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Multiparametric MR Imaging Features of Primary CNS Lymphomas
Rustam Talybov1, Ozal Beylerli1, Vadim Mochalov1
1Federal Center of Neurosurgery, Tyumen, Russia.
Frontiers in Surgery
|May 5, 2022
Summary
MR/CT perfusion imaging is not highly effective for diagnosing primary central nervous system lymphomas (PCNS). Despite limitations, it remains valuable in complex multiparametric diagnostics for these rare brain tumors.
Area of Science:
- Neuroimaging
- Oncology
- Radiology
Background:
- Primary central nervous system lymphomas (PCNS) are rare brain tumors, comprising approximately 4% of all intracranial neoplasms.
- Typical neuroimaging findings include low T1 MR signal, isointense T2 signal, uniform contrast enhancement, and diffusion restriction.
- Accurate differentiation of PCNS from other brain tumors like high-grade gliomas and metastases is crucial for effective treatment.
Purpose of the Study:
- To evaluate the effectiveness of MR/CT perfusion techniques in the differential diagnosis of PCNS.
- To compare the diagnostic utility of perfusion imaging in PCNS against highly malignant gliomas and brain metastases.
- To assess the role of multiparametric imaging in complex cases of PCNS with atypical manifestations.
Main Methods:
- Prospective study of 80 patients with CNS tumors (2018-2021) at the Federal Center for Neurosurgery, Tyumen, Russia.
- Patient groups included primary CNS lymphomas (n=33), anaplastic astrocytomas (n=14), glioblastomas (n=23), and solitary metastases (n=10).
- Imaging performed on a 3T MRI and multi-slice CT scanner; immunohistochemical analysis included CD3, CD20, CD34, Ki-67, and VEGF markers.
Main Results:
- MR/CT perfusion demonstrated limited sensitivity in visualizing primary CNS lymphomas, contrary to previous assumptions.
- Atypical manifestations of PCNS were observed in 10 cases, highlighting exceptions to typical perfusion parameter findings.
- Despite sensitivity limitations, perfusion techniques offer advantages within a comprehensive multiparametric diagnostic approach.
Conclusions:
- Neuroimaging capabilities for PCNS, even with advanced techniques, are limited in reliably differentiating them from other neoplasms.
- MR/CT perfusion is not a definitive standalone method for PCNS diagnosis but contributes to complex diagnostic algorithms.
- The study underscores the challenge of differentiating PCNS, particularly atypical presentations, using current advanced imaging modalities.
