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Rozenblum L, Galanaud D, Houillier C, Soussain C, Baptiste A, Belin L, Edeline V, Naggara P, Soret M, Causse-Lemercier V, Willems L, Choquet S, Ursu R, Hoang-Xuan K, Kas A. [18F]FDG PET-MRI provides survival biomarkers in primary central nervous system lymphoma in the elderly: an ancillary study from the BLOCAGE trial of the LOC network. Eur J Nucl Med Mol Imaging 2023; 50:3684-3696. [PMID: 37462774 DOI: 10.1007/s00259-023-06334-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/05/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) incidence is rising among elderly patients, presenting challenges due to poor prognosis and treatment-related toxicity risks. This study explores the potential of combining [18F]fluorodeoxyglucose ([18F]FDG) PET scans and multimodal MRI for improving management in elderly patients with de novo PCNSL. METHODS Immunocompetent patients over 60 years with de novo PCNSL were prospectively enrolled in a multicentric study between January 2016 and April 2021. Patients underwent brain [18F]FDG PET-MRI before receiving high-dose methotrexate-based chemotherapy. Relationships between extracted PET (metabolic tumor volume (MTV), sum of MTV for up to five lesions (sumMTV), metabolic imaging lymphoma aggressiveness score (MILAS)) and MRI parameters (tumor contrast-enhancement size, cerebral blood volume (CBV), cerebral blood flow (CBF), apparent diffusion coefficient (ADC)) and treatment response and outcomes were analyzed. RESULTS Of 54 newly diagnosed diffuse large B-cell PCNSL patients, 52 had positive PET and MRI with highly [18F]FDG-avid and contrast-enhanced disease (SUVmax: 27.7 [22.8-36]). High [18F]FDG uptake and metabolic volume were significantly associated with low ADCmean values and high CBF at baseline. Among patients, 69% achieved an objective response at the end of induction therapy, while 17 were progressive. Higher cerebellar SUVmean and lower sumMTV at diagnosis were significant predictors of complete response: 6.4 [5.7-7.7] vs 5.4 [4.5-6.6] (p = 0.04) and 5.5 [2.1-13.3] vs 15.9 [4.2-19.5] (p = 0.01), respectively. Two-year overall survival (OS) was 71%, with a median progression-free survival (PFS) of 29.6 months and a median follow-up of 37 months. Larger tumor volumes on PET or enhanced T1-weighted MRI were significant predictors of poorer OS, while a high MILAS score at diagnosis was associated with early death (< 1 year). CONCLUSION Baseline cerebellar metabolism and sumMTV may predict response to end of chemotherapy in PCNSL. Tumor volume and MILAS at baseline are strong prognostic factors.
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Affiliation(s)
- Laura Rozenblum
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France.
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France.
| | - Damien Galanaud
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
- Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Caroline Houillier
- Deparrment of Neurology 2 Mazarin, APHP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Paris, France
| | - Carole Soussain
- Department of Hematology, Institut Curie, Site Saint-Cloud and INSERM U932 Institut Curie, Université PSL, 75005, Paris, France
| | - Amandine Baptiste
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Paris, France
| | - Lisa Belin
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Paris, France
| | | | - Philippe Naggara
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Marine Soret
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Valérie Causse-Lemercier
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Lise Willems
- Department of Hematology, Cochin Hospital, APHP, Paris, France
| | - Sylvain Choquet
- Department of Hematology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Renata Ursu
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Service de Neurologie, Paris, France
| | - Khê Hoang-Xuan
- Deparrment of Neurology 2 Mazarin, APHP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Paris, France
| | - Aurélie Kas
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
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Mizutani Y, Inoue Y, Goda Y, Mizutani S, Asanuma T, Miura N, Hidaka Y, Sato R, Satoh H. Successful Treatment of Central Nervous System Lymphoma with Combination Therapy of Nimustine and Prednisolone in Two Dogs. Vet Sci 2023; 10:533. [PMID: 37756055 PMCID: PMC10538104 DOI: 10.3390/vetsci10090533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/28/2023] Open
Abstract
Of intracranial tumors, primary central nervous system lymphoma (PCNSL) is rare in dogs. Herein, we describe our experience with two dogs (a 3-year-old intact female toy poodle and a 5-year-old spayed female toy poodle) that developed neurological symptoms. Magnetic resonance imaging (MRI) revealed intracranial disseminated lesions. Cerebrospinal fluid (CSF) examination revealed pleocytosis and B-cell monoclonal proliferation in both cases. PCNSL or secondary central nervous system lymphoma (SCNSL) was diagnosed on the basis of MRI findings and CSF examinations. Nimustine (ACNU) is a nitrosourea alkylating agent, a class of drugs that includes lomustine. Nimustine is mainly used to treat human intracranial neoplasia because of its high permeability across the blood-brain barrier. The dogs in this study were treated with combined chemotherapy comprising nimustine and prednisolone, which achieved complete or nearly complete remission of neurological symptoms and long-term survival (>2583 days and 1218 days), but with problematic adverse effects. We determined that the dose of nimustine for canine PCNSL or SCNSL with intravenous infusion was 25-30 mg/m2 every 3-4 weeks for a total of four times; however, the data were insufficient to determine the optimal regimen.
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Affiliation(s)
- Yuko Mizutani
- Faculty of Agriculture, Veterinary Teaching Hospital, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki-shi 889-2192, Miyazaki, Japan
| | - Yoshiyuki Inoue
- Faculty of Agriculture, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki-shi 889-2192, Miyazaki, Japan
| | - Yoshimichi Goda
- Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki-shi 889-2192, Miyazaki, Japan
| | - Shinya Mizutani
- Faculty of Veterinary Medicine, Okayama University of Science, 1-3 Ikoinooka, Imabari 794-8555, Ehime, Japan
| | - Taketoshi Asanuma
- Faculty of Veterinary Medicine, Okayama University of Science, 1-3 Ikoinooka, Imabari 794-8555, Ehime, Japan
| | - Naoki Miura
- Joint Faculty of Veterinary Medicine, Veterinary Teaching Hospital, Kagoshima University, 1-21-24 Korimoto, Kagoshima 890-0065, Kagoshima, Japan
| | - Yuichi Hidaka
- Faculty of Agriculture, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki-shi 889-2192, Miyazaki, Japan
- Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki-shi 889-2192, Miyazaki, Japan
| | - Reiichiro Sato
- Faculty of Agriculture, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki-shi 889-2192, Miyazaki, Japan
- Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki-shi 889-2192, Miyazaki, Japan
| | - Hiroyuki Satoh
- Faculty of Agriculture, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki-shi 889-2192, Miyazaki, Japan
- Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki-shi 889-2192, Miyazaki, Japan
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3
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Chien HC, Yeh LR, Hung KC, Lim SW, Cheng CY, Lee YC, Chen JH, Ko CC. Pretreatment diffusion-weighted imaging for prediction of relapsed and refractory primary central nervous system lymphoma. Front Neurol 2023; 14:1227607. [PMID: 37638189 PMCID: PMC10447899 DOI: 10.3389/fneur.2023.1227607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives A subset of primary central nervous system lymphoma (PCNSL) has been shown to undergo an early relapsed/refractory (R/R) period after first-line chemotherapy. This study investigated the pretreatment clinical and MRI features to predict R/R in PCNSL, emphasizing the apparent diffusion coefficient (ADC) values in diffusion-weighted imaging (DWI). Methods This retrospective study investigated the pretreatment MRI features for predicting R/R in PCNSL. Only patients who had undergone complete preoperative and postoperative MRI follow-up studies were included. From January 2006 to December 2021, 52 patients from two medical institutions with a diagnosis of PCNSL were included (median follow-up time, 26.3 months). Among these, 24 (46.2%) had developed R/R (median time to relapse, 13 months). Cox proportional hazard regression analyses were performed to determine hazard ratios for all parameters. Results Significant predictors of R/R in PCNSL were female sex, complete response (CR) to first-line chemotherapy, and ADC value/ratio (p < 0.05). Cut-off points of ADC values and ADC ratios for prediction of R/R were 0.68 × 10-3 mm2/s and 0.97, with AUCs of 0.78 and 0.77, respectively (p < 0.05). Multivariate Cox proportional hazards analysis showed that failure of CR to first-line chemotherapy and low ADC values (<0.68 × 10-3 mm2/s) were significant risk factors for R/R, with hazard ratios of 5.22 and 14.45, respectively (p < 0.05). Kaplan-Meier analysis showed that lower ADC values and ratios predicted significantly shorter progression-free survival (p < 0.05). Conclusion Pretreatment ADC values in DWI offer quantitative valuable information for the treatment planning in PCNSL.
