Primary CNS Lymphomas: Challenges in Diagnosis and Monitoring

Primary Central Nervous System Lymphoma (PCNSL) is a rare neoplasm that can involve brain, eye, leptomeninges, and rarely spinal cord. PCNSL lesions most typically enhance homogeneously on T1-weighted magnetic resonance imaging (MRI) and appear T2-hypointense, but high variability in MRI features is commonly encountered. Neurological symptoms and MRI findings may mimic high grade gliomas (HGGs), tumefactive demyelinating lesions (TDLs), or infectious and granulomatous diseases. Advanced MRI techniques (MR diffusion, spectroscopy, and perfusion) and metabolic imaging, such as Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) or amino acid PET (usually employing methionine), may be useful in distinguishing these different entities and monitoring the disease course. Moreover, emerging data suggest a role for cerebrospinal fluid (CSF) markers in predicting prognosis and response to treatments. In this review, we will address the challenges in PCNSL diagnosis, assessment of response to treatments, and evaluation of potential neurotoxicity related to chemotherapy and radiotherapy.

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Liquid Biopsy and Other Non-Invasive Diagnostic Measures in PCNSL

Cancers ◽

10.3390/cancers13112665 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2665

Author(s):

Alexander Baraniskin ◽

Roland Schroers

Keyword(s):

Central Nervous System Lymphoma ◽

Circulating Tumor Dna ◽

Mri Findings ◽

Diagnostic Measures ◽

Non Hodgkin Lymphoma ◽

Specificity And Sensitivity ◽

Demyelinating Lesions ◽

Granulomatous Diseases ◽

High Level ◽

Almost All

Primary central nervous system lymphoma is a rare but highly aggressive form of non-Hodgkin lymphoma that remains confined to the CNS neuroaxis. The diagnosis of PCNSL requires a high level of suspicion as clinical presentation varies depending on the involved CNS areas. Neurological symptoms and MRI findings may mimic gliomas, demyelinating lesions, or infectious and granulomatous diseases. Almost all PCNSL patients undergo invasive surgical procedures for definite diagnosis. Stereotactic biopsy is still the gold standard in achieving a diagnostic accuracy of 73–97%. Both the potential procedural morbidity and mortality, as well as the time to definite histopathologic diagnosis resulting in delays of treatment initiation, have to be considered. On the contrary, minimally invasive procedures, such as MRI, CSF cytology, and flow cytometry, still have limited value due to inferior specificity and sensitivity. Hence, novel diagnostic approaches, including mutation analyses (MYD88) in circulating tumor DNA (ctDNA) and the determination of microRNAs (miR-21, miR-19b, and miR-92) as well as cytokine levels (IL10 and IL6) in blood, cerebrospinal fluid (CSF), and vitreous fluid (VRF), move into the focus of investigation to facilitate the diagnosis of PCNSL. In this review, we outline the most promising approaches that are currently under clinical consideration.

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Balo’s Concentric Sclerosis Mimicking Tumor on Magnetic Resonance Imaging in a Young Patient

Clinical Medicine Insights Case Reports ◽

10.1177/1179547621989673 ◽

2021 ◽

Vol 14 ◽

pp. 117954762198967

Author(s):

Van Trung Hoang ◽

Cong Thao Trinh ◽

Hoang Anh Thi Van ◽

Thanh Tam Thi Nguyen ◽

Vichit Chansomphou ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Demyelinating Disease ◽

Management Strategies ◽

Resonance Imaging ◽

Mri Findings ◽

Demyelinating Lesions ◽

Baló’S Concentric Sclerosis ◽

Magnetic Resonance Imaging Mri ◽

Subcortical Regions

Balo’s concentric sclerosis (BCS) is a rare demyelinating disease known as Multiple Sclerosis (MS) lesion type III. It is a disease of the white matter of the brain characterized by a round lesion with variable concentric myelinated and demyelinated layers, appearing as “onion bulb.” We present a case of BCS and discuss the imaging findings and management strategies of this disease. A 26-y-old male developed headache, weakness, and numbness of limbs. Magnetic resonance imaging (MRI) showed concentric lamellar like demyelinating lesions at the subcortical regions. The patient’s neurological symptoms were consistent with the MRI findings.

