MRI features of primary central nervous system lymphoma in patients with different immune statuses

doi:10.19871/j.cnki.xfcrbzz.2023.02.008

Abstract

Abstract: Objective This study aims to investigate the MRI features of primary central nervous system lymphoma (PCNSL) in patients with different immune statuses, in order to enhance the understandings of PCNSL and offer clinical guidance for the diagnosis of PCNSL. Method A retrospective analysis was conducted on cases of primary central nervous system lymphoma confirmed by pathology at Zhongnan Hospital of Wuhan University. The sample included 16 males and 14 females, with an average age of (60.1±11.6) years. Additionally, 5 AIDS patients were included in the study. The misdiagnosis rate was 33.3%. The aim of the study was to analyze the imaging findings of PCNSL. Result A total of 30 patients with PCNSL were included in the study, all pathologically classified as diffuse large B-cell lymphoma. Of these patients, 20 cases (66.6%) presented as solitary lesions and 10 cases (33.3%) as multiple lesions, with 26 cases (86.7%) located in the supratentorial area and 4 cases (13.3%) in the infratentorial area. The lesions were found to be round in shape in 13 cases (43.3%), irregular in 11 cases (36.7%), and lobulated in 6 cases (20.0%). Peripheral edema was observed in 29 cases. On T₁WI, the lesions showed slightly hypo-signal in 25 cases (83.3%), while on T₂WI, the signal intensity was and slightly hyper-signal in 23 cases (76.7%). 14 cases (46.7%) exhibited homogeneous enhancement, 10 cases (33.3%) showed nonhomogeneous enhancement, and 6 cases (20.0%) showed circular enhancement. In addition, 20 cases (66.6%) exhibited special features. Conclusion The lesions of PCNSL in immunocompetent patients are mostly round in shape and typically exhibit a well-defined, markedly homogeneous enhancement with special features. In contrast, the lesions of PCNSL in immunocompromised patients are often lobulated and irregular in shape, and show ring enhancement with lower ADC values compared to those in immunocompetent patients.

Key words: Primary central nervous system lymphoma, Acquired immunodeficiency syndrome, Immunologic function, Magnetic resonance imaging

CLC Number:

R445.2

Shi Yanbin, Zeng Yingting, Li Yipan, Song Lu, Lu Zhiyan. MRI features of primary central nervous system lymphoma in patients with different immune statuses[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(2): 39-44.

