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Persistent lesion hyperintensity on brain diffusion-weighted MRI is an early sign of intravascular lymphoma
Takashi Kageyama1,2, Haruo Yamanaka1, Fumihiko Nakamura3
1Department of Neurology, Tenri Hospital, Tenri, Japan.
Abstract:
A 63-year-old man presented with right-sided hemianopia and unsteady gait. Brain MRI revealed multiple hyperintense infarct-like lesions on diffusion-weighted images (DWI). Hyperintensity persisted in some of these lesions even after 6 weeks, although his symptoms were ameliorated then. The patient developed episodic dizziness and a transient event of apraxia at 18 weeks after the first episode. Brain MRI revealed additional hyperintense lesions on DWI, which persisted even after 7 weeks. Eventually, the patient manifested cauda equina syndrome 39 weeks after the first episode. Brain MRI showed the presence of new lesions in addition to the persistent hyperintense lesions on DWI over 21 weeks in the right frontal lobe. Based on laboratory findings and the pathological assessment of bone marrow and random skin biopsies, the patient was diagnosed with intravascular lymphoma (IVL). Persistent hyperintense lesions on DWI of brain MRI may precede the clinical exacerbation of IVL.
Insights
Persistent brain lesions on diffusion-weighted imaging (DWI) may indicate worsening intravascular lymphoma (IVL) symptoms. This case highlights DWI
Area of Science:
- Neurology
- Oncology
- Radiology
Background:
- Intravascular lymphoma (IVL) is a rare extranodal non-Hodgkin lymphoma.
- Neurological manifestations are common in IVL but diagnosis can be challenging.
Observation:
- A 63-year-old man presented with hemianopia and gait instability.
- Brain MRI revealed multiple, persistent hyperintense lesions on diffusion-weighted imaging (DWI).
- The patient experienced symptom exacerbations and new lesions over 39 weeks.
Findings:
- Pathological assessment confirmed intravascular lymphoma (IVL).
- Persistent DWI hyperintensities correlated with disease progression and clinical worsening.
- New DWI lesions appeared preceding neurological events.
Implications:
- Serial brain MRI with DWI may be crucial for monitoring IVL progression.
- Persistent DWI lesions could serve as an early indicator of clinical relapse or exacerbation in IVL.
- This case underscores the utility of advanced neuroimaging in diagnosing and managing rare hematologic malignancies affecting the CNS.
