The Utility of Multiparametric Magnetic Resonance Imaging in Reducing Diagnostic Uncertainty for Primary Central Nervous System Lymphoma.

Autor: Goel A; Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom., Flintham R; Department of Imaging, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom., Pohl U; Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom., Nagaraju S; Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom., Meade S; Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom., Sanghera P; Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom., Benghiat H; Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom., Ughratdar I; Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom., Wykes V; Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, United Kingdom., Sawlani V; Department of Imaging, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; School of Psychology, University of Birmingham, United Kingdom. Electronic address: vijay.sawlani@uhb.nhs.uk.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Aug; Vol. 188, pp. e71-e80. Date of Electronic Publication: 2024 May 11.
DOI: 10.1016/j.wneu.2024.05.037
Abstrakt: Background: A key limitation in treatment initiation in primary central nervous system lymphoma (PCNSL) is the diagnostic delay caused by lack of recognition of a lesion as a possible lymphoma, steroid initiation, and lesion involution, often resulting in an inconclusive biopsy result. We highlight the importance of multiparametric magnetic resonance imaging (MRI), which incorporates diffusion-weighted imaging, dynamic susceptibility contrast-enhanced perfusion-weighted imaging, and proton magnetic resonance spectroscopy in addition to standard MRI sequences in resolving diagnostic uncertainty for PCNSL.
Methods: At our center, a consecutive series of 10 patients with histology-proven PCNSL (specifically, diffuse large B-cell lymphoma of the central nervous system) underwent multiparametric MRI. We retrospectively analyzed qualitative and semiquantitative parameters and assessed their radiological concordance for this diagnosis.
Results: We noted overall low apparent diffusion coefficient on diffusion-weighted imaging (mean minimum apparent diffusion coefficient of 0.74), high percentage signal recovery on perfusion-weighted imaging (mean 170%), a high choline-to-creatine ratio, and a high-grade lipid peak on proton magnetic resonance spectroscopy giving an appearance of twin towers. Of 10 patients, 9 had MRI findings concordant for PCNSL, defined as at least 3 of 4 parameters being consistent for PCNSL.
Conclusions: Concordance between these imaging multiparametric modalities could be used as a radiological predictor of PCNSL, reducing diagnostic delays, providing a more accurate biopsy target, and resulting in quicker treatment initiation.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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