Insufficiency of Positron Emission Tomography and Magnetic Resonance Spectroscopy in the Diagnosis of Intravascular Lymphoma of the Central Nervous System

Abstract

Intravascular large B-cell lymphoma (IVL) is a rare type of extranodal lymphoma with an aggressive clinical course characterized by the proliferation of lymphoma cells within the lumen of small vessels. Diagnosis is often difficult because of marked variability in clinical presentation and nonspecific laboratory and radiological findings, especially when central nervous system (CNS) symptoms are the only manifestation. Modern metabolic imaging techniques such as positron emission tomography (PET) and ¹H-magnetic resonance spectroscopy (MRS) have been reported to be useful in the diagnosis of conventional primary CNS lymphoma. We report the case of a 69-year-old man who presented with a progressive leukoencephalopathic syndrome. The patient was examined by ¹⁸F-fluorodeoxyglucose and ¹¹C-methionine PET and MRS, but none of these examinations were able to show the presence of a tumor in the lesions or to clarify the tumor characteristics. Brain biopsy was the only way to obtain a definite diagnosis of IVL. The patient was treated intensively with standard immunochemotherapy but died 6 months after the diagnosis. Here, we discuss the insufficiency of modern metabolic imaging techniques, including PET and MRS, and recommend a rapid decision of brain biopsy in the diagnosis of IVL only involving the CNS.

Renal Intravascular Large B-cell Lymphoma: A Case Report and Review of the Literature

“…Several case reports have illustrated the added input of PET-CT to diagnose IVLBCL in the early stage ( 44 , 45 ). However, its low sensitivity makes it unfit for the evaluation of organ involvement, especially for central nervous system-localized disease (25% of all IVLBCL) ( 46 , 47 ).…”

Clinical Features and Treatment Outcomes of Intravascular Large B-Cell Lymphoma: A Single-Center Experience in Korea

“…Some cases reported that a PET/CT scan might be insufficient for diagnosis of IVLBCL due to false negativity [22,23,24]. On the contrary, other reports suggest that a PET/CT scan may be useful for the diagnosis of IVLBCL even in hardly detectable lesions, such as the brain, meninges and vagina [25,26,27,28].…”

Intravascular large B-cell lymphoma presenting as multiple stroke

“…PET/CT imaging can be helpful in some cases but several studies have also suggested significant false negative results. [ 13 , 14 ] In our patient, PET/CT imaging was inconclusive and not helpful.…”