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[18F]Fluoromethylcholine PET/CT for CNS lymphoma assessment: a new tool

F1000Research ◽

10.12688/f1000research.73232.1 ◽

2021 ◽

Vol 10 ◽

pp. 1137

Author(s):

Kirsty Marshall ◽

Bhupinder Sharma ◽

Thomas Millard ◽

Sahil Chhabda ◽

Fayed Sheikh ◽

...

Keyword(s):

Grey Matter ◽

Response Assessment ◽

Complete Response ◽

Cns Lymphoma ◽

Residual Tumour ◽

Alternative Mode ◽

Positron Emission ◽

Pet Ct ◽

Magnetic Resonance Imaging Mri ◽

Cns Lymphomas

Background Central nervous system (CNS) lymphomas are a rare subset of lymphoma, which are associated with a poor outcome. The gold standard for CNS imaging is with gadolinium-enhanced magnetic resonance imaging (MRI); however, there are a number of limitations, including some patients with small persistent abnormalities from scarring due to focal haemorrhage or from a previous biopsy, which can be difficult to discern from residual tumour. [18F]Fluoromethylcholine positron emission tomography–computed tomography (FCH-PET/CT) uses an analogue of choline, which due to the upregulation of choline kinase in tumour cells, allows increased uptake of FCH. As there is minimal background grey matter uptake of FCH, FCH-PET/CT can be used in CNS imaging and provide a useful tool for response assessment. Methods This is a cohort study, where we identified 40 patients with a diagnosis of primary or secondary CNS lymphoma between 1st November 2011 and 10th October 2019. Results 26 of the 40 patients (65%) had concordant results. Of the discordant results, 11 out of 14 had partial response (PR) on MRI but showed a metabolic complete response (mCR) on FCH-PET. The overall response rates (ORR) were similar between the two modalities (90% for MRI versus 95% with FCT-PET/CT). Conclusion We conclude that FCH-PET/CT is a reasonable alternative mode of imaging to gadolinium-enhanced MRI brain imaging, providing a new tool for assessment of CNS lymphoma.

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Comparison of the clinical and MRI features of patients with hepatic hemangioma, epithelioid hemangioendothelioma, or angiosarcoma

10.21203/rs.2.16278/v1 ◽

2019 ◽

Author(s):

Zhuangsheng Liu ◽

Lilei Yi ◽

Junhao Chen ◽

Ruqiong Li ◽

Keming Liang ◽

...

Keyword(s):

