Conventional and Advanced Imaging Features of CNS Intravascular Lymphoma

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging Pub Date : 2025-07-03 DOI:10.1111/jon.70061

Sunpob Cheewadhanaraks, Otto Rapalino

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Abstract

Background and Purpose

Intravascular lymphoma (IVL) is a rare and aggressive lymphoma subtype that poses diagnostic challenges due to its nonspecific clinical presentation. This study aimed to evaluate the imaging findings of this disease in the CNS and to assess the diagnostic potential of advanced imaging techniques, including dynamic susceptibility contrast (DSC) perfusion, magnetic resonance spectroscopy (MRS), and fluorine-18 fluorodeoxyglucose (FDG) PET.

Methods

Twenty-one pathologically confirmed cases of IVL with CNS involvement were evaluated. Two cases underwent DSC perfusion, three underwent MRS, and three underwent FDG PET.

Results

Ninety percent of patients had intracranial imaging findings. The most common imaging pattern on brain MRI was infarct-like lesions (68%), followed by mass-like enhancement and nonspecific white matter changes (11% each). The remaining findings included enhancing lesions without mass effect and a central pontine T2/fluid-attenuated inversion recovery hyperintensity, each observed in one patient. T2* imaging abnormalities were found in 60% of cases. Vascular irregularity on noninvasive angiographic imaging was observed in 30% of cases. Spinal intradural involvement was found in four cases (19%), including three cases with nerve root enhancement and one case with spinal cord infarction. MRS showed variable choline/creatine ratios elevation in two out of three cases. No cases showed apparent cerebral blood volume elevation on DSC perfusion or increased uptake on FDG PET.

Conclusion

Several imaging findings can be observed in CNS IVL, with infarct-like lesions being the most common. Awareness of these imaging features is crucial for the accurate diagnosis of this challenging entity.

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中枢神经系统血管内淋巴瘤的常规和高级影像学特征

背景与目的血管内淋巴瘤（IVL）是一种罕见的侵袭性淋巴瘤亚型，由于其非特异性的临床表现，给诊断带来了挑战。本研究旨在评估该疾病在中枢神经系统的影像学表现，并评估先进成像技术的诊断潜力，包括动态敏感性对比（DSC）灌注、磁共振波谱（MRS）和氟-18氟脱氧葡萄糖（FDG） PET。方法对21例经病理证实的IVL累及中枢神经系统的病例进行分析。2例行DSC灌注，3例行MRS， 3例行FDG PET。结果90%的患者有颅内显像。脑MRI最常见的成像模式是梗死样病变（68%），其次是肿块样增强和非特异性白质改变（各占11%）。其余发现包括无肿块效应的强化病变和桥桥中央T2/液体衰减反转恢复高强度，各在1例患者中观察到。T2*显像异常占60%。30%的病例无创血管造影显示血管不规则。脊髓硬膜内受累4例（19%），其中3例神经根增强，1例脊髓梗死。MRS显示3例中2例胆碱/肌酸比值升高。没有病例显示DSC灌注明显的脑血容量升高或FDG PET摄取增加。结论CNS IVL有多种影像学表现，以梗死样病变最为常见。了解这些影像学特征对于准确诊断这种具有挑战性的实体至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuroimaging 医学-核医学

CiteScore

4.70

自引率

0.00%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!