análisis de los elementos del capital social que se encuentran presentes en la gestión de demandas ciudadanas de las asociaciones de vecinos a la Alcaldía del Municipio San Francisco del Estado Zulia.Alos fines, se concretó un estudio de campo, descriptivo-analítico. El referente empírico fueron 20 Asociaciones de vecinos distribuidas en las parroquias que lo conforman. El instrumento utilizado consistió en un cuestionario tipo estándar; se hace énfasis en la observación directa o participante, las entrevistas abiertas, y el análisis de documentos proporcionados por los informantes clave. Los hallazgos dan cuenta de: a) El Capital Social de las asociaciones de vecinos del municipio, se distingue por ser medianamente positivo, pero enfrenta serias amenazas. b) La confianza y los valores éticos, se encuentran orientados hacia la baja y atentan contra la acción social y gestión de demandas de las asociaciones de vecinos; c) la participación como dimensión del capital social es restringida, limitada solo al voto; por lo que deslegitima la acción del gobierno local. Todo lo anterior refleja desconfianza hacia este tipo de organizaciones. e) Se percibe un espacio muy limitado para la construcción de ciudadanía y la generación de mecanismos de empoderamiento ciudadano, f) Se registra una inconsistencia entre el discurso, la acción y los resultados de la gestión gubernamental. Se concluye que estos rasgos se constituyen en una barrera para la legitimidad y gobernabilidad del gobierno local en cuestión