Primary central nervous system lymphoma in AIDS: a wider spectrum of CT and MRI findings

Diagnosis of primary central nervous system lymphoma (PCNSL) in patients with AIDS based on radiological findings is still a challenging problem. Our purpose was to review the CT and MRI findings in PCNSL in our patients with AIDS and compare them with those reported in the literature. CT and MRI of 28 patients with AIDS and pathologically confirmed PCNSL were analysed retrospectively for the number of lesions, their site, size, density, signal intensity, contrast enhancement, oedema and mass effect. We found 82 lesions. On CT 45 lesions were found in 22 patients, whereas MRI revealed 66 in 20 patients. The lymphoma was solitary in 20 patients (29 %) and multiple in 20 (71 %). Spontaneous haemorrhage was seen in 7 patients. Contrast-enhanced MRI showed no enhancement in 27.3 % (18/66) of the lesions. In one patient diffuse signal abnormalities in the white matter were seen on T2-weighted images. Our findings suggest that the previously described spectrum imaging characteristics of PCNSL has widened. Neuroradiologists should be aware of the variable appearance in patients with AIDS. Spontaneous haemorrhage, a nonenhancing lesion, or diffuse white matter changes do not exclude lymphoma in an immunocompromised patient. Received: 25 January 2000/Accepted: 12 July 2000     

Primary central nervous system lymphoma: CT and pathologic correlation

CT findings of 15 patients with histologically proven primary central nervous system (CNS) lymphoma were reviewed with pathologic correlation in order to evaluate variable CT patterns. There were a total of 32 lesions. Of the 15 patients studied, seven had acquired immunodeficiency syndrome (AIDS), all diagnosed within the past 3 years. The CT observations of eight non-AIDS patients were consistent with findings reported previously. Most of the lymphomatous lesions were either hyper- or isodense, round or oval masses with homogeneous contrast enhancement and variable surrounding edema. Pathologic examination showed tightly packed preserved lymphoma cells without necrosis. In AIDS patients, rim or ring enhancement of lymphoma, indistinguishable from brain abscess, was frequently seen. Histologic examination consistently showed extensive tumor necrosis with preservation of viable tumor cells at the periphery. A third and infrequent CT pattern was multiple infiltrative nonnodular solid enhancement with extensive edema. Pathologic correlation showed infiltrating viable tumor cells without necrosis. The rim- or ring-enhancing brain lesion seen in AIDS patients can either be an abscess or a primary lymphoma; proper tissue collection is essential for correct diagnosis and appropriate treatment.     

原发性中枢神经系统恶性淋巴瘤(附10例病例报告)

目的：提高对原发性中枢神经系统恶性淋巴瘤(PCNSL)临床特征的认识。方法：回顾性分析经病理证实的10例PCNSL，结合文献对其发病机制、临床表现和治疗方法等进行探讨。结果：10例患者随访3～48个月，中位时间27.4个月。其中除手术外单纯放疗组、化疗加放疗组和干细胞移植治疗组的中位生存时间分别为11．4，39．7和40个月。结论：本病诊断难，病程短，预后差，加强以HD-MTX化疗为主的综合治疗是提高本病疗效的关键。     

Nonenhancing primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is rare, although its frequency has increased in recent years. Radiographically, almost all PCNSL enhance on CT and/or MRI, and nonenhancing PCNSL has been thought to be extremely rare. We present PCNSL showing multiple nonenhancing lesions on MRI in an immunocompetent patient.     

Nonenhancing primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is rare, although its frequency has increased in recent years. Radiographically, almost all PCNSL enhance on CT and/or MRI, and nonenhancing PCNSL has been thought to be extremely rare. We present PCNSL showing multiple nonenhancing lesions on MRI in an immunocompetent patient.     