Vascular Endothelial Cell ◽

Measurement Data ◽

Epithelioid Hemangioendothelioma ◽

Vascular Tumors ◽

Hepatic Hemangioma ◽

Mri Findings ◽

Mri Features ◽

Rim Enhancement ◽

The Difference ◽

Magnetic Resonance Imaging Mri

Abstract Background Comparisons of hepatic epithelioid hemangioendothelioma (HEHE), hepatic hemangioma, and hepatic angiosarcoma (HAS) have rarely been reported. The purpose of our study was to analyze the clinical and magnetic resonance imaging (MRI) findings of these conditions.Methods A total of 57 patients (25 with hemangioma, 13 with HEHE, and 19 with HAS) provided hepatic vascular endothelial cell data between June 2006 and May 2017. The measurement data were represented as means±SDs. Between-group comparisons were performed using independent-samples t-tests. Count data were represented as frequencies or rates, and χ2- or Fisher’s exact tests were performed.Results The proportions of cases with circumscribed margins were 88% (22/25), 84.6% (11/3), and 31.6% (6/19) for hemangioma, HEHE, and HAS, respectively (P<0.001). HAS lesions were less likely to have circumscribed margins. The proportions of lesions with hemorrhaging were 4% (1/25), 44.4% (4/13), and 36.8% (7/13) for hemangioma, HEHE, and HAS, respectively (P=0.014). HEHE and HAS cases were more likely to show heterogeneous signals on T1-weighted (T1WI) MRI. HEHE and HAS cases were more likely to show heterogeneous signals on T2-weighted (T2WI) MRI. Centripetal enhancement was the most common pattern in vascular tumors, with proportions of 100%, 46.2% (6/13), and 68.4% (13/19) for hemangioma, HEHE, and HAS, respectively. The difference in enhancement pattern between HEHE and HAS was not significant, but rim enhancement was more common for HEHE (46.2%, 6/13).Conclusions Our study revealed clinical and imaging differences between HEHE and HAS. The platelet count (PLT) and coagulation function of the HAS group decreased, whereas the alpha-fetoprotein (AFP) level increased. The 5-year survival rate for HAS was significantly lower than that of HEHE. A higher malignancy degree indicated a more blurred lesion margin, easier occurrence of hemorrhaging, and more heterogeneous plain T1WI and T2WI signals.

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Cerebral schistosomiasis: MRI features with pathological correlation

Acta Radiologica ◽

10.1177/0284185120934475 ◽

2020 ◽

pp. 028418512093447

Author(s):

Chun-yan Lu ◽

Sha Zhao ◽

Yi Wei

Keyword(s):

Magnetic Resonance Imaging ◽

Brain Area ◽

Pathological Findings ◽

Resonance Imaging ◽

Mri Findings ◽

Mri Features ◽

Cerebral Involvement ◽

Magnetic Resonance Imaging Mri ◽

The Brain ◽

Radiology And Pathology

Background Neuroschistosomiasis is not commonly encountered and is probably underrecognized. We hope these findings can help clinicians and radiologists to raise awareness of this disabling disorder. Purpose To demonstrate the magnetic resonance imaging (MRI) findings of cerebral schistosomiasis and correlate it with pathological findings. Material and Methods We identified seven patients with cerebral schistosomiasis from radiology and pathology archives of our hospital. Of the seven patients, six were pathologically confirmed. The remaining patient had pathologically confirmed spinal schistosomiasis with MRI findings of cerebral involvement. MRI and pathological findings of these patients were analyzed and correlated. Results Multiple enhancing nodules at varying size were found in all patients. Prominent leptomeningeal or choroidal veins were found in six patients, four at the center of the foci and two at the periphery. Hemorrhage was identified in two patients. Histology revealed granulomas around ova in six patients. A prominent vein with ova in the lumen and wall of a vein was found in one patient and perivascular ova deposition was found in one patient. Conclusion Multiple enhancing nodules with central or peripheral veins in a circumscribed brain area are important signs to the diagnosis of cerebral schistosomiasis. The inflamed veins involved may be the route taken by the ova to spread to the brain tissue.

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Diverse MRI findings and clinical outcomes of acute Marchiafava-Bignami disease

Acta Radiologica ◽

10.1177/0284185120943040 ◽

2020 ◽

pp. 028418512094304

Author(s):

Wei Li ◽

Chao Ran ◽

Jun Ma

Keyword(s):

