Since glymphatic was proposed and meningeal lymphatic was discovered, MRI and even PET were introduced to investigate brain parenchymal interstitial fluid (ISF), cerebrospinal fluid (CSF), and lymphatic outflow in rodents and humans. Previous findings by ex vivo fluorescent microscopic, and in vivo two-photon imaging in rodents were reproduced using intrathecal contrast (gadobutrol and the similar)-enhanced MRI in rodents and further in humans. On dynamic MRI of meningeal lymphatics, in contrast to rodents, humans use mainly dorsal meningeal lymphatic pathways of ISF-CSF-lymphatic efflux. In mice, ISF-CSF exchange was examined thoroughly using an intra-cistern injection of fluorescent tracers during sleep, aging, and neurodegeneration yielding many details. CSF to lymphatic efflux is across arachnoid barrier cells over the dorsal dura in rodents and in humans. Meningeal lymphatic efflux to cervical lymph nodes and systemic circulation is also well-delineated especially in humans onintrathecal contrast MRI. Sleep-or anesthesia-related changes of glymphatic-lymphatic flow and the coupling of ISF-CSF-lymphatic drainage are major confounders ininterpreting brain glymphatic/lymphatic outflow in rodents. PET imaging in humans should be interpreted based on human anatomy and physiology, different in some aspects, using MRI recently. Based on the summary in this review, we propose non-invasive and longer-term intrathecal SPECT/PET or MRI studies to unravel the roles of brain glymphatic/lymphatic in diseases.
Background:It has been known that plasmablastic lymphoma (PBL) is a neoplasm of immunocompromised patients occurring in soft tissue of oral cavity or in the vicinity whereas bone is an unlikely site to harbor PBL. However, its occurrence is increasingly being reported in immunocompetent individuals in either osseous or extra-oral sites. To our best knowledge, F-18 FDG PET/CT findings of PBL involving bones in an immunocompetent patient have not been reported, yet .Case summary:We report a case of PBL involving multiple bones in an immunocompetent patient. Features of different imaging modalities including F-18 Fluoro-deoxy glucose (FDG) positron emission tomography/computed tomography (PET/CT) were correlated well as findings of osteosarcoma in mandible with metastatic lesions. However, the histopathology and immunohistochemistry (IHC) of bone tissues from 2 separate biopsy sites revealed features of PBL.Conclusion:awareness to F-18 FDG PET/CT findings of PBL involving bones in an immunocompetent patient may prevent misdiagnosis.
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