Imaging of primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) comprises 5% of all primary brain tumours. PCNSL demonstrates a variety of well-documented imaging findings, which can vary depending on immune status and histological type. Imaging features of PCNSL may overlap with other tumours and infection making definitive diagnosis challenging. In addition, several rare variants of PCNSL have been described, each with their own imaging characteristics. Advanced imaging techniques including 2-[(18)F]-fluoro-2-deoxy-d-glucose ((18)FDG) and (11)C?positron-emission tomography (PET), (201)Tl single-photon emission computed tomography (SPECT), (1)H-magnetic resonance spectroscopy (MRS), and MR perfusion, have been used to aid differentiation of PCNSL from other tumours. Ultimately, no imaging method can definitively diagnose PCNSL, and histology is required.     

累及双侧动眼神经的原发性弥漫性中枢神经系统淋巴瘤一例

患者男,53岁,因头痛、头晕4 d于2007年12月22日入院.于入院前4 d无明显诱因出现全头胀痛,头痛剧烈时伴头晕、冷汗、伴恶心、非喷射性呕吐,呕吐物为非咖啡样胃内容物,伴视物模糊、复视、左侧耳鸣、听力下降,无发热.1 d前头痛加重,伴意识模糊,对答不切题,拟"头痛"收治.既往:无特殊.体检:体温36.6℃,血压146/84/mm Hg(1 mm Hg=0.133 kPa),神志清楚,浅表淋巴结未触及肿大,双瞳孔等大等圆,直径3 mm,对光灵敏,双侧视乳头边界不清,无出血,双眼外展露白、复视,无眼震,鼻唇沟对称,伸舌居中,颈软,心肺腹部无异常,四肢肌力、肌张力、腱反射正常,脑膜刺激征、病理征阴性,共济、感觉检查无异常.     

Primary lymphoma of the central nervous system: experience at Addenbrooke's Hospital, Cambridge

A series of 22 cases of primary intercerebral lymphoma are reported. The clinical presentation and natural history were similar to high grade glioma in adults. There was a male to female ratio of 2.7:1, and a mean age at presentation of 63 years (range 47-72 years). Single masses were present in 77%, and the frontal lobe was the most frequently involved (64%). Treatment regimes included varying combinations of surgical resection and cranial irradiation. Sixteen patients have died, twelve due to recurrent or persistent intracerebral disease. The median survival was ten months. Six patients are still alive at 52, 12, 10, 9, 6 and 4 months. Failure to control the intracranial tumours was the main cause of death. Significant debulking of the tumour was the single most important prognostic factor, although a good initial response to steroids was also favourable. No patient developed spinal deposits. Even when there is a good response to radiation and prolonged survival, the quality of life may be poor: in this series only five out of 22 patients (23%) returned to a normal life. Radiation dosage and the indications for spinal treatment are discussed.     

原发性中枢神经系统淋巴瘤的MRI诊断

目的 研究原发性中枢神经系统淋巴瘤(PCNSL)的MRI表现特点,提高对该病的诊断与鉴别诊断率.方法 回顾分析了12例经病理证实的原发性中枢神经系统淋巴瘤的MRI表现.结果 病灶T1WI多呈略低或等信号,T2WI呈等或略高信号;增强扫描多呈明显均匀强化,极少数呈环形强化,肿瘤坏死囊变少见,未见出血、钙化;瘤周水肿相对较轻,占位效应轻.结论 原发性中枢神经系统淋巴瘤MRI表现具有一定特征性,可做出较准确的诊断.     

原发性中枢神经系统淋巴瘤的磁共振成像表现

目的探讨原发性中枢神经系统淋巴瘤（PCNSL）的磁共振成像（MRI）特征及鉴别诊断。方法回顾性分析15例经手术病理证实的PCNSL的MRI表现。结果病理检查均为B细胞来源的弥漫性大B细胞性淋巴瘤。15例PCNSL19个病灶,单发13例（87％）,多发2例（13％）共6个病灶。病灶常位于脑表浅部位和近中线部位,T1wI呈等或稍低信号,T2WI及液体衰减反转恢复序列（FLAIR）呈等或稍高信号,弥散加权成像（DWI）呈高信号。所有病灶均明显强化,增强后病灶大多呈均匀实质团块状或结节状强化,典型的可出现“尖角征”、“握拳征”,3例可见小囊变,呈“硬环征”。结论PCNSL的MRI表现具有一定的特征性,术前MRI检查有助于诊断及鉴别诊断,结合患者影像学及临床资料,术前可作出明确诊断。     