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Affiliation(s)
- Hsi-Cheng Chien
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Lee-Ren Yeh
- Department of Medical Imaging, E-Da Hospital, Kaohsiung, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi Mei Medical Center, Chiali, Tainan, Taiwan
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Chung-Yu Cheng
- Department of Medical Imaging, E-Da Hospital, Kaohsiung, Taiwan
| | - Yu-Chang Lee
- Department of Medical Imaging, E-Da Hospital, Kaohsiung, Taiwan
| | - Jeon-Hor Chen
- Department of Medical Imaging, E-Da Hospital, Kaohsiung, Taiwan
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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Matejka M, Moreno Beredjiklian C, Rezai A, Kraus TFJ, Pizem D, Klausner F, Pöppe JP, Griessenauer CJ, Schwartz C. Extra- and Intracranial Diffuse Large B-Cell Lymphoma (DLBCL) Mimicking Meningioma: A Case Report and Literature Review. Cureus 2023; 15:e42500. [PMID: 37637562 PMCID: PMC10456976 DOI: 10.7759/cureus.42500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Primary central nervous system lymphomas (PCNLSs) are malignant non-Hodgkin lymphomas solely affecting the central nervous system (CNS). Here, we present a rare case of extra- and intracranial manifestation without adjacent calvarial infiltration. We report a 67-year-old woman who presented with right leg paresis and hypoesthesia, facial hypoesthesia, focal epileptic seizures, and an indolent tumor on the left parietal scalp. MRI showed a left paramedian extra- and intracranial contrast-enhancing tumor with infiltration of the superior sagittal sinus, but without osseous infiltration on CT. The tumor was radiologically suspected to be a meningioma and resection was performed. Histological examination, however, revealed a diffuse large B-cell lymphoma (DLBCL). Thus, the patient received adjuvant treatment according to the MATRix protocol. We provide a detailed analysis of this rare case with a focus on preoperative radiological findings and differential diagnoses. To the best of our knowledge, this is one of only four published cases of DLBCL with extra- and intracranial manifestation without bone affection.
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Affiliation(s)
| | | | - Arwin Rezai
- Neurosurgery, University Hospital Salzburg, Salzburg, AUT
| | - Theo F J Kraus
- Pathology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AUT
| | - Dominik Pizem
- Neuroradiology, University Hospital Salzburg, Salzburg, AUT
| | - Fritz Klausner
- Neuroradiology, University Hospital Salzburg, Salzburg, AUT
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5
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Velicu MA, Lavrador JP, Sibtain N, Vergani F, Bhangoo R, Gullan R, Ashkan K. Neurosurgical Management of Central Nervous System Lymphoma: Lessons Learnt from a Neuro-Oncology Multidisciplinary Team Approach. J Pers Med 2023; 13:jpm13050783. [PMID: 37240953 DOI: 10.3390/jpm13050783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Central nervous system lymphoma (CNSL) represents one of the most aggressive forms of extranodal lymphoma. The gold standard for CNSL diagnosis remains the stereotactic biopsy, with a limited role for cytoreductive surgery that has not been supported by historical data. Our study aims to provide a comprehensive overview of neurosurgery's role in the diagnosis of systemic relapsed and primary CNSL, with an emphasis on the impact on management and survival. This is a single center retrospective cohort study with data collected between August 2012 and August 2020, including patients referred with a potential diagnosis of CNSL to the local Neuro-oncology Multidisciplinary Team (MDT). The concordance between the MDT outcome and histopathological confirmation was assessed using diagnostic statistics. A Cox regression is used for overall survival (OS) risk factor analysis, and Kaplan-Meier statistics are performed for three prognostic models. The diagnosis of lymphoma is confirmed in all cases of relapsed CNSL, and in all but two patients who underwent neurosurgery. For the relapsed CNSL group, the highest positive predictive value (PPV) is found for an MDT outcome when lymphoma had been considered as single or topmost probable diagnosis. Neuro-oncology MDT has an important role in establishing the diagnosis in CNSL, not only to plan tissue diagnosis but also to stratify the surgical candidates. The MDT outcome based on history and imaging has good predictive value for cases where lymphoma is considered the most probable diagnosis, with the best prediction for cases of relapsed CNSL, questioning the need for invasive tissue diagnosis in the latter group.
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Affiliation(s)
- Maria Alexandra Velicu
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Naomi Sibtain
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
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Capasso R, Negro A, Russo C, Zeccolini F, Muto G, Caranci F, Pinto A. Conventional and advanced MRI techniques in the evaluation of primary CNS lymphoma. Semin Ultrasound CT MR 2023; 44:126-135. [DOI: 10.1053/j.sult.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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7
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Vasconcelos Miranda TA, Tsuchiya K, Lucato LT. Imaging of Central Nervous System Parasitic Infections. Neuroimaging Clin N Am 2023; 33:125-146. [DOI: 10.1016/j.nic.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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8
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Yokogami K, Azuma M, Takeshima H, Hirai T. Lymphomas of Central Nervous System. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:527-543. [PMID: 37452952 DOI: 10.1007/978-3-031-23705-8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Central nervous system (CNS) lymphoma consists of primary central nervous system lymphoma (PCNSL) and secondary CNS involvement by systemic lymphoma. This chapter focuses on the former. PCNSL is a relative rare disease, accounting for approximately 2.4-4.9% of all primary CNS tumors. It is an extra-nodal variant of non-Hodgkin's lymphoma (NHL), confined to the brain, leptomeninges, spinal cord, and eyes, with no systemic involvement. Recently, elderly patients (≥ 60 years) are increasing. Histologically, B cell blasts, which originate from late germinal center exit B cell, are growing and homing in CNS. Immunohistochemically, these cells are positive for PAX5, CD19, CD20, CD22, and CD79a. PCNSL shows relatively characteristic appearances on CT, MR imaging, and PET. Treatment first line of PCNSL is HD-MTX-based chemotherapy with or without rituximab and irradiation. Severe side-effect of this treatment is delayed onset neurotoxicity, which cause of cognitive impairment. Therefore, combined chemotherapy alone or chemotherapy with reduced-dose irradiation is more recommended for elderly patients. There is no established standard care for relapse of the PCNSLs. Temsirolimus, lenalidomide, temozolomide, and Bruton's tyrosine kinase (BTK) inhibitor ibrutinib are candidates for refractory patients. The prognosis of PCNSL has significantly improved over the last decades (median OS: 26 months, 5-year survival: 31%). Younger than 60 age and WHO performance status less than < or = 1 are associated with a significantly better overall survival.
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Affiliation(s)
- Kiyotaka Yokogami
- Departments of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
| | - Minako Azuma
- Departments of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hideo Takeshima
- Departments of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Toshinori Hirai
- Departments of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Pekic S, Stojanovic M, Manojlovic Gacic E, Antic D, Milojevic T, Milicevic M, Stanimirovic A, Doknic M, Miljic D, Banjalic S, Jovanovic M, Jemuovic Z, Nikolic Djurovic M, Grujicic D, Popovic V, Petakov М. The sellar region as presenting theater for hematologic malignancies-A 17-year single-center experience. Endocr J 2022; 69:1079-1090. [PMID: 35400679 DOI: 10.1507/endocrj.ej21-0790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hematological neoplastic mass lesions of the sellar region are rare. We identified five cases of hematological malignancy with first presentation in the sellar region from our departmental database of 1,405 patients (0.36%) with sellar lesions diagnosed over the 17-year period (2005-2021). All patients were females (mean age 55.2 ± 3.4 years). One patient had multiple myeloma (MM), one patient had acute myeloid leukemia (AML), while three other patients had lymphoma (intravascular lymphoma (IVL, n = 1) or non-Hodgkin's lymphoma (NHL, n = 2). Most patients presented with ophthalmoplegia, and one patient with diabetes insipidus (DI), with short duration of symptoms (median 30 days). All patients had an elevated erythrocyte sedimentation rate and altered blood count, while patients with lymphoma had elevated lactate dehydrogenase (LDH). Sellar mass was demonstrated in three patients while the patient with IVL had an empty sella and in the AML patient posterior lobe T1W hyperintensity was lost. Two patients (IVL and NHL) presented with multiple anterior pituitary deficiencies and one patient (AML) had DI. All patients were treated with chemotherapy. Two patients responded well to treatment (one had reversed hypopituitarism), while three patients died. Differential diagnosis of sellar-parasellar pathology should include suspicion of hematological malignancy, particularly in patients with short duration of nonspecific symptoms, neurological signs (ophthalmoplegia), blood count alterations and LDH elevation, pituitary dysfunction and imaging features atypical for pituitary adenoma. Early diagnosis is crucial for timely initiation of hematological treatment aimed at inducing disease remission and partial or full recovery of pituitary function.