Clinical Outcomes ◽

Clinical Manifestations ◽

Acute Onset ◽

Restricted Diffusion ◽

Type I ◽

Type Ii ◽

Mri Findings ◽

Type Iii ◽

Mri Features ◽

Magnetic Resonance Imaging Mri

Background The acute onset of Marchiafava-Bignami disease (MBD) is difficult to capture, and its clinical manifestations are overlapped. Magnetic resonance imaging (MRI) is very useful in the diagnosis of acute MBD. Purpose To investigate the MRI features and clinical outcomes of acute MBD. Materials and Methods Sagittal T2-weighted (T2W) or T1-weighted (T1W) imaging, axial T1W and T2W imaging, and axial FLAIR and diffusion-weighted imaging (DWI) sequences were performed in 17 patients with acute MBD on 1.5-T MR. According to the different ranges of callosal restricted diffusion, MBD was divided into Type I (n = 7, the completely involved), Type II (n = 5, the mostly involved), and Type III (n = 5, the partly involved). The MRI findings and outcomes of each type were retrospectively analyzed. Results With the reduced range of the callosal restricted diffusion, the callosal atrophy or cavitation was more common: no case of Type I; 1 (20%) case of Type II; and 3 (60%) cases of Type III. With the increased range of callosal restricted diffusion, the extracallosal involvement was more common: 6 (86%) cases of Type I; 3 (60%) cases of Type II; and 1 (20%) case of Type III. During the follow-up, five cases had neuropsychiatric sequelae: 1 (14%) case of type I; 1 (20%) case of Type II; 3 (60%) cases of Type III. Conclusion The MRI findings and clinical outcomes of acute MBD are regular. The extensive restricted diffusion of acute MBD may present the curable condition. Callosal heterogeneity may affect the outcome of acute MBD.

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A Case of Primary T-Cell Central Nervous System Lymphoma: MR Imaging and MR Spectroscopy Assessment

Case Reports in Radiology ◽

10.1155/2013/916348 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

G. Manenti ◽

F. Di Giuliano ◽

A. Bindi ◽

V. Liberto ◽

V. Funel ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Mr Imaging ◽

Mr Spectroscopy ◽

Neuropsychiatric Symptoms ◽

Central Nervous System Lymphoma ◽

Mri Findings ◽

Characteristic Appearance ◽

The Right ◽

Cns Lymphomas

Primary central nervous system lymphomas (PCNSLs) are mainly B-cells lymphomas. A risk factor for the development of PCNSL is immunodeficiency, which includes congenital disorders, iatrogenic immunosuppression, and HIV. The clinical course is rapidly fatal; these patients usually present signs of increased intracranial pressure, nausea, papilledema, vomiting, and neurological and neuropsychiatric symptoms. PCNSL may have a characteristic appearance on CT and MR imaging. DWI sequences and MR spectroscopy may help to differentiate CNS lymphomas from other brain lesions. In this paper, we report a case of a 23-year-old man with T-primary central nervous system lymphoma presenting with a mass in the right frontotemporal lobe. We describe clinical, CT, and MRI findings. Diagnosis was confirmed by stereotactic biopsy of the lesion.

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The utility of dynamic MRI in differentiating the hormone-producing ability of pituitary adenomas

Japanese Journal of Radiology ◽

10.1007/s11604-021-01121-9 ◽

2021 ◽

Author(s):

Taishi Amano ◽

Tomohiko Masumoto ◽

Hiroyoshi Akutsu ◽

Noriaki Sakamoto ◽

Sodai Hoshiai ◽

...

Keyword(s):