原发性中枢神经系统淋巴瘤的影像学诊断

原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)即是原发于脑、脑脊膜、脊髓、眼球等处的恶性非霍奇金淋巴瘤(non-Hodgkin,s lymphoma,NHL),发病率有逐渐增高的趋势.临床工作中此类肿瘤与其他脑肿瘤鉴别困难,本文总结分析经手术病理证实的原发性颅内恶性淋巴瘤16例,总结分析其影像学表现,提高对该病认识. 1资料与方法 1.1 一般资料 收集本院2009-2012年经手术或穿刺后经病理证实为大脑非霍奇金淋巴瘤16例,临床观察6个月无脑外淋巴结肿大,均排除继发型淋巴瘤.术前9例行CT平扫,其中7例行CT增强检查;16例行磁共振平扫加增强.16例中男12例,女4例,年龄17～75岁,平均50.5岁,病程3 d～5个月不等.本组患者人类免疫缺陷病毒(HIV)抗体均为阴性、无器官移植后免疫抑制剂使用史.临床症状表现为头晕、头痛、恶心、呕吐10例,肢体乏力、偏瘫5例,神经精神紊乱1例.     

Analysis of the utility of diffusion-weighted MRI and apparent diffusion coefficient values in distinguishing central nervous system toxoplasmosis from lymphoma

Introduction Toxoplasmosis and lymphoma are common lesions of the central nervous system in patients with AIDS. It is often difficult to distinguish between these lesions both clinically and radiographically. Previous research has demonstrated restricted diffusion within cerebral lymphomas and bacterial abscesses. However, little work has been done to evaluate the diffusion characteristics of toxoplasmosis lesions. This study was designed to explore further the utility of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps and values in making the distinction between toxoplasmosis and lymphoma.Methods The magnetic resonance imaging (MRI) studies of 36 patients, including 22 with toxoplasmosis (all of whom had AIDS) and 14 with lymphoma (8 of whom had AIDS), at two institutions were reviewed retrospectively. The characteristics of the lesions on DWI were evaluated, and the ADC ratios of the lesions were calculated and compared.Results There was significant overlap of the ADC ratios of toxoplasma and lymphoma, most notably in the intermediate (1.0–1.6) range. There was variability in ADC ratios even among different lesions in the same patient. In only a minority of the lymphoma patients were the ADC ratios low enough to suggest the correct diagnosis.Conclusion Our study showed that toxoplasmosis exhibits a wide spectrum of diffusion characteristics with ADC ratios which have significant overlap with those of lymphoma. Therefore, in the majority of patients, ADC ratios are not definitive in making the distinction between toxoplasmosis and lymphoma.     

Primary central nervous system lymphoma: analysis of prognostic variables and patterns of treatment failure

The authors retrospectively analyzed the data on 36 patients with primary central nervous system (CNS) lymphoma. Most patients received radiation therapy to the whole brain with or without a boost. Chemotherapy was administered to six patients (18%) as part of their initial therapy. The 1- and 2- year rates of progression-free survival were 46% and 27%. The following factors had a favorable impact on survival: age of 60 years or less, normal or mildly impaired preirradiation neurologic function, and confinement of the tumor to the cerebral hemispheres or cerebellum. Chemotherapy as part of initial therapy appears to improve local control. Increasing radiation doses delayed local failure. Failure occurred in the brain (88%), in the eye (23%), and systemically (8%). There were no neuraxis failures identified. The authors conclude that primary CNS lymphoma is a locally aggressive disease that is poorly controlled with conventional radiation therapy. Investigation for more effective therapy is ongoing.     