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Affiliation(s)
- Sandra Pekic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Clinic for Endocrinology, Diabetes and Diseases of the Metabolism, University Clinical Center of Serbia, Belgrade, Serbia
| | - Marko Stojanovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Clinic for Endocrinology, Diabetes and Diseases of the Metabolism, University Clinical Center of Serbia, Belgrade, Serbia
| | - Emilija Manojlovic Gacic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Institute of Pathology, Belgrade, Serbia
| | - Darko Antic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Toplica Milojevic
- Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Mihajlo Milicevic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Mirjana Doknic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Clinic for Endocrinology, Diabetes and Diseases of the Metabolism, University Clinical Center of Serbia, Belgrade, Serbia
| | - Dragana Miljic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Clinic for Endocrinology, Diabetes and Diseases of the Metabolism, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sandra Banjalic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
| | - Marija Jovanovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
| | - Zvezdana Jemuovic
- Clinic for Endocrinology, Diabetes and Diseases of the Metabolism, University Clinical Center of Serbia, Belgrade, Serbia
| | - Marina Nikolic Djurovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Clinic for Endocrinology, Diabetes and Diseases of the Metabolism, University Clinical Center of Serbia, Belgrade, Serbia
| | - Danica Grujicic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Vera Popovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Мilan Petakov
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Clinic for Endocrinology, Diabetes and Diseases of the Metabolism, University Clinical Center of Serbia, Belgrade, Serbia
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10
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Ashtekar RM, Epari S, Shetty PM, Sahu AA. Unleashing the Mystery of a Treated Case of Medulloblastoma. Indian J Radiol Imaging 2022; 32:416-421. [PMID: 36177290 PMCID: PMC9514894 DOI: 10.1055/s-0042-1753466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Medulloblastoma (MB) is the most common malignant brain tumor in children. Despite advancement in treatment modalities, recurrence remains common, even among those treated with a combination of neurosurgery, craniospinal irradiation, and chemotherapy. The diagnosis of recurrence is usually not difficult in these cases. However, it may pose a challenge in cases with unusual clinical presentation and imaging. Imaging findings on magnetic resonance imaging, with application of perfusion, in conjunction with positron emission tomography-computed tomography can help in clinching the diagnosis in such cases. MB subgroups show consistent patterns even in cases of recurrence, and sonic hedgehog group MB may present as local recurrence showing enhancement with no diffusion restriction, as demonstrated in this case.
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Affiliation(s)
- Renuka M. Ashtekar
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prakash M. Shetty
- Department of Neurosurgery, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arpita A. Sahu
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
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11
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Scheichel F, Pinggera D, Popadic B, Sherif C, Marhold F, Freyschlag CF. An Update on Neurosurgical Management of Primary CNS Lymphoma in Immunocompetent Patients. Front Oncol 2022; 12:884724. [PMID: 35515113 PMCID: PMC9065338 DOI: 10.3389/fonc.2022.884724] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Primary central nervous system lymphomas (PCNSL) are rare CNS tumors that harbor a conspicuously longer diagnostic delay compared to other malignant brain tumors. The gold standard for diagnosis is stereotactic biopsy to acquire tissue for histopathological analysis and therefore neurosurgery plays a central role when reducing the diagnostic period is mandated. However, histopathological diagnosis could be complicated if the patient was preoperatively exposed to corticosteroids. Besides the histopathological result, diagnosis of a PCNSL also requires full diagnostic workup to exclude cerebral metastatic disease of a systemic lymphoma. Most reviews of PCNSL discuss recent advancements in systemic treatment options from an (neuro-)oncologic viewpoint, whereas our intention was to discuss the optimization of the diagnostic period and therefore describe current standards of imaging, summarizing the diagnostic workup, discussing the surgical workup and future diagnostic prospects as well as the influence of preoperative corticosteroid therapy to reduce the diagnostic delay of PCNSL patients.
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Affiliation(s)
- Florian Scheichel
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Branko Popadic
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Camillo Sherif
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Franz Marhold
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
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12
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Talybov R, Beylerli O, Mochalov V, Prokopenko A, Ilyasova T, Trofimova T, Sufianov A, Guang Y. Multiparametric MR Imaging Features of Primary CNS Lymphomas. Front Surg 2022; 9:887249. [PMID: 35510125 PMCID: PMC9058099 DOI: 10.3389/fsurg.2022.887249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/18/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Primary central nervous system lymphomas (PCNS) are relatively rare tumors, accounting for about 4% of all brain tumors. On neuroimaging, they are characterized by a low MR signal in T1, isointense in T2, bright uniform contrast enhancement, and diffusion restriction. The aim of this study is to note the lack of effectiveness of the MR/CT perfusion technique in complex multiparametric imaging in the differential diagnosis of primary lymphomas of the central nervous system in comparison with highly malignant gliomas and brain metastases. Materials and Methods This prospective study included 80 patients with CNS tumors examined/operated at the Federal Center for Neurosurgery (Tyumen, Russia) from 2018 to 2021. The patients were divided into 4 groups: group 1 consisted of 33 cases with primary CNS lymphomas (10 cases with atypical manifestations according to perfusion parameters and 23 cases of classic CNS lymphomas), group 2 with anaplastic astrocytomas—14 cases, group 3—23 cases with glioblastomas and group 4—10 cases with solitary metastatic lesions. The study was carried out on a General Electric Discovery W750 3T magnetic resonance tomograph, a Canon Aquilion One multispiral X-ray computed tomograph (Gadovist 7.5 ml, Yomeron 400 mg−50 ml). Additionally, immunohistochemical analysis was carried out with the following markers: CD3, CD20, CD34, Ki-67, VEGF. Results It has been established that MR/CT perfusion is not a highly sensitive method for visualizing primary CNS lymphomas, as previously thought, but at the same time, the method has a number of undeniable advantages that make it indispensable in the algorithm of a complex multiparametric diagnostic approach for this type of tumor. Nevertheless, PLCNS is characterized by an atypical manifestation, which is an exception to the rule. Conclusions The possibilities of neuroimaging of primary lymphomas, even with the use of improved techniques for collecting MR/CT data, are limited and do not always allow reliable differentiation from other neoplasms.
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Affiliation(s)
| | | | | | | | | | - Tatiana Trofimova
- V.M. Bekhterev Psychoneurological Research Institute, St. Petersburg, Russia
| | - Albert Sufianov
- Federal Center of Neurosurgery, Tyumen, Russia
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Albert Sufianov
| | - Yang Guang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Institute of Brain Science, Harbin Medical University, Harbin, China
- *Correspondence: Yang Guang
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13
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An Equivocal SCC Lesion—Antiepileptic-Induced CLOCC. Brain Sci 2022; 12:brainsci12030384. [PMID: 35326340 PMCID: PMC8946132 DOI: 10.3390/brainsci12030384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 12/14/2022] Open
Abstract
We present a case of a woman who reported to the emergency unit due to recurrent episodes of severe headache and collapse. MRI examination revealed no relevant findings apart from small meningioma of the right parietal region. The patient was diagnosed with epilepsy and received outpatient treatment, which was changed due to poor toleration. A follow-up MRI was performed which revealed an isolated, focal lesion of the splenium of the corpus callosum. The patient underwent extensive laboratory testing and antiseizure medications were started again. Another MRI indicated substantial regression of the splenium of the corpus callosum (SCC) lesion. Both the complete clinical image and results of the diagnostic evaluation spoke in favor of cytotoxicity of the corpus callosum associated with anti-epileptic drug treatment. Pathologies involving the corpus callosum include congenital, demyelination, infection, neoplasm, trauma and vascular changes. Isolated, non-specific lesions of the splenium of corpus callosum usually indicate multiple sclerosis; however, other pathologies should be considered. Anti-epileptic drugs may evoke cytotoxic lesions of the corpus callosum (CLOCCs).
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14
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Valerio F, Whitehouse DP, Menon DK, Newcombe VFJ. The neurological sequelae of pandemics and epidemics. J Neurol 2021; 268:2629-2655. [PMID: 33106890 PMCID: PMC7587542 DOI: 10.1007/s00415-020-10261-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022]
Abstract
Neurological manifestations in pandemics frequently cause short and long-term consequences which are frequently overlooked. Despite advances in the treatment of infectious diseases, nervous system involvement remains a challenge, with limited treatments often available. The under-recognition of neurological manifestations may lead to an increase in the burden of acute disease as well as secondary complications with long-term consequences. Nervous system infection or dysfunction during pandemics is common and its enduring consequences, especially among vulnerable populations, are frequently forgotten. An improved understanding the possible mechanisms of neurological damage during epidemics, and increased recognition of the possible manifestations is fundamental to bring insights when dealing with future outbreaks. To reverse this gap in knowledge, we reviewed all the pandemics, large and important epidemics of human history in which neurological manifestations are evident, and described the possible physiological processes that leads to the adverse sequelae caused or triggered by those pathogens.
