Primary central nervous system lymphoma: is absence of intratumoral hemorrhage a characteristic finding on MRI?

Abstract Background. Previous studies have shown that intratumoral hemorrhage is a common finding in glioblastoma multiforme, but is rarely observed in primary central nervous system lymphoma. Our aim was to reevaluate whether intratumoral hemorrhage observed on T2-weighted imaging (T2WI) as gross intratumoral hemorrhage and on susceptibilityweighted imaging as intratumoral susceptibility signal can differentiate primary central nervous system lymphoma from glioblastoma multiforme. Patients and methods. A retrospective cohort of brain tumors from August 2008 to March 2013 was searched, and 58 patients (19 with primary central nervous system lymphoma, 39 with glioblastoma multiforme) satisfied the inclusion criteria. Absence of gross intratumoral hemorrhage was examined on T2WI, and an intratumoral susceptibility signal was graded using a 3-point scale on susceptibility-weighted imaging. Results were compared between primary central nervous system lymphoma and glioblastoma multiforme, and values of P < 0.05 were considered significant. Results. Gross intratumoral hemorrhage on T2WI was absent in 15 patients (79%) with primary central nervous system lymphoma and 23 patients (59%) with glioblastoma multiforme. Absence of gross intratumoral hemorrhage could not differentiate between the two disorders (P = 0.20). However, intratumoral susceptibility signal grade 1 or 2 was diagnostic of primary central nervous system lymphoma with 78.9% sensitivity and 66.7% specificity (P < 0.001), irrespective of gross intratumoral hemorrhage. Conclusions. Low intratumoral susceptibility signal grades can differentiate primary central nervous system lymphoma from glioblastoma multiforme. However, specificity in this study was relatively low, and primary central nervous system lymphoma cannot be excluded based solely on the presence of an intratumoral susceptibility signal.

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Differentiating glioblastoma multiforme from cerebral lymphoma: application of advanced texture analysis of quantitative apparent diffusion coefficients

The Neuroradiology Journal ◽

10.1177/1971400920937382 ◽

2020 ◽

Vol 33 (5) ◽

pp. 428-436

Author(s):

Mehrsad Mehrnahad ◽

Sara Rostami ◽

Farnaz Kimia ◽

Reza Kord ◽

Morteza Sanei Taheri ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Diffusion Coefficient ◽

Glioblastoma Multiforme ◽

Apparent Diffusion Coefficient ◽

Central Nervous System Lymphoma ◽

Second Order ◽

Regions Of Interest ◽

Apparent Diffusion ◽

Histogram Feature

Purpose The purpose of this study was to differentiate glioblastoma multiforme from primary central nervous system lymphoma using the customised first and second-order histogram features derived from apparent diffusion coefficients. Methods and materials: A total of 82 patients (57 with glioblastoma multiforme and 25 with primary central nervous system lymphoma) were included in this study. The axial T1 post-contrast and fluid-attenuated inversion recovery magnetic resonance images were used to delineate regions of interest for the tumour and peritumoral oedema. The regions of interest were then co-registered with the apparent diffusion coefficient maps, and the first and second-order histogram features were extracted and compared between glioblastoma multiforme and primary central nervous system lymphoma groups. Receiver operating characteristic curve analysis was performed to calculate a cut-off value and its sensitivity and specificity to differentiate glioblastoma multiforme from primary central nervous system lymphoma. Results Based on the tumour regions of interest, apparent diffusion coefficient mean, maximum, median, uniformity and entropy were higher in the glioblastoma multiforme group than the primary central nervous system lymphoma group ( P ≤ 0.001). The most sensitive first and second-order histogram feature to differentiate glioblastoma multiforme from primary central nervous system lymphoma was the maximum of 2.026 or less (95% confidence interval (CI) 75.1–99.9%), and the most specific first and second-order histogram feature was smoothness of 1.28 or greater (84.0% CI 70.9–92.8%). Based on the oedema regions of interest, most of the first and second-order histogram features were higher in the glioblastoma multiforme group compared to the primary central nervous system lymphoma group ( P ≤ 0.015). The most sensitive first and second-order histogram feature to differentiate glioblastoma multiforme from primary central nervous system lymphoma was the 25th percentile of 0.675 or less (100% CI 83.2–100%) and the most specific first and second-order histogram feature was the median of 1.28 or less (85.9% CI 66.3–95.8%). Conclusions Texture analysis using first and second-order histogram features derived from apparent diffusion coefficient maps may be helpful in differentiating glioblastoma multiforme from primary central nervous system lymphoma.

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Diagnostic delay and prognosis in primary central nervous system lymphoma compared with glioblastoma multiforme

Neurological Sciences ◽

10.1007/s10072-015-2353-4 ◽

2015 ◽

Vol 37 (1) ◽

pp. 23-29 ◽

Cited By ~ 7

Author(s):

R. Cerqua ◽

S. Balestrini ◽

C. Perozzi ◽

V. Cameriere ◽

S. Renzi ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Glioblastoma Multiforme ◽

Diagnostic Delay ◽

Central Nervous System Lymphoma

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Case report of an elderly woman with atypical imaging for primary central nervous system lymphoma who needed a brain biopsy for diagnosis

Journal of International Medical Research ◽

10.1177/03000605211035197 ◽

2021 ◽

Vol 49 (8) ◽

pp. 030006052110351

Author(s):

Kosuke Matsuzono ◽

Tomoya Yagisawa ◽

Keisuke Ohtani ◽

Yohei Ishishita ◽

Takashi Yamaguchi ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Fdg Pet ◽

Single Photon ◽

Photon Emission ◽

Central Nervous System Lymphoma ◽

Brain Biopsy ◽

Emission Computed Tomography ◽

Stereotactic Brain Biopsy ◽

Imaging Results

Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma, but its diagnosis is challenging in some cases. A brain biopsy is the gold standard for diagnosing PCNSL, but its invasiveness can be problematic. Thus, noninvasive imaging examinations have been developed for the pre-surgical diagnosis of PCNSL, including gadolinium-enhanced magnetic resonance imaging (MRI), 123I-N-isopropyl-p-iodoamphetamine single-photon emission computed tomography (123I-IMP SPECT), and positron emission tomography with 18F-fluorodeoxyglucose (18F-FDG PET). Here, we report the case of a 71-year-old woman with negative imaging findings for PCNSL, but who was diagnosed with PCNSL by a brain biopsy and histological analysis. Her imaging results were negative for gadolinium-enhanced cranial MRI, with low uptake in 123I-IMP SPECT and hypometabolism in 18F-FDG PET. However, a stereotactic brain biopsy from an abnormal lesion revealed that many round cells had infiltrated into the brain. Moreover, many infiltrating cells were positive for cluster of differentiation (CD)20 and CD79a, and proliferation marker protein Ki-67-positive cells accounted for nearly 80% of all cells. Based on these results, our final pathological diagnosis was PCNSL. The present case highlights the possibility of a PCNSL diagnosis even when all imaging-related examinations display negative results.

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