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Primary CNS lymphoma: a whole-brain disease?
Rose Lai1, Marc K Rosenblum, Lisa M DeAngelis
1Departments of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
Neurology
|November 27, 2002
Summary
Magnetic Resonance Imaging (MRI) underestimates the extent of primary CNS lymphoma (PCNSL) tumor burden. Autopsy revealed widespread infiltration, even in areas appearing normal on MRI scans, highlighting limitations in assessing PCNSL.
Area of Science:
- Neuro-oncology
- Radiology
- Pathology
Background:
- Autopsy studies indicate primary CNS lymphoma (PCNSL) extensively infiltrates the brain.
- A correlation between autopsy findings and modern neuroimaging for tumor burden assessment is lacking.
Purpose of the Study:
- To correlate autopsy findings of PCNSL with findings from MRI scans.
Main Methods:
- A retrospective analysis of 10 immunocompetent PCNSL patients who underwent autopsy.
- Comparison of autopsy-confirmed PCNSL pathology with MRI scans obtained shortly before death.
Main Results:
- All 10 patients had widespread CNS lymphoma at autopsy, with no systemic involvement.
- MRI revealed enhancing lesions in seven patients and T2 abnormalities in some, but all patients had microscopic infiltration in radiographically normal areas.
- Periventricular white matter abnormalities were noted on T2 MR images in all patients.
Conclusions:
- MRI underestimates the true tumor burden in PCNSL.
- Contrast-enhancing lesions on MRI reflect bulky disease due to blood-brain barrier disruption.
- Microscopic PCNSL infiltration may not be detected or may appear as T2 hyperintensity on MRI.