原发性中枢神经系统淋巴瘤的影像学研究进展

原发性中枢神经系统淋巴瘤（PCNSL）是一种罕见且侵袭性极强的结外非霍奇金淋巴瘤,其占所有结外淋巴瘤的4%~6%,原发性中枢神经系统肿瘤的4%。近年来,PCNSL发病率呈逐年上升趋势,其确诊主要依靠组织病理学检查,包括立体定向活体组织病理学检查和（或）手术期间的组织病理学检查,然而这2种方法均风险较高且并发症较多。因此,寻找能准确评估PCNSL的无创性影像学方法就显得尤为重要。目前,临床常用于评价PCNSL的影像学检查方法主要有CT、 MRI、 PET/CT和PET/MRI。笔者主要对近年来PCNSL的影像学研究进展进行综述。     

原发性中枢神经系统淋巴瘤的影像学表现

目的：探讨原发性中枢神经系统淋巴瘤的影像学表现,以提高影像诊断水平。方法回顾性分析25例经病理证实的原发性中枢神经系统淋巴瘤的CT、MRI等影像学资料。结果单发16例,多发9例,共有39个病灶,幕上35个病灶,幕下4个病灶。单发病灶多位于脑白质深部,多发病灶常位于脑实质中线部位及大脑凸面。肿瘤在CT表现呈稍高密度,病灶T1WI多呈等或稍低信号,T2WI多呈等或稍高信号,DWI多呈高信号。增强扫描多呈明显均匀强化,少数呈斑片状强化;瘤周可见不同程度的水肿。结论原发性中枢神经系统淋巴瘤的CT、MRI表现具有一定特征性,结合临床并综合其影像学表现,可提高其诊断准确率。     

原发中枢神经系统淋巴瘤的颅脑MRI表现

目的:全面分析原发性中枢神经系统淋巴瘤颅脑MRI表现,进一步探讨MRI对该病的诊断价值,以期提高影像学对该病的诊断率。方法:回顾性分析经立体定向活检或开颅手术病理证实的150例原发性中枢神经系统淋巴瘤颅脑MRI表现,男性77例、女性73例,男∶女=1.05∶1,平均年龄53.2（28～87）岁,并复习相关临床及文献资料。结果:150例原发性中枢神经系统淋巴瘤患者中,单发病灶56例（37.3％）,多发病灶94例（62.7％）;幕上皮质下及深部脑白质为好发部位,小脑、脑膜、室管膜也可受累。平扫大部分病灶呈稍长T1、稍长T2信号,增强扫描148例病灶可见强化。增强病灶位于脑实质的93例、可见脑室播散病灶的42例、可见硬脑膜强化的5例、累及柔脑膜的7例、累及神经的1例。结论:原发性中枢神经系统淋巴瘤大多为弥漫性大B细胞淋巴瘤,多发于中老年人,多发病灶多见,MRI表现各有特点,增强扫描表现具有一定特点及规律性。全面了解并掌握MRI表现特点对原发性中枢神经系统淋巴瘤的诊断、鉴别诊断有重要价值,对临床诊治具有重要的指导作用,最终确诊仍需依赖于病理诊断。     

颅内原发性中枢神经系统淋巴瘤的MRI表现

目的研究颅内原发性中枢神经系统淋巴瘤（PCNSL）的MR／表现特点。方法回顾性分析8例经手术病理证实的原发性中枢神经系统淋巴瘤的MR／表现。结果8例均为弥漫大B细胞型非霍奇金淋巴瘤。3例为单发,5例为多发,共13个病灶,其中大脑半球8个,基底节区4个,右侧背侧丘脑及基底节区1个。8例病变均表现为局灶性肿块,T1WI呈稍低或等信号;T2WI呈等或稍高信号。增强扫描7例呈明显均匀强化,1例轻度强化。6例瘤周重度水肿,2例瘤周中度水肿。结论原发性中枢神经系统淋巴瘤较为罕见,MRI是诊断该病的重要的无创性检查方法。颅内PCNSL影像学表现多样,但具有一定特征。