Central Nervous System Lymphoma Characterization by Diffusion‐Weighted Imaging and MR Spectroscopy

Zacharia, Thomas; Law, Meng; Naidich, Thomas P.; Leeds, Norman E.

doi:10.1111/j.1552-6569.2007.00231.x

Cited by 137 publications

(107 citation statements)

References 27 publications

(65 reference statements)

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“…In our study, we did not observe a clear tendency in DWI, although in immunocompetent patients, twice as many lesions were restricted than in immunodeficient patients (perhaps due to the high percentage of necrosis). This is similar to some other studies showing high rates of restricted diffusion in immunocompetent patients [30] . We must consider, especially in immunodeficient patients, that in lesions with peripheral enhancement and central necrosis, abscesses should be included in the differential diagnosis, as they have a typical restricted pattern in DWI [19] .…”

Section: Mri Featuressupporting

confidence: 80%

Findings at presentation in primary CNS diffuse large B-cell lymphoma of the brain: A comparison of immunocompetent and immunodeficient patients

Sampedro

Corroto²,

Arias³

et al. 2013

JBGC

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Background/Objectives: Primary central nervous system lymphoma (PCNSL) is a rare tumour with poor prognosis. Due to the increased number of patients with PCNSL over the past two decades our purpose are to describe magnetic resonance imaging (MRI) and Computed Tomography (CT) findings in (PCNSL) of the brain, and to study the differences between immunocompetent and immunodeficient patients with PCNSL. Methods:A retrospective, descriptive study was performed with 59 patients diagnosed of PCNSL in two hospitals from 1997 to 2010. Immunocompetent (n=38) and immunodeficient (n=21) patients were compared and differences between both groups were analyzed. Patients were evaluated according to sex, age, median time from clinical symptoms presentation to pathologic diagnosis, clinical symptoms, location, number of lesions, size, MRI and CT characteristics. Significance was defined as p < 0.05.Results: MRI findings: 50% of lesions in immunocompetent and 52.4% in immunodeficient group were heterogeneous, 89.5% of lesions in immunocompetent and 85,7% in immunodeficient were hypo-isointense on T1WI; 63.2% of lesions in immunocompetent and 76.2% in immunodeficient group were hyperintense on T2WI. CT images: 48.39% of lesions in immunocompetent and 20% in immunodeficient group were hyperdense. Statistically significant differences between immunocompetent and immunodeficient patients were found when evaluating the age (p < 0.000) and median time from clinical symptoms presentation to pathologic diagnosis (p < 0.008).Conclusions: MRI and CT are able to define imaging characteristics of PCNSL, promoting a quick diagnosis. There are no significant differences between immunocompetent and immunodeficient patients for MR and CT features.

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Section: Mri Featuressupporting

confidence: 80%

Findings at presentation in primary CNS diffuse large B-cell lymphoma of the brain: A comparison of immunocompetent and immunodeficient patients

Sampedro

Corroto²,

Arias³

et al. 2013

JBGC

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“…Cerebral edema is usually larger than the area of contrast enhancement and is thus responsible for the apparent mass effect. The diffusion weighted scans are consistent with the increased diffusivity of water protons [4]. Even if these MRI features of PCNSL are recognized, differentiating it from other diagnoses -including malignant gliomas, metastases, and inflammatory disorders-is not always easy [5].…”

Section: Introductionmentioning

confidence: 55%

The diagnostic role of 18F-FDG PET for primary central nervous system lymphoma

et al. 2014

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Objective 18F-FDG PET has become one of the most important methods for studying malignant lymphoma, but its diagnostic role for primary central nervous system lymphoma (PCNSL) has not been established. The aim of this study is to determine the appropriate cut-off values of FDG uptake and to investigate how corticosteroid administration influences PCNSL. MethodsWe retrospectively reviewed 82 patients with contrast-enhanced brain tumors who underwent an FDG PET scan at onset, including 19 PCNSLs. FDG uptake of the lesion was assessed by the maximum standardized uptake value (SUVmax) and the ratio of tumor to normal contralateral cortex activity (T/N ratio). Receiver operating characteristic (ROC) curves were generated from the SUVmax and T/N ratios. To investigate the influence of corticosteroid application before a FDG PET scan, we evaluated the association between the FDG uptake of the lesion and the cumulative dose of corticosteroid administration on 13 PCNSL patients who had received steroid treatment before an FDG PET examination. ResultsThe mean FDG SUVmax and T/N ratio of PCNSLs were 22.6 and 2.79, respectively, and these values were significantly higher than that of the other malignant brain tumors.ROC analysis indicated that the evaluation of FDG uptake using the T/N ratio was more reliable than the SUVmax with respect to the differential diagnosis. When PCNSL patients went without steroid application before FDG PET, the accuracy of the T/N ratio with a cut-off point of 2.0 was 91.1%, the sensitivity was 94.7%, and the specificity was 87.3%. Although there are no significant differences in the FDG T/N ratio for PCNSL patients with or without steroid treatment, a negative correlation was found between the T/N ratio and cumulative dose of corticosteroid before PET study (r = 0.71, p = 0.032). ConclusionsWe concluded that the T/N ratio was superior to SUVmax for FDG uptake assessment as for distinguishing PCNSLs from other malignant brain tumors; the appropriate T/N ratio cut-off point was 2.0. In addition, FDG uptake could be influenced by cumulative doses of corticosteroid before a PET scan, and thus this fact should be taken into consideration when evaluating FDG PET for PCNSL diagnosis.

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“…A high lipid peak in PCNSLs and a variable lip-lac peak in patients with TDL have been previously noted by many other researchers. 1,3,10,15,16 In our study, we classified the lip-lac grade by visual judgment, which could easily be applied in daily clinical practice. We found that a high-grade lip-lac (grade Ͼ3) was mostly shown in PCNSLs regardless of whether there was necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…1 Their incidence has been increasing during the past 2 decades not only in immunocompromised patients but also in immunocompetent patients. 2,3 Typical MR imaging features of PCNSLs are characterized by their periventricular locations, well-defined margin, moderate or marked edema, and intense and homogeneous nodular enhancement and are usually easy to correctly diagnose. [4][5][6] However, some patients present with atypical MR imaging features, commonly those of heterogeneous enhancement, such as patchy enhancement, streaky enhancement without mass formation, or even no enhancement.…”

mentioning

confidence: 99%

Utility of Proton MR Spectroscopy for Differentiating Typical and Atypical Primary Central Nervous System Lymphomas from Tumefactive Demyelinating Lesions

Kim

et al. 2013

American Journal of Neuroradiology

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Central Nervous System Lymphoma Characterization by Diffusion‐Weighted Imaging and MR Spectroscopy

Cited by 137 publications

References 27 publications

Findings at presentation in primary CNS diffuse large B-cell lymphoma of the brain: A comparison of immunocompetent and immunodeficient patients

Findings at presentation in primary CNS diffuse large B-cell lymphoma of the brain: A comparison of immunocompetent and immunodeficient patients

The diagnostic role of 18F-FDG PET for primary central nervous system lymphoma

Utility of Proton MR Spectroscopy for Differentiating Typical and Atypical Primary Central Nervous System Lymphomas from Tumefactive Demyelinating Lesions

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