Pituitary Adenomas ◽

Dynamic Mri ◽

Thyroid Stimulating Hormone ◽

Washout Rate ◽

Mri Findings ◽

Mean Values ◽

Mri Features ◽

Magnetic Resonance Imaging Mri ◽

The Relationship ◽

Tissue Enhancement

Abstract Purpose To investigate the relationship between dynamic magnetic resonance imaging (MRI) findings and hormonal activity in pituitary adenomas. Methods We retrospectively evaluated the dynamic MRI findings in 244 patients with pathologically confirmed pituitary adenomas and a diagnosis of clinically active prolactin (PRL)-producing adenomas. Among the 244 pituitary adenomas, 55, 16, 6, and 4 produced growth hormone (GH), PRL, adrenocorticotropic hormone, and thyroid-stimulating hormone, respectively, while 163 were non-functioning (NF) adenomas. For each adenoma, we calculated the washout rate (WR) and early (EER) and delayed (DER) tumour-to-normal-tissue enhancement ratios. Results The respective mean values of the WR, EER, and DER were 9.4%, 75.2%, and 64.5% for GH-producing adenomas; 6.2%, 117.1%, and 106.2% for PRL-producing adenomas; and 5.4%, 116.7%, and 108.7% for NF adenomas. GH-producing adenomas had significantly lower EER and DER values than PRL-producing (P < 0.001) and NF adenomas (P < 0.001). In ROC analysis of GH-producing and non-GH-producing adenomas, the areas under the curves of WR, EER, and DER were 0.593, 0.825, and 0.857, respectively. Conclusion There are differences in dynamic MRI features between GH-producing and non-GH-producing adenomas, which suggests that EER and DER may be useful for diagnosing GH-producing adenomas.

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Imaging features of skeletal muscle lymphoma: a case report and literature review

BMC Medical Imaging ◽

10.1186/s12880-021-00667-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shuxi Gao ◽

Hong Shu ◽

Hua Yang

Keyword(s):

Skeletal Muscle ◽

Lower Extremity ◽

B Cell Lymphoma ◽

Imaging Features ◽

Left Lower Extremity ◽

Non Hodgkin Lymphoma ◽

Guided Biopsy ◽

Mri Features ◽

Positron Emission ◽

Magnetic Resonance Imaging Mri

Abstract Background Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), occurring predominantly in older people. Skeletal muscle lymphoma is a rare form of DLBCL, most frequently affecting the thigh, upper extremities, calf, and pelvis. Case presentation We report a case of skeletal muscle DLBCL that was diagnosed using ultrasound (US)-guided biopsy. A 70-year-old man presented with progressive swelling and pain in the left lower extremity and an elevated erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP), ferritin, and CA125 levels. US, magnetic resonance imaging (MRI), and computed tomography (CT) showed diffuse lesions in several muscles of the left lower extremity. Positron emission tomography/CT (PET/CT) showed FDG-uptake in the affected muscles. The patient was treated with chemotherapy and achieved a good response. A systematic review of the literature published between 1992 and 2019 was conducted to investigate the role of imaging, including imaging-guided biopsy, in the diagnosis of skeletal muscle lymphoma. Conclusions Skeletal muscle lymphoma is rare. US and MRI features include enlargement of muscular structures, with preservation of the architecture of the tissue and surrounding anatomical structures. Definitive diagnosis relies on histological and immunohistological analysis of a sample obtained through imaging-guided biopsy.

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Magnetic Resonance Imaging in Cavitary Choroidal Melanoma

European Journal of Ophthalmology ◽

10.1177/112067210001000412 ◽

2000 ◽

Vol 10 (4) ◽

pp. 335-337 ◽

Cited By ~ 3

Author(s):

G. Rebolleda ◽

M. Suárez Figueroa ◽

F.J. Muñoz-Negrete ◽

A. Rocamora

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Choroidal Melanoma ◽

Solid Mass ◽

Resonance Imaging ◽

Mri Findings ◽

Nevus Of Ota ◽

Spindle Cells ◽

Mri Features ◽

Magnetic Resonance Imaging Mri

Purpose To report the development of a cavitary choroidal melanoma in a patient with nevus of Ota and describe its magnetic resonance imaging (MRI) features. Patient A 66-year-old man with right oculodermal melanocytosis and an ipsilateral choroidal cavitary melanoma was seen. Diagnosis was suspected on the clinical, ultrasonographic and MRI findings. Results T1-weighted image showed a hyperintense solid mass containing hypointense cystic-like spaces delineated by hyperintense septa with respect to the vitreous. The reverse image was observed on T2-weighted images. A choroidal melanoma comprising epithelioid and spindle cells with multilocular cavities was documented histopathologically. Conclusions There may be an association between cavitary melanoma and nevus of Ota. Characteristic MRI findings could be helpful in the differential diagnosis of cavitary uveal melanoma.

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