Imaging Features of Double-hit Lymphoma on Contrast-enhanced Neck CT

Area of Science:

• Radiology
• Oncology
• Pathology

Background:

• Double-hit lymphoma (DHL) is an aggressive subtype of diffuse large B-cell lymphoma (DLBCL) characterized by MYC and BCL2/BCL6 gene rearrangements.
• DHL often presents with aggressive clinical features and has a poor prognosis, with rare long-term survivors.
• High-grade lymphomas like Burkitt lymphoma exhibit infiltrative tumor masses, differing from conventional DLBCL.

Purpose of the Study:

• To investigate and compare neck CT imaging findings between patients with DHL and those with non-double-hit, conventional DLBCL.
• To identify imaging features that can help differentiate DHL from conventional DLBCL on contrast-enhanced neck CT.

Main Methods:

• Retrospective analysis of contrast-enhanced neck CT scans from 13 DHL patients and 26 age/sex-matched conventional DLBCL patients.
• Evaluation of imaging features including tumor mass size, gross internal necrosis, infiltrative margins, and lymph node patterns.
• Logistic regression analysis to determine independent predictors distinguishing DHL from conventional DLBCL.

Main Results:

• No significant difference in the largest tumor mass size was observed between DHL and conventional DLBCL groups.
• DHL patients showed a significantly higher frequency of gross internal necrosis and infiltrative patterns compared to conventional DLBCL patients (P < 0.001 and P = 0.002, respectively).
• Gross internal necrosis was an independent predictor distinguishing DHL from conventional DLBCL (OR=14.14, P=0.04).

Conclusions:

• DHL patients exhibit a greater prevalence of gross internal necrosis and infiltrative patterns on neck CT imaging than conventional DLBCL patients.
• These imaging findings, particularly gross internal necrosis, can aid in differentiating DHL from conventional DLBCL.