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Affiliation(s)
- Fernanda Valerio
- University Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Box 93, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Daniel P Whitehouse
- University Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Box 93, Hills Road, Cambridge, CB2 0QQ, UK
| | - David K Menon
- University Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Box 93, Hills Road, Cambridge, CB2 0QQ, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Virginia F J Newcombe
- University Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Box 93, Hills Road, Cambridge, CB2 0QQ, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
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15
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Brown DA, Goyal A, Richter KR, Haglin JM, Himes BT, Lu VM, Snyder K, Hughes J, Decker PA, Opoku-Darko M, Link MJ, Burns TC, Parney IF. Clinical utility of brain biopsy for presumed CNS relapse of systemic lymphoma. J Neurosurg 2021; 136:30-39. [PMID: 34214988 DOI: 10.3171/2020.12.jns202517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to determine the frequency with which brain biopsy for presumed CNS relapse of systemic hematological malignancies yields new, actionable diagnostic information. Hematological malignancies represent a disparate group of genetic and histopathological disorders. Proclivity for brain involvement is dependent on the unique entity and may occur synchronously or metasynchronously with the systemic lesion. Diffuse large B-cell lymphomas (DLBCLs) have a high propensity for brain involvement. Patients in remission from systemic DLBCL may present with a lesion suspicious for brain relapse. These patients often undergo brain biopsy. The authors' a priori hypothesis was that brain biopsy in patients with a history of systemic DLBCL and a new brain MRI lesion would have lower diagnostic utility compared with patients with non-DLBCL systemic malignancies. METHODS The authors performed a retrospective review of patients who underwent brain biopsy between 2000 and 2019. Inclusion criteria were patients ≥ 18 years of age with a prior systemic hematological malignancy in remission presenting with a new brain MRI lesion concerning for CNS relapse. Patients with a history of any CNS neoplasms, demyelinating disorders, or active systemic disease were excluded. The main outcome was the proportion of patients with a distinct histopathological brain diagnosis compared with the systemic malignancy. The authors secondarily assessed overall survival, procedure-related morbidity, and 30-day mortality. RESULTS Sixty patients met inclusion criteria (40 males and 20 females); the median age at brain biopsy was 67 years (range 23-88 years). The median follow-up was 8.5 months (range 0.1-231 months). Thirty-nine (65.0%) patients had DLBCL and 21 (35%) had non-DLBCL malignancies. Thirty-five of 36 (97.2%) patients with prior systemic DLBCL and a diagnostic biopsy had histopathological confirmation of the original systemic disease versus 0 of 21 patients with non-DLBCL systemic malignancies (p < 0.001). Morbidity and 30-day mortality were 8.3% and 10.0%, respectively; 2 of 6 30-day mortalities were directly attributable to the biopsy. The median overall survival following brain biopsy was 10.8 months. CONCLUSIONS Patients with a history of systemic DLBCL and presumed CNS relapse gained minimal clinical benefit from brain biopsy but were at high risk of morbidity and mortality. In patients with a history of non-DLBCL systemic malignancies, brain biopsy remained critical given the high likelihood for discovery of distinct diagnostic entities. It was determined that patients with a prior systemic DLBCL and presumed brain relapse should likely receive empirical therapy obviating treatment delay and the risks of brain biopsy.
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Affiliation(s)
| | | | - Kent R Richter
- 2Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona; and
| | - Jack M Haglin
- 2Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona; and
| | | | | | | | - Joshua Hughes
- 3Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee
| | - Paul A Decker
- 4Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
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16
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ChoK-Full of Potential: Choline Kinase in B Cell and T Cell Malignancies. Pharmaceutics 2021; 13:pharmaceutics13060911. [PMID: 34202989 PMCID: PMC8234087 DOI: 10.3390/pharmaceutics13060911] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 12/20/2022] Open
Abstract
Aberrant choline metabolism, characterized by an increase in total choline-containing compounds, phosphocholine and phosphatidylcholine (PC), is a metabolic hallmark of carcinogenesis and tumor progression. This aberration arises from alterations in metabolic enzymes that control PC biosynthesis and catabolism. Among these enzymes, choline kinase α (CHKα) exhibits the most frequent alterations and is commonly overexpressed in human cancers. CHKα catalyzes the phosphorylation of choline to generate phosphocholine, the first step in de novo PC biosynthesis. CHKα overexpression is associated with the malignant phenotype, metastatic capability and drug resistance in human cancers, and thus has been recognized as a robust biomarker and therapeutic target of cancer. Of clinical importance, increased choline metabolism and CHKα activity can be detected by non-invasive magnetic resonance spectroscopy (MRS) or positron emission tomography/computed tomography (PET/CT) imaging with radiolabeled choline analogs for diagnosis and treatment monitoring of cancer patients. Both choline-based MRS and PET/CT imaging have also been clinically applied for lymphoid malignancies, including non-Hodgkin lymphoma, multiple myeloma and central nervous system lymphoma. However, information on how choline kinase is dysregulated in lymphoid malignancies is very limited and has just begun to be unraveled. In this review, we provide an overview of the current understanding of choline kinase in B cell and T cell malignancies with the goal of promoting future investigation in this area.
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17
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Khan B, Chong I, Ostrom Q, Ahmed S, Dandachi D, Kotrotsou A, Colen R, Morón F. Diffusion-weighted MR imaging histogram analysis in HIV positive and negative patients with primary central nervous system lymphoma as a predictor of outcome and tumor proliferation. Oncotarget 2020; 11:4093-4103. [PMID: 33227089 PMCID: PMC7665236 DOI: 10.18632/oncotarget.27800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ki-67 expression, a marker of tumor proliferation, is considered a prognostic factor in primary CNS lymphoma (PCNSL). Apparent diffusion coefficient (ADC) parameters have also been proposed as imaging biomarkers for tumor progression and proliferative activity in various malignancies. The aim of this study is to investigate the correlation between ADC parameters, Ki-67 expression, overall survival (OS) and progression free survival (PFS) in PCNSL. MATERIALS AND METHODS Patients diagnosed with PCNSL at MD Anderson Cancer Center between Mar 2000 and Jul 2016 and at Ben Taub Hospital between Jan 2012 and Dec 2016 were retrospectively studied. Co-registered ADC maps and post-contrast images underwent whole tumor segmentation. Normalized ADC parameters (nADC) were calculated as the ratio to normal white matter. Percentiles of nADC were calculated and were correlated with Ki-67 using Pearson's correlation coefficient and clinical outcomes (OS and PFS) using Cox proportional hazards models. RESULTS Selection criteria yielded 90 patients, 23 patients living with HIV (PLWH) and 67 immunocompetent patients. Above median values for nADCmean, nADC15, nADC75 and nADC95 were associated with improved OS in all patients (p < 0.05). Above median values for nADCmin, nADCmean, nADC1, nADC5 and kurtosis were associated with improved PFS in all patients (p < 0.05). In patients with available Ki-67 expression data (n = 22), nADCmean, nADC15 and nADC75 inversely correlated with Ki-67 expression (p < 0.05). For PLWH, there was no correlation between ADC parameters and Ki-67 expression or clinical outcomes. CONCLUSIONS ADC histogram analysis can predict tumor proliferation and survival in immunocompetent patients with PCNSL, but with limited utility in PLWH.
