Background: Cranial vault lymphomas (CVLs) are rare skull lesions, mostly caused by diffuse large B-cell lymphoma, a subtype of non-Hodgkin lymphoma (NHL). Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) extremely rarely causes cranial vault lesions. Herein, we report a case of a CLL/SLL causing a unique and extensive cranial vault lesion with a striking presentation of a helmet-shaped tumor, whose treatment with ibrutinib led to full bone regeneration. Case Description: A 63-year-old woman was admitted to our hospital for the continuation of treatment of CLL/SLL, which presented with hypercalcemia, generalized lymphadenopathy, and osteolytic lesions of Th10, Th11, and L2 vertebrae. An initial head computed tomography (CT) scan, performed due to psychomotor impairment, showed an extensive CVL. Despite therapy, a control CT scan showed progression of the CVL-shaped like a helmet, destroying the occipital, both parietal and a part of the frontal bone, with the effacement of the external table and somewhat preserved internal table. Successful therapy with ibrutinib led to full bone regeneration. Conclusion: Striking CVL presentations like the extensive permeative dissolution of the whole cranium rarely occur, especially in otherwise indolent types of NHL. Nevertheless, full bone regeneration and recovery are possible with modern treatment options, given adequate analysis is obtained beforehand. In case of a discrepancy between core-needle biopsy or fine-needle aspiration findings and the clinical picture, a surgical biopsy is warranted.

Objectives: The primary aim of this study was to improve the diagnosis of lymphocytic pleural effusions (LPEs) by combining their ultrasound characteristics with their macroscopic and biochemical features. Methods: This prospective, single-center, clinical observational study was conducted over a period of three years. The possible malignant etiology of LPEs was assessed using several diagnostic criteria: 1. ultrasound characteristics of the LPEs; 2. typical combinations of macroscopic and ultrasound features; and 3. the logistic regression method with three parameters—pleural nodularity, absence of fibrin, and serum protein concentration. Results: Eighty-four patients with LPEs were included in this study. Pleural nodularity (first criterion) was an ultrasound characteristic that yielded the best individual results (p < 0.001) in the differentiation of malignant and nonmalignant etiologies of LPEs (accuracy 73.81%). The combination of the second and third criteria yielded the best results in the prediction of a malignant etiology of LPEs (sensitivity 90.48%, specificity 83.33%, PPV 84.44%, NPV 89.74%, accuracy 86.90%). Based on the results of this prospective study, a protocol for the diagnostic procedure of lymphocytic pleural effusions without a definitive fluid diagnosis has been proposed. Conclusions: A combination of the ultrasound characteristics of LPEs and their macroscopic and biochemical features has improved the predictive accuracy for the malignant etiology of LPEs.

Background: Advanced imaging techniques play a pivotal role in oncology. A large variety of computed tomography (CT) scanners, scan protocols, and acquisition techniques have led to a wide range in image quality and radiation exposure. This study aims at implementing verifiable oncological imaging by quality assurance and optimization (i-Violin) through harmonizing image quality and radiation dose across Europe. Methods: The 2‑year multicenter implementation study outlined here will focus on CT imaging of lung, stomach, and colorectal cancer and include imaging for four radiological indications: diagnosis, radiation therapy planning, staging, and follow-up. Therefore, 480 anonymized CT data sets of patients will be collected by the associated university hospitals and uploaded to a repository. Radiologists will determine key abdominopelvic structures for image quality assessment by consensus and subsequently adapt a previously developed lung CT tool for the objective evaluation of image quality. The quality metrics will be evaluated for their correlation with perceived image quality and the standardized optimization strategy will be disseminated across Europe. Results: The results of the outlined study will be used to obtain European reference data, to build teaching programs for the developed tools, and to create a culture of optimization in oncological CT imaging. Conclusion: The study protocol and rationale for i‑Violin, a European approach for standardization and harmonization of image quality and optimization of CT procedures in oncological imaging, is presented. Future results will be disseminated across all EU member states, and i‑Violin is thus expected to have a sustained impact on CT imaging for cancer patients across Europe.