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Imaging Features of Double-hit Lymphoma on Contrast-enhanced Neck CT
Inseon Ryoo1,2, Karen Buch1, Elly Arizono1,3
1Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Objective:
Double-hit lymphoma (DHL) is a type of high-grade diffuse large B-cell lymphoma (DLBCL) with a dual rearrangement of myelocytomatosis oncogene (MYC) and either B-cell CLL/lymphoma 2 (BCL2) and/or BCL6 genes. Patients with DHL frequently present with aggressive clinical features, and long-term survivors are rare. Previous reports have shown that high-grade lymphomas, such as Burkitt lymphoma, exhibit infiltrative tumor masses, distinct from those of conventional DLBCLs. In this study, we evaluated differences in neck CT imaging findings between patients with DHL and those with non-double-hit, conventional DLBCL.
Materials And Methods:
This was an IRB-approved, retrospective study that included 13 DHL patients and 26 age and sex-matched non-double-hit, conventional DLBCL patients who underwent contrast-enhanced neck CTs at our health care system. All CT images were reviewed, and imaging features including the largest tumor mass size (measured in the long and short axes) and the presence/absence of gross internal necrosis, infiltrative margins, and matted patterns of lymph nodes were recorded. These findings were compared between the DHL and conventional DLBCL groups. Multiple logistic regression analyses were conducted to determine which factors independently discriminated DHL from conventional DLBCL.
Results:
The long and short axis diameters of the largest tumor mass showed no significant difference between the two groups (P = 0.50 and 0.98, respectively). The DHL patients demonstrated a greater frequency of gross internal necrosis and infiltrative patterns than conventional DLBCL patients (P < 0.001 and P = 0.002, respectively). DHL patients more frequently had matted lymphadenopathy than conventional DLBCL patients; however, statistical significance for this finding was not achieved (P = 0.099). The presence of gross internal necrosis independently distinguished DHL from conventional DLBCL (P = 0.04; odds ratio, 14.14; 95% CI, 1.16-172.86).
Conclusion:
DHL patients more frequently had gross internal necrosis and infiltrative patterns on the neck CT images than conventional DLBCL patients.