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Affiliation(s)
- Bilal Khan
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Insun Chong
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Quinn Ostrom
- Department of Medicine, Section of Epidemiology and Population Sciences, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Sara Ahmed
- Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Dima Dandachi
- Department of Medicine, Division of Infectious Diseases, University of Missouri, Columbia, MO, USA
| | - Aikaterini Kotrotsou
- Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA.,Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Rivka Colen
- Department of Radiology, Neuroradiology Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Fanny Morón
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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18
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Luna LP, Drier A, Aygun N, Mokhtari K, Hoang-Xuan K, Galanaud D, Donadieu J, Dormont D, Haroche J, Martin-Duverneuil N. MRI features of intra-axial histiocytic brain mass lesions. Clin Radiol 2020; 76:159.e19-159.e28. [PMID: 33077156 DOI: 10.1016/j.crad.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022]
Abstract
AIM To describe MRI features, including diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), and perfusion-weighted imaging (PWI), of intra-axial tumour-like presentations of four different subtypes of histiocytosis. MATERIAL AND METHODS The brain MRI findings of 23 patients with histologically proven histiocytosis were reviewed retrospectively (11 Langerhans cell histiocytosis [LCH], eight Erdheim-Chester disease [ECD], one overlap form LCH/ECD, two Rosai-Dorfman disease [RDD], and one haemophagocytic lymphohistiocytosis [HLH]) with single or multiple enhancing intraparenchymal brain lesions. RESULTS Histiocytic brain mass lesions show some similar MRI features including Supra and/or infratentorial and/or paraventricular subcortical well-delineated masses, linear ependymal enhancement along the ventricles and brain stem lesions. Masses always present with mixed hyper- and hypointense signal on T2-weighted imaging (WI). Their enhancement is often homogeneous. Apparent diffusion coefficient (ADC) values are often normal or elevated. CONCLUSION The presence of multiple periventricular and subcortical enhancing lesions with mixed signal intensity on T2WI and normal or high ADC values should lead radiologists to consider the diagnosis of histiocytic lesions and search for associated systemic lesions.
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Affiliation(s)
- L P Luna
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, USA.
| | - A Drier
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - N Aygun
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - K Mokhtari
- APHP, Department of Neuropathology, Pitié-Salpêtrière Hospital, Paris, France
| | - K Hoang-Xuan
- APHP, Department of Neuro-oncology, Pitié-Salpêtrière Hospital, Paris, France
| | - D Galanaud
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - J Donadieu
- APHP, Department of Hematology, Trousseau Hospital, Paris, France
| | - D Dormont
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - J Haroche
- APHP, Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France
| | - N Martin-Duverneuil
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
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19
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Baek DW, Cho HJ, Bae JH, Sohn SK, Moon JH. Apparent diffusion coefficient as a valuable quantitative parameter for predicting clinical outcomes in patients with newly diagnosed primary CNS lymphoma. Blood Res 2020; 55:99-106. [PMID: 32408414 PMCID: PMC7343555 DOI: 10.5045/br.2020.2020032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/27/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background This study attempted to identify novel prognostic factors in patients with newly diagnosed primary central nervous system lymphoma (PCNSL) using magnetic resonance imaging (MRI). Methods We retrospectively evaluated 67 patients diagnosed with central nervous system (CNS) tumors. The enrollment criteria were as follows: i) pathologic diagnosis of CNS lymphoma, ii) no evidence of systemic involvement, iii) no evidence of human immunodeficiency virus-1 infection or other immunodeficiencies, and iv) MRI scans available at diagnosis. Fifty-two patients met these criteria and were enrolled. Results The 3-year overall survival (OS) and failure-free survival rates were 69.7% and 45.6%, respectively, with a median follow-up duration of 36.2 months. OS of patients with low apparent diffusion coefficient (ADC) was lower than those with higher ADC. Multivariate analysis revealed that old age (>60 yr) [hazard ratio (HR), 20.372; P=0.001], Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 (HR, 10.429; P<0.001), higher lactate dehydrogenase (LDH) levels (HR, 7.408; P=0.001), and low ADC (HR, 0.273; P=0.009) were associated with lower OS. We modified the conventional prognostic scoring system using low ADC, old age (>60 yr), ECOG PS ≥2, and higher LDH. The risk of death was categorized as high (score 3-4), intermediate-2 (score 2), intermediate-1 (score 1), and low (score 0), with three-year OS rates of 33.5%, 55.4%, 88.9%, and 100%, respectively. Conclusion ADC demonstrated significant prognostic value for long-term survival in patients with newly diagnosed PCNSL. Low ADC was an independent unfavorable prognostic factor, suggesting that ADC obtained from MRI can improve the current prognostic scoring system.
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Affiliation(s)
- Dong Won Baek
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hee Jeong Cho
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae Heung Bae
- Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Kyun Sohn
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joon Ho Moon
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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20
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Franceschi E, Frappaz D, Rudà R, Hau P, Preusser M, Houillier C, Lombardi G, Asioli S, Dehais C, Bielle F, Di Nunno V, van den Bent M, Brandes AA, Idbaih A. Rare Primary Central Nervous System Tumors in Adults: An Overview. Front Oncol 2020; 10:996. [PMID: 32676456 PMCID: PMC7333775 DOI: 10.3389/fonc.2020.00996] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022] Open
Abstract
Overall, tumors of primary central nervous system (CNS) are quite common in adults with an incidence rate close to 30 new cases/100,000 inhabitants per year. Significant clinical and biological advances have been accomplished in the most common adult primary CNS tumors (i.e., diffuse gliomas). However, most CNS tumor subtypes are rare with an incidence rate below the threshold defining rare disease of 6.0 new cases/100,000 inhabitants per year. Close to 150 entities of primary CNS tumors have now been identified by the novel integrated histomolecular classification published by the World Health Organization (WHO) and its updates by the c-IMPACT NOW consortium (the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy). While these entities can be better classified into smaller groups either by their histomolecular features and/or by their location, assessing their treatment by clinical trials and improving the survival of patients remain challenging. Despite these tumors are rare, research, and advances remain slower compared to diffuse gliomas for instance. In some cases (i.e., ependymoma, medulloblastoma) the understanding is high because single or few driver mutations have been defined. The European Union has launched European Reference Networks (ERNs) dedicated to support advances on the clinical side of rare diseases including rare cancers. The ERN for rare solid adult tumors is termed EURACAN. Within EURACAN, Domain 10 brings together the European patient advocacy groups (ePAGs) and physicians dedicated to improving outcomes in rare primary CNS tumors and also aims at supporting research, care and teaching in the field. In this review, we discuss the relevant biological and clinical characteristics, clinical management of patients, and research directions for the following types of rare primary CNS tumors: medulloblastoma, pineal region tumors, glioneuronal and rare glial tumors, ependymal tumors, grade III meningioma and mesenchymal tumors, primary central nervous system lymphoma, germ cell tumors, spinal cord tumors and rare pituitary tumors.
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Affiliation(s)
- Enrico Franceschi
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Didier Frappaz
- Department of Neuro-Oncology and Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Roberta Rudà
- Department of Neuro-Oncology, City of Health and Science and University of Turin, Turin, Italy
| | - Peter Hau
- Wilhelm Sander NeuroOncology-Unit, Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Caroline Houillier
- Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Giuseppe Lombardi
- Department of Oncology, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | - Sofia Asioli
- Section of Anatomic Pathology "M. Malpighi", Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, Bologna, Italy
| | - Caroline Dehais
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Franck Bielle
- Department of Neuropathology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, AP-HP, Sorbonne Université, SIRIC Curamus, Paris, France
| | - Vincenzo Di Nunno
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Martin van den Bent
- The Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Alba A Brandes
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Ahmed Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
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Su M, Huang D, Sun L, Dong Z, Wu L, Yu S. A diagnostic challenge of primary Central nervous system lymphoma: from the eyes to the brain. Int J Neurosci 2020; 131:1139-1145. [PMID: 32449877 DOI: 10.1080/00207454.2020.1773822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Being a subtype of primary central nervous system lymphoma (PCNSL), primary vitreoretinal lymphoma (PVRL) is a rare and fatal intraocular malignancy manifesting as blurred vision and floaters, and is usually combined with, or eventually progresses to, central nervous system lesions. The diagnosis of PVRL/PCNSL remains challenging because of the nonspecific clinical features and diagnostic dependency on biopsy.Case presentation: In this paper, we present the clinical, imaging, laboratory, brain biopsy, and vitreous biopsy findings of a 56-year-old immunocompetent woman who presented with blurred vision of the left eye, but which rapidly evolved into lesions of the central nervous system. The dramatic changes on brain imaging and the undiagnostic brain and vitreous biopsy results presented great challenges for the diagnosis. PCNSL was eventually presumed according to comprehensive consideration of the disease progression pattern, the characteristic neuroimaging, and molecular hints.Conclusions: PCNSL is a highly invasive tumor, and timely diagnosis is the key point in clinical practice. However, the requirement for biopsy and the existence of sentinel lesions impedes the diagnosis. Therefore, follow-up and repeated biopsy is always necessary for a definitive diagnosis. This case indicates that a complete evaluation of neuroimaging, ophthalmic testing, cytologic examination of the cerebrospinal fluid, diagnostic vitrectomy, and brain biopsy are essential for diagnosis of PCNSL. Moreover, molecular and cytokine analyses are useful adjuncts to the diagnostic cytology. Of note, the analysis of cytokine levels (IL-10/IL-6) is an important auxiliary diagnostic strategy in the diagnosis of diffuse large B-cell lymphoma.