References

[1] GROMMES C, DEANGELIS LM.Primary CNS Lymphoma[J]. J Clin Oncol, 2017, 35(21):2410-2418.
[2] HOANG XK, BESSELL E, BROMBERG J, et al.European Association for Neuro-Oncology Task Force on Primary CNS Lymphoma. Diagnosis and treatment of primary CNS lymphoma in immunocompetent patients: guidelines from the European Association for Neuro-Oncology[J]. Lancet Oncol, 2015, 16(7):e322-e332.
[3] DANDACHI D, OSTROM QT, CHONG I, et al.Primary central nervous system lymphoma in patients with and without HIV infection: a multicenter study and comparison with USA[J]. Cancer Causes Control, 2019, 30(5):477-488.
[4] VALLES FE, PEREZ-VALLES CL, REGALADO S, et al.Combined diffusion and perfusion MR imaging as biomarkers of prognosis in immunocompetent patients with primary central nervous system lymphoma[J]. AJNR Am J Neuroradiol, 2013, 34(1):35-40.
[5] YAP KK, SUTHERLAND T, LIEW E, et al.Magnetic resonance features of primary central nervous system lymphoma in the immunocompetent patient: a pictorial essay[J]. J Med Imaging Radiat Oncol, 2012, 56(2):179-186.
[6] MANSOUR A, QANDEEL M, ABDEL-RAZEQ H, et al.MR imaging features of intracranial primary CNS lymphoma in immune competent patients[J]. Cancer Imaging. 2014,14(1):1-9.
[7] 中华医学会感染病学分会艾滋病丙型肝炎学组,中国疾病预防控制中心.中国艾滋病诊疗指南(2021年版)[J]. 协和医学杂志,2022, 13(2):203-226.
[8] BARAJAS RF, POLITI LS.Consensus recommendations for MRI and PET imaging of primary central nervous system lymphoma: guideline statement from the International Primary CNS Lymphoma Collaborative Group (IPCG)[J]. Neuro Oncol, 2021, 23(7):1056-1071.
[9] 覃亚勤,罗凤,黎彦君,等. 艾滋病合并恶性肿瘤住院患者疾病谱分析[J/CD]. 新发传染病电子杂志,2022, 7(1):39-42.
[10] CARBONE A, VACCHER E, GLOGHINI A, et al.Diagnosis and management of lymphomas and other cancers in HIV-infected patients[J]. Nat Rev Clin Oncol, 2014, 11(4):223-238.
[11] SHIELS MS, PFEIFFER RM, HALL HI, et al.Proportions of Kaposi sarcoma, selected non-Hodgkin lymphomas, and cervical cancer in the United States occurring in persons with AIDS, 1980-2007[J]. JAMA, 2011, 305(14):1450-1459.
[12] 钟明,宋毅杰,王宁,等. 719例HIV感染/AIDS合并恶性肿瘤的流行病学特征分析[J/CD]. 新发传染病电子杂志,2022, 7(3):60-63.
[13] 陈力,刘敏,何小庆,等.29例艾滋病相关淋巴瘤临床特点及预后因素分析[J/CD]. 新发传染病电子杂志,2018,3(3):154-156.
[14] DEFFENBACHER KE, IQBAL J, LIU Z,et al.Recurrent chromosomal alterations in molecularly classified AIDS-related lymphomas: an integrated analysis of DNA copy number and gene expression[J]. JAIDS, 2010,54(1):18-26.
[15] 何京美,黄德晖,吴卫平. 原发性中枢神经系统淋巴瘤的临床特点和影像特征分析[J].解放军医学院学报,2021,42(3):291-296.
[16] 万云青,杨亚英,冯艳玲,等. 艾滋病相关原发性中枢神经系统淋巴瘤的MRI表现分析[J].放射学实践,2020,35(11):1391-1395.
[17] HALDORSEN IS, ESPELAND A, LARSSON EM.Central nervous system lymphoma: characteristic findings on traditional and advanced imaging[J]. AJNR Am J Neuroradiol, 2011, 32(6):984-992.
[18] BATHLA G, HEGDE A.Lymphomatous involvement of the central nervous system[J]. Clin Radiol, 2016, 71(6):602-609.
[19] NORRINGTON M, RATHI N, JENKINSON MD, et al.Neuroinflammation preceding primary central nervous system lymphoma (PCNSL) - Case reports and literature review[J]. J Clin Neurosci, 2021,89:381-388.
[20] HE YX, QU CX, HE YY, et al.Conventional MR and DW imaging findings of cerebellar primary CNS lymphoma: comparison with high-grade glioma[J]. Sci Rep, 2020, 10(1):10007.
[21] LIU S, FAN X, ZHANG C, et al.MR imaging based fractal analysis for differentiating primary CNS lymphoma and glioblastoma[J]. Eur Radiol, 2019,29(3):1348-1354.
[22] LIN X, LEE M, O BUCK, et al. Diagnostic Accuracy of T1-Weighted Dynamic Contrast-Enhanced-MRI and DWI-ADC for Differentiation of Glioblastoma and Primary CNS Lymphoma[J]. AJNR Am J Neuroradiol, 2017, 38(3):485-491.
[23] LI J, XUE M, LV Z, et al.Differentiation of Acquired Immune Deficiency Syndrome Related Primary Central Nervous System Lymphoma from Cerebral toxoplasmosis with Use of Susceptibility-Weighted Imaging and Contrast Enhanced 3D-T1WI[J]. Int J Infect Dis, 2021,113:251-258.
[24] MARCUS C, FEIZI P, HOGG J, et al.Imaging in Differentiating Cerebral Toxoplasmosis and Primary CNS Lymphoma With Special Focus on FDG PET/CT[J]. AJR Am J Roentgenol, 2021,216(1):157-164.