MR imaging features of intracranial primary CNS lymphoma in immune competent patients

Mansour, Asem; Qandeel, Monther; Abdel‐Razeq, Hikmat; Ali, Hussain Ali Abu

doi:10.1186/1470-7330-14-22

Cited by 75 publications

(59 citation statements)

References 20 publications

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“…NAA is predominantly located in neurons and is thus decreased in all neoplasms that cause neurons to be displaced or replaced with malignant cells. 29 Numerous studies have demonstrated decreased NAA peak, mainly in glial neoplasms 30 and primary CNS lymphoma, 31 consistent with our results. Our results also suggest that APT mean indirectly reflects neuronal loss due to brain tumor infiltration.…”

Section: Discussionsupporting

confidence: 92%

Diagnostic performance between contrast enhancement, proton MR spectroscopy, and amide proton transfer imaging in patients with brain tumors

Sakata

Fushimi

Okada

et al. 2017

Magnetic Resonance Imaging

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Section: Discussionsupporting

confidence: 92%

Diagnostic performance between contrast enhancement, proton MR spectroscopy, and amide proton transfer imaging in patients with brain tumors

Sakata

Fushimi

Okada

et al. 2017

Magnetic Resonance Imaging

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“…5,6 The unique features of our patient are that she did not have classic MRI findings of a PCNSL but later evolved to classic MRI findings with T1 and T2 FLAIR hyperintesities with homogenous contrast enhancement. 13 Also, her CSF cytology and flow cytometry was negative for lymphoma, but her 14-3-3 protein was elevated with Creutzfeldt-Jakob disease in the differential diagnosis. 14-3-3 protein is found in neuronal cytoplasm, glia, and synaptic membranes of the brain.…”

Section: Discussionmentioning

confidence: 97%

Primary Central Nervous System Lymphoma Presenting as Parkinsonism with Atypical MRI Findings and Elevated 14-3-3 Protein

Nagarajan

Yerram

Digala

et al. 2020

JNRP

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Primary central nervous system lymphoma (PCNSL) is a rare neoplasm with an incidence of 2 to 3% of all CNS malignancies. The diagnosis can be challenging, especially with atypical presentations. Movement disorders can be one of the rare presentations of PCNSL. Here, we present an unusual case of gradually progressing Parkinsonism with an elevation of cerebrospinal fluid (CSF) 14–3-3 protein and atypical imaging findings found to have PCNSL. A 76-year-old female patient presented with gait and intermittent speech difficulty. Initial workup revealed a contrast-enhancing lesion in the bilateral putamen and head of caudate without any mass effect. Her symptoms were rapidly progressed over 6 months and presented with mild dysarthria, bradykinesia, mild rigidity, and reduced left arm swinging. These features were consistent with Parkinsonism. The repeat imaging showed the progression of hyperintensities in the bilateral putamen. The patient underwent a stereotypic biopsy of the right caudate nucleus, which revealed PCNSL. She was treated with high-dose methotrexate and is currently in remission. Diagnosis of movement disorders remains clinical and rapid progression of symptoms, and atypical presentation must warrant further imaging and workup.

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“…On routine MRI, low grade gliomas are typically non-enhancing 11 while lymphomas typically demonstrate homogeneous enhancement and restricted diffusion on diffusion-weighted imaging. 12 Pattern of contrast enhancement may be another useful tool in identifying a TDL. In this study, all TDLs demonstrated incomplete ring-enhancement while this pattern did not occur among the HGG group.…”

Section: Discussionmentioning

confidence: 99%

Perfusion Imaging of Tumefactive Demyelinating Lesions Compared to High Grade Gliomas

Parks¹,

Bhan²,

Shankar³

2015

Can. J. Neurol. Sci.

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Tumefactive demyelinating lesions (TDLs) have been defined as demyelinating lesions >20 mm variably associated with mass effect, perilesional edema, and/or contrast enhancement. 1-2 A retrospective study of 168 individuals with biopsy-confirmed central nervous system inflammatory demyelinating disease showed that TDLs present a diagnostic challenge given the broad differential diagnosis suggested by conventional magnetic resonance imaging (MRI) sequences (tumour, abscess, vascular disease) and initial misinterpretation of approximately one-third of biopsy specimens by a referring pathologist. 1 High grade gliomas (HGGs) are an especially important diagnostic consideration given the shared features of peripheral enhancement, perilesional edema, and mass effect on conventional MRI. 3 Cerebral blood volume calculated from dynamic contrastenhanced perfusion MRI approximates lesion vascularity and may help differentiate TDLs from neoplastic lesions. [4][5][6][7] CASE CONTROL STUDYFollowing Capital Health Research Ethics Board approval (CDHA-RS/2014-127), we performed a retrospective review of all patients with a TDL or HGG pre-operatively imaged using dynamic contrast-enhanced perfusion MRI as part of clinical care at the Halifax Infirmary between July 2010 and September 2013.Images were acquired using a 1.5 T MRI system (Signa HDxt 1.5 T, GE Healthcare). All patients had axial T2-weighted imaging, axial fluid attenuated inversion recovery (FLAIR) imaging, axial isotropic diffusion-weighted imaging (DWI), magnetic resonance perfusion axial T2*-weighted imaging echo-planar image sequence, and post-gadolinium T1-weighted imaging. For magnetic resonance perfusion, a total of 40 data sets (axial T2*-weighted imaging echo-planar image sequence with TR 2000, TE 26, flip angle 5, matrix 96x128, Nex 1, FOV 22) were acquired with a time resolution of two seconds during and after injection of 0.1 mmol/kg or 0.2 ml/kg of MultiHance (gadobenate dimeglumine, Bracco Diagnostics) at a rate of five ml/s. Total acquisition time was 80 seconds. Acquisition covered the whole head with 20 slices of five mm thickness and inter-slice spacing of 1.5 mm.Perfusion maps were calculated from time-intensity curves using the vendor provided software package (Functool v. 5.2.09, GE Healthcare). Cerebral blood volume (CBV) and cerebral blood flow (CBF) maps were quantitatively analyzed by placing the region of interest (5-10 mm 2 ) in areas of maximum CBV or CBF on qualitative analysis. Lesion relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) were calculated as a ratio to contralateral normal appearing white matter (Figure 1).Perfusion MRI was performed for three individuals with a TDL (two biopsy confirmed, one inferred given clinical response to steroids) and six individuals with a HGG (five World Health Organization (WHO) grade IV astrocytoma, one WHO grade III anaplastic oligodendroglioma). There was no difference in age of presentation for patients with a TDL (40.3, range 31-49 years) or HGG (57.2, range 38-70 yea...

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MR imaging features of intracranial primary CNS lymphoma in immune competent patients

Cited by 75 publications

References 20 publications

Diagnostic performance between contrast enhancement, proton MR spectroscopy, and amide proton transfer imaging in patients with brain tumors

Diagnostic performance between contrast enhancement, proton MR spectroscopy, and amide proton transfer imaging in patients with brain tumors

Primary Central Nervous System Lymphoma Presenting as Parkinsonism with Atypical MRI Findings and Elevated 14-3-3 Protein

Perfusion Imaging of Tumefactive Demyelinating Lesions Compared to High Grade Gliomas

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