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Affiliation(s)
- Min Su
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Dehui Huang
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Liuqing Sun
- Department of Neurology, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan Province, China
| | - Zhao Dong
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lei Wu
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
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Ouyang T, Wang L, Zhang N, Zhang Z, Xiong Y, Li M, Hong T. Clinical Characteristics, Surgical Outcomes, and Prognostic Factors of Intracranial Primary Central Nervous System Lymphoma. World Neurosurg 2020; 139:e508-e516. [PMID: 32311566 DOI: 10.1016/j.wneu.2020.04.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Intracranial primary central nervous system lymphoma (PCNSL) is a rare aggressive malignant tumor with poor prognosis. The effect of surgical resection on intracranial PCNSL is still controversial. This study investigates the efficacy and safety of surgical resection, as well as to analyze the clinical characteristics and prognostic factors of intracranial PCNSL. METHODS The clinical materials of 89 consecutive patients with intracranial PCNSL were analyzed retrospectively. Outcome in survival was assessed by progression-free survival (PFS) and overall survival (OS). Univariate and multivariate analyses were performed for various potential prognostic factors to identify independent prognostic factors of intracranial PCNSL. RESULTS Among the 89 patients, gross total resection (GTR) was achieved in 57 patients (64.0%), subtotal resection (STR) in 14 patients (15.8%), and biopsy in 18 patients (20.2%).The PFS and OS at 2 years were estimated at 32.3% and 74.1%, respectively. The median PFS was 20 months (95% confidence interval, 16-23) and the median OS was 32 months (95% confidence interval, 25-38). Patients with surgical resection (GTR and STR) had better PFS than those with biopsy, and the difference of PFS was statistically significant (P = 0.007). However, the difference of OS was not statistically significant (P = 0.062). Multivariate analysis showed that invasion of deep structure was the only independent risk factor for intracranial PCNSL. Eleven patients (12.4%) had surgical complications, mainly including limb weakness and visual field defect. CONCLUSIONS For intracranial PCNSL, surgical excision can improve PFS but not OS. Invasion of deep structure was the only independent risk factor for intracranial PCNSL.
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Affiliation(s)
- Taohui Ouyang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Long Wang
- Department of Neurosurgery, Affiliated Heping Hospital of Chang Zhi Medical College, Changzhi, Shanxi, China
| | - Na Zhang
- Department of Neurology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Zongyong Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yifeng Xiong
- Department of Pathology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Meihua Li
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Tao Hong
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Lin X, Khan IRA, Seet YHC, Lee HY, Yu WY. Atypical radiological findings of primary central nervous system lymphoma. Neuroradiology 2020; 62:669-676. [PMID: 32077984 DOI: 10.1007/s00234-020-02377-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/29/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) presenting with atypical radiological findings often leads to delayed diagnosis. We aim to characterize the radiological features and apparent diffusion coefficient (ADC) values of PCNSL with atypical neuroimaging presentation in our local population. METHODS We retrospectively reviewed all patients with histological diagnosis of CNS lymphoma at our tertiary center from 2005 to 2016. We screened all initial pre-treatment MRIs and excluded cases with typical imaging findings of contrast-enhancing lesions without intra-lesional susceptibility and central non-enhancement. Additional exclusion criteria included (i) relapsed PCNSL, (ii) secondary CNS lymphoma, and (iii) positive HIV status. Two independent raters scored MRI and CT scans at presentation. We computed ADC values in the tumors by 2 methods: single region of interest (ROI1) and multiple ROI (ROI2). RESULTS Sixteen (25.4%) of 63 patients with CNS lymphoma met inclusion criteria. There were 8 men; median age was 61 (range 22-81) years. Histological diagnoses were diffuse large B cell lymphoma (n = 14) and intravascular lymphoma (n = 2). Fifteen (93%) patients had enhancing lesions (5 solitary; 10 multifocal); most enhancing lesions had T1 hypointense (67%) and T2 mixed (53%) signals, and 6 (40%) had central non-enhancing regions. Nine (56%) patients had lesions with susceptibility. Using the ROI methods, median values for minimum ADC and mean ADC ranged 0.65-0.71 × 10-3 mm2/s and 0.79-0.84 × 10-3 mm2/s respectively. CONCLUSION PCNSL with atypical radiological features represented one-fourth of our histologically diagnosed lymphoma cases; low ADC values in atypical lesions should prompt clinicians to consider early biopsy for definitive diagnosis.
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Affiliation(s)
- Xuling Lin
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Iram Rais Alam Khan
- Department of Neuroradiology, National Neuroscience Institute, Singapore, Singapore
| | - Ying Hao Christopher Seet
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Hwei Yee Lee
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wai-Yung Yu
- Department of Neuroradiology, National Neuroscience Institute, Singapore, Singapore
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Whole Tumor Histogram Analysis Using DW MRI in Primary Central Nervous System Lymphoma Correlates with Tumor Biomarkers and Outcome. Cancers (Basel) 2019; 11:cancers11101506. [PMID: 31597366 PMCID: PMC6827036 DOI: 10.3390/cancers11101506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 11/16/2022] Open
Abstract
The ability to non-invasively predict outcomes and monitor treatment response in primary central nervous system lymphoma (PCNSL) is important as treatment regimens are constantly being trialed. The aim of this study was to assess the validity of using apparent diffusion coefficient (ADC) histogram values to predict Ki-67 expression, a tumor proliferation marker, and patient outcomes in PCNSL in both immunocompetent patients and patients living with HIV (PLWH). Qualitative PCNSL magnetic resonance imaging (MRI) characteristics from 93 patients (23 PLWH and 70 immunocompetent) were analyzed, and whole tumor segmentation was performed on the ADC maps. Quantitative histogram analyses of the segmentations were calculated. These measures were compared to PCNSL Ki-67 expression. Progression-free survival (PFS) and overall survival (OS) were analyzed via comparison to the International Primary Central Nervous System Lymphoma Collaboration Group Response Criteria. Associations between ADC measures and clinical outcomes were assessed using univariate and multivariate Cox proportional hazards models. Normalized ADC (nADC)Min, nADCMean, nADC1, nADC5, and nADC15 values were significantly associated with a poorer OS. nADCMax, nADCMean, nADC5, nADC15, nADC75, nADC95, nADC99 inversely correlated with Ki-67 expression. OS was also significantly associated with lesion hemorrhage. PFS was not significantly associated with ADC values but with lesion hemorrhage. ADC histogram values and related parameters can predict the degree of tumor proliferation and patient outcomes for primary central nervous system lymphoma patients and in both immunocompetent patients and patients living with HIV.
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25
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Kayed MH, Saleh TR, Reda IS, Elsirafy MN, Farhoud AH, Abdelzaher E. The added value of advanced neuro-imaging (MR diffusion, perfusion and proton spectroscopy) in diagnosis of primary CNS lymphoma. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2013.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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26
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Liu D, Liu X, Ba Z, Xie L, Han J, Yu D, Ma X. Delayed Contrast Enhancement in Magnetic Resonance Imaging and Vascular Morphology of Primary Diffuse Large B-Cell Lymphoma (DLBCL) of the Central Nervous System (CNS): A Retrospective Study. Med Sci Monit 2019; 25:3321-3328. [PMID: 31055591 PMCID: PMC6515976 DOI: 10.12659/msm.913439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to compare the magnetic resonance imaging (MRI) findings of primary diffuse large B-cell lymphoma (DLBCL) of the central nervous system (CNS) with delayed contrast enhancement and histological microvessel density (MVD). T1-weighted and T2-weighted contrast-enhanced and non-enhanced brain imaging were used. CNS lymphoma tissue was evaluated using primary antibodies to endothelial cells and smooth muscle cells, and histochemical staining for reticulin fibers and basement membrane, which allowed quantification of the MVD. Material/Methods Twenty-one patients with histologically confirmed primary DLBCL of the CNS underwent pre-contrast-enhanced and postcontrast-enhanced MRI. Histology of the CNS lymphoma tissue included immunohistochemical staining with antibodies to CD34 for vascular endothelial cells and alpha smooth muscle actin (ASMA) for vascular smooth muscle cells, and histochemical staining included periodic acid-Schiff (PAS) and silver staining for reticulin fibers to evaluate microvessel density (MVD). Results In primary DLBCL of the CNS, a positive correlation was found between the degree of necrosis and the size of the lymphoma (r=0.546, P=0.01). Delayed imaging enhancement was significantly correlated with the number of mature vessels, MVD, basement membrane, and reticulin fibers (r=0.593, 0.466, 0.446 and 0.497, respectively). Standardized β regression coefficient analysis showed that the MVD, PAS-positive structures, the number of mature vessels, and reticulin fibers, were significantly associated with delayed enhancement on MRI (β values, 0.425, 0.409, 0.295, and 0.188, respectively). Conclusions In primary DLBCL of the CNS, delayed imaging enhancement on MRI may be due to reduced neovascularization and vascular infiltration by lymphoma cells.
