Pretreatment findings on magnetic resonance imaging in primary central nervous system lymphoma may predict overall survival duration

Abstract

Background and purpose: Primary central nervous system lymphoma (PCNSL) lesions often show avid contrast enhancement on T1-weighted contrast-enhanced MRI sequences. However, several case reports and a clinical study have described PCNSL in patients with no contrast enhancement on MRI. We assessed whether overall survival (OS) time was related to any tumor characteristics (lesion location, volume, and number; contrast enhancement; necrosis; proximity to the subarachnoid space; and edema) on MRI in patients with PCNSL. Materials and Methods We retrospectively reviewed records (MRI features, pathology, and survival data) of all patients at our institution with PCNSL who had been seen from, 2007 through 2017, and had undergone pretreatment MRI. Results We identified 79 patients (42 men, 37 women) with a mean age at diagnosis of 61.7 ± 10.4 years. The mean OS duration was 44.6 ± 41.7 months. The most common pathological diagnosis (74 patients) was diffuse large B-cell lymphoma. No associations were found between OS time and lesion location, volume, and number; contrast enhancement; necrosis; proximity to the subarachnoid space; or edema. However, a sole patient with non-enhancing PCNSL on MRI was found to have low-grade disease, with prolonged survival (>83 months). Several other patients with leptomeningeal disease had a mean OS time of 80 months. Patients with hemorrhagic lesions had a mean OS of 25.5 months. Conclusions The survival time for patients with PCNSL may be longer than previously thought, especially for patients with leptomeningeal seeding and lesions with hemorrhagic components Also, non-enhancing tumors may be less aggressive than enhancing tumors.

[18F]FDG PET-MRI provides survival biomarkers in primary central nervous system lymphoma in the elderly: an ancillary study from the BLOCAGE trial of the LOC network

“…In our study of patients with CNS lymphoma, we also found that higher volume on PET or enhanced T1weighted MRI sequence was a second independent biomarker of poor response to induction therapy and poor survival. Although tumor burden is well established as a prognostic factor in systemic lymphomas, data in the CNS setting is limited [39][40][41][42]. Our findings align with previous research by Albano et al, who reported in a study of 52 patients that patients with larger MTV had shorter PFS and OS [16].…”

Primary central nervous system lymphoma in elderly: An illustrative case of the new role of surgery and integrative medical management

“…[ 4 ] In the present case, the patient had an expansive intraparenchymal lesion in the subcortical white matter of the left temporal lobe with features suggestive of a lymphoproliferative tumor, but differentials such as secondary neoplastic processes and primary glial neoplasms could not be ruled out. [ 9 ]…”

“…Recurrences after the initial response are common and generally occur within the CNS. [ 9 ] In contrast, the prognosis of relapsed disease is even worse, with a median OS of 2 months without therapy, and 7 months with it. [ 8 ] The 5-year OS rate is approximately 30%, and thus, new therapeutic approaches are necessary to improve these patients’ quality of life and prognosis.…”

“…[4] In the present case, the patient had an expansive intraparenchymal lesion in the subcortical white matter of the left temporal lobe with features suggestive of a lymphoproliferative tumor, but differentials such as secondary neoplastic processes and primary glial neoplasms could not be ruled out. [9] Moreover, a CSF analysis was precluded due to the imminent risk of brain herniation, as indicated by the significant midline shift and extensive brain edema seen in the patient's MRI. [16] is scenario mirrors a broader challenge in PCNSL management: often, patients manifest in advanced disease stages.…”