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Affiliation(s)
- Dandan Liu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland).,Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, China (mainland)
| | - Xiaojun Liu
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, China (mainland)
| | - Zhaogui Ba
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, China (mainland)
| | - Limei Xie
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, China (mainland)
| | - Jiwu Han
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, China (mainland)
| | - Dexin Yu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Xiangxing Ma
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
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27
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Cheng G, Zhang J. Imaging features (CT, MRI, MRS, and PET/CT) of primary central nervous system lymphoma in immunocompetent patients. Neurol Sci 2018; 40:535-542. [PMID: 30580380 PMCID: PMC6433804 DOI: 10.1007/s10072-018-3669-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 11/29/2018] [Indexed: 12/18/2022]
Abstract
Background Because of the low incidence of primary central nervous system lymphoma (PCNSL) in non-HIV individuals and because of the lack of specific clinical manifestations and auxiliary examinations, the disease is easily missed or misdiagnosed. Objective To analyze the imaging features of PCNSL in non-HIV patients. Methods This was a retrospective study of patients with PCNSL treated between January 2001 and December 2011 at the Naval General Hospital (Beijing, China). All included patients were pathologically diagnosed with PCNSL. Specimens were obtained by stereotactic biopsy and diagnosed by pathological examination. Serological panel had to be negative for HIV. Results Out of the 118 patients, 73 (61.9%) were male and 45 (38.1%) were female. Median age was 54 (range 11–83) years. All patients had B cell lymphoma. The lesions showed slightly hyperintense shadows on computed tomography (CT) images, and mostly hyperintense T1 and iso- or hyperintense T2 signals on magnetic resonance imaging (MRI). Most lesions showed patchy enhancement after enhanced scanning, and some had the characteristic “butterfly sign” on enhanced MRI. The magnetic resonance spectroscopy of PCNSL manifested as increased Cho peak, moderately decreased NAA peak, and slightly decreased Cr peak. Positron emission computed tomography indicated high metabolism of 18F-FDG in PCNSL lesions. Conclusion MRI is important in the diagnosis of PCNSL. Understanding the imaging features of PCNSL will help improve its diagnosis in clinics.
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Affiliation(s)
- Gang Cheng
- Institute of Neurosurgery, Navy General Hospital, Beijing, 100048, China
| | - Jianning Zhang
- Institute of Neurosurgery, Navy General Hospital, Beijing, 100048, China.
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28
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Housni A, Boujraf S, Alami B, Benzagmout M, Maaroufi M. Assessment of Primary Brain Lymphoma Using Multimodal Magnetic Resonance Imaging and Proton Magnetic Resonance Spectroscopy. Asian J Neurosurg 2018; 13:1205-1208. [PMID: 30459895 PMCID: PMC6208237 DOI: 10.4103/ajns.ajns_137_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objectives: The primary lymphoma of the central nervous system is a cancer rare. The diagnosis of this tumoral entity must be considered as an emergency considering the therapeutical involved. Therefore, we report this entity while reporting diagnostic challenges. Patients and Methods: Unfortunately, the conventional clinical and imaging signs can be confusing and might contribute to delay the diagnosis process of potentially curable pathological entity. The diagnosis confirmation in immunocompetent patients is based on a stereotaxic biopsy. Results and Conclusion: In this paper, we report a case illustrating the contribution of multimodal imaging including diffusion-weighted magnetic resonance imaging (MRI), diffusion tensor MRI, perfusion MRI, and proton MR spectroscopy to the diagnostic approach of the atypical primary lymphoma of the central nervous system.
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Affiliation(s)
- Abdelkhalek Housni
- Department of Biophysics, High Institute of Nursing Professions and Health Techniques of Fez, Fez, Morocco.,Department of Biophysics, Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, University of Fez, Fez, Morocco.,Department of Radiology and Clinical Imaging, University Hospital of Fez, Fez, Morocco
| | - Saïd Boujraf
- Department of Biophysics, Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, University of Fez, Fez, Morocco.,Department of Biophysics and Clinical MRI Methods, Faculty of Medicine and Pharmacy, University of Fez, Fez, Morocco
| | - Badreddine Alami
- Department of Biophysics, Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, University of Fez, Fez, Morocco.,Department of Radiology and Clinical Imaging, University Hospital of Fez, Fez, Morocco.,Department of Biophysics and Clinical MRI Methods, Faculty of Medicine and Pharmacy, University of Fez, Fez, Morocco
| | - Mohammed Benzagmout
- Department of Biophysics, Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, University of Fez, Fez, Morocco
| | - Mustapha Maaroufi
- Department of Biophysics, Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, University of Fez, Fez, Morocco.,Department of Radiology and Clinical Imaging, University Hospital of Fez, Fez, Morocco
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29
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Saini J, Kumar Gupta P, Awasthi A, Pandey C, Singh A, Patir R, Ahlawat S, Sadashiva N, Mahadevan A, Kumar Gupta R. Multiparametric imaging-based differentiation of lymphoma and glioblastoma: using T1-perfusion, diffusion, and susceptibility-weighted MRI. Clin Radiol 2018; 73:986.e7-986.e15. [DOI: 10.1016/j.crad.2018.07.107] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/31/2018] [Indexed: 01/19/2023]
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30
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Gómez Roselló E, Quiles Granado A, Laguillo Sala G, Pedraza Gutiérrez S. Primary central nervous system lymphoma in immunocompetent patients: Spectrum of findings and differential characteristics. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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31
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van Westrhenen A, Smidt LCA, Seute T, Nierkens S, Stork ACJ, Minnema MC, Snijders TJ. Diagnostic markers for CNS lymphoma in blood and cerebrospinal fluid: a systematic review. Br J Haematol 2018; 182:384-403. [PMID: 29808930 PMCID: PMC6099264 DOI: 10.1111/bjh.15410] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/28/2018] [Indexed: 12/31/2022]
Abstract
Diagnosing central nervous system (CNS) lymphoma remains a challenge. Most patients have to undergo brain biopsy to obtain tissue for diagnosis, with associated risks of serious complications. Diagnostic markers in blood or cerebrospinal fluid (CSF) could facilitate early diagnosis with low complication rates. We performed a systematic literature search for studies on markers in blood or cerebrospinal fluid for the diagnosis CNS lymphoma and assessed the methodological quality of studies with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS‐2). We evaluated diagnostic value of the markers at a given threshold, as well as differences between mean or median levels in patients versus control groups. Twenty‐five studies were included, reporting diagnostic value for 18 markers in CSF (microRNAs ‐21, ‐19b, and ‐92a, RNU2‐1f, CXCL13, interleukins ‐6, ‐8, and ‐10, soluble interleukin‐2‐receptor, soluble CD19, soluble CD27, tumour necrosis factor‐alfa, beta‐2‐microglobulin, antithrombin III, soluble transmembrane activator and calcium modulator and cyclophilin ligand interactor, soluble B cell maturation antigen, neopterin and osteopontin) and three markers in blood (microRNA‐21 soluble CD27, and beta‐2‐microglobulin). All studies were at considerable risk of bias and there were concerns regarding the applicability of 15 studies. CXCL‐13, beta‐2‐microglobulin and neopterin have the highest potential in diagnosing CNS lymphoma, but further study is still needed before they can be used in clinical practice.
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Affiliation(s)
- Anouk van Westrhenen
- University Medical Center Utrecht, Utrecht, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | | | - Tatjana Seute
- University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan Nierkens
- University Medical Center Utrecht, Utrecht, The Netherlands.,Laboratory of Translational Immunology, Department Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Abraham C J Stork
- University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | - Monique C Minnema
- University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Haematology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tom J Snijders
- University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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32
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Gómez Roselló E, Quiles Granado AM, Laguillo Sala G, Pedraza Gutiérrez S. Primary central nervous system lymphoma in immunocompetent patients: spectrum of findings and differential characteristics. RADIOLOGIA 2018; 60:280-289. [PMID: 29482953 DOI: 10.1016/j.rx.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
Primary central nervous system (CNS) lymphomas are uncommon and their management differs significantly from that of other malignant tumors involving the CNS. This article explains how the imaging findings often suggest the diagnosis early. The typical findings in immunocompetent patients consist of a supratentorial intraaxial mass that enhances homogeneously. Other findings to evaluate include multifocality and incomplete ring enhancement. The differential diagnosis of primary CNS lymphomas should consider mainly other malignant tumors of the CNS such as glioblastomas or metastases. Primary CNS lymphomas tend to have less edema and less mass effect; they also tend to spare the adjacent cortex. Necrosis, hemorrhage, and calcification are uncommon in primary CNS lymphomas. Although the findings in morphologic sequences are characteristic, they are not completely specific and atypical types are sometimes encountered. Advanced imaging techniques such as diffusion or especially perfusion provide qualitative and quantitative data that play an important role in differentiating primary CNS lymphomas from other brain tumors.
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Affiliation(s)
- E Gómez Roselló
- Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, España.
| | - A M Quiles Granado
- Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, España
| | - G Laguillo Sala
- Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, España
| | - S Pedraza Gutiérrez
- Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, España
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33
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McKnight CD, Motuzas CL, Srinivasan A. Approach to Brain Neoplasms: What the Oncologist Wants to Know. Semin Roentgenol 2018; 53:6-22. [PMID: 29405956 DOI: 10.1053/j.ro.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Colin D McKnight
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN.
| | - Cari L Motuzas
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
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Abstract
Human immunodeficiency virus (HIV) enters the brain early after infecting humans and may remain in the central nervous system despite successful antiretroviral treatment. Many neuroimaging techniques were used to study HIV+ patients with or without opportunistic infections. These techniques assessed abnormalities in brain structures (using computed tomography, structural magnetic resonance imaging (MRI), diffusion MRI) and function (using functional MRI at rest or during a task, and perfusion MRI with or without a contrast agent). In addition, single-photon emission computed tomography with various tracers (e.g., thallium-201, Tc99-HMPAO) and positron emission tomography with various agents (e.g., [18F]-dexoyglucose, [11C]-PiB, and [11C]-TSPO tracers), were applied to study opportunistic infections or HIV-associated neurocognitive disorders. Neuroimaging provides diagnoses and biomarkers to quantitate the severity of brain injury or to monitor treatment effects, and may yield insights into the pathophysiology of HIV infection. As the majority of antiretroviral-stable HIV+ patients are living longer, age-related comorbid disorders (e.g., additional neuroinflammation, cerebrovascular disorders, or other dementias) will need to be considered. Other highly prevalent conditions, such as substance use disorders, psychiatric illnesses, and the long-term effects of combined antiretroviral therapy, all may lead to additional brain injury. Neuroimaging studies could provide knowledge regarding how these comorbid conditions impact the HIV-infected brain. Lastly, specific molecular imaging agents may be needed to assess the central nervous system viral reservoir.
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Affiliation(s)
- Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Medicine and Department of Neurology, John A. Burns School of Medicine, University of Hawaii, Manoa, United States.
| | - Dinesh K Shukla
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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35
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Mari L, Stavinohova R, Dominguez E, Premont J, Oliver J, De Risio L. Ischemic Optic Neuropathy in a Dog with Acute Bilateral Blindness and Primary Systemic Hypertension. J Vet Intern Med 2017; 32:423-427. [PMID: 29130572 PMCID: PMC5787170 DOI: 10.1111/jvim.14878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/05/2017] [Accepted: 10/17/2017] [Indexed: 11/26/2022] Open
Abstract
A 6-year-old neutered female Jack Russell terrier was investigated for sudden onset prechiasmatic bilateral blindness, left circling, reduced proprioception in the right pelvic limb and right facial allodynia. Electroretinography was normal. Magnetic resonance imaging (MRI) examination revealed that the right optic nerve and the optic chiasm were hyperintense on diffusion weighted imaging and hypointense on apparent diffusion coefficient map consistent with ischemic optic neuropathy. A concurrent lacunar infarct was detected in the left rostral colliculus. Primary systemic hypertension was diagnosed based on blood pressure measurement and no detectable abnormalities on hematology, comprehensive serum biochemistry, urinalysis including protein/creatinine and cortisol/creatinine ratios and thoracic/abdominal imaging. Prednisolone for 10 days and amlodipine long-term were administered. Vision was not recovered after 7 months. Repeat MRI supported the diagnosis of ischemic lesions and revealed a recent striatocapsular infarct. Ischemic optic neuropathy is a well-recognized cause of blindness in humans and should be included as a differential diagnosis for acute prechiasmatic blindness in dogs.
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Affiliation(s)
- L Mari
- Neurology/Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - R Stavinohova
- Ophthalmology Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - E Dominguez
- Diagnostic Imaging Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - J Premont
- Ophthalmology Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - J Oliver
- Ophthalmology Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - L De Risio
- Neurology/Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
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Yu H, Gao B, Liu J, Yu YC, Shiroishi MS, Huang MM, Yang WX, Guan ZZ. Lymphomatosis cerebri: a rare variant of primary central nervous system lymphoma and MR imaging features. Cancer Imaging 2017; 17:26. [PMID: 28982392 PMCID: PMC5629795 DOI: 10.1186/s40644-017-0128-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/25/2017] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Lymphomatosis cerebri (LC) is a rare variant of primary central nervous system lymphoma (PCNSL), characterized by diffuse infiltration without the formation of a discrete mass. The diagnosis of LC is a challenge because the imaging findings are atypical for lymphoma. The purpose of present study is to investigate MRI characteristics and clinical features of LC and potentially facilitate an early and accurate diagnosis of this often-missed disease. METHODS Seven patients (average 44 years, 19-58 years) with LC proved basing on MRI and histology were retrospectively reviewed the clinical data and cerebral MR imaging findings. RESULTS The common presenting symptoms were cognitive decline, behavioral disturbance, gait disturbance. All patients had both deep and lobar lesion distribution, and two of them had infratentorial involvement. Lack of contrast enhancement and subtle patchy enhanced pattern were observed in two and three patients, respectively. The remaining two patients presented multiple patchy enhancement. Most of the lesions were slightly hyperintense to normal brain on DWI as well as hyperintense on ADC maps. Three patients presented a pattern of marked decrease of NAA/Cr, increase of Cho/Cr, and two of the three cases showed increased Lip/Cr and Lac/Cr on MRS. CONCLUSIONS We conclude that diffuse bilateral lesions especially in deep and lobar region including white and gray matter, without enhancement or with patchy enhancement, marked decrease of NAA/Cr and increase of Cho/Cr, and increased Lip/Cr and Lac/Cr are suggestive of LC. Prompt recognition of these imaging patterns may lead to early diagnosis of LC and brain biopsy with improved prognosis.
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Affiliation(s)
- Hui Yu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004 People’s Republic of China
| | - Bo Gao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, 264000 Shandong People’s Republic of China
| | - Jing Liu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004 People’s Republic of China
| | - Yong-Cheng Yu
- Department of Neurology, the second affiliated Hospital of Guizhou Medical University, Kaili, 556000 People’s Republic of China
| | - Mark S. Shiroishi
- Department of Radiology,Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Ming-Ming Huang
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004 People’s Republic of China
| | - Wen-Xiu Yang
- Department of Pathology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004 People’s Republic of China
| | - Zhi-Zhong Guan
- Department of Pathology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004 People’s Republic of China
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Jiang DZ, Zhou DY, Wu WQ, Wu GY, Quan H. Value of multi-b value DWI in the assessment of early cerebral changes in asymptomatic HIV-positive adolescents. Acta Radiol 2017; 58:867-875. [PMID: 27733641 DOI: 10.1177/0284185116673123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Magnetic resonance imaging (MRI) and functional MRI techniques have been widely used in the diagnosis of human immunodeficiency virus (HIV) infection related diseases. Purpose To explore whether magnetic resonance diffusion-weighted imaging (DWI) can track water molecular diffusion changes in the brain of asymptomatic HIV-positive adolescents. Material and Methods Multi-b value DWI was performed in 23 adolescents, including 15 HIV-positive participants and eight HIV-negative healthy participants. Mean apparent diffusion coefficient (ADC), slow apparent diffusion coefficient (ADCs) values, fast apparent diffusion coefficient (ADCf) values, distribution diffusion coefficient (DDC) values, and heterogeneity index (α) values were calculated within regions of interest (ROIs) in the frontal lobes, basal ganglia, and temporal lobe. Non-parametric tests were then performed. Results In the bilateral frontal lobes, the mean α values in HIV-positive participants were significantly increased compared with those in healthy participants (right side P = 0.001; left side P = 0.000). In the left frontal lobe, the mean DDC value in HIV-positive participants was significantly increased compared with that in healthy participants ( P = 0.008). In the bilateral frontal lobes, the mean ADCf values in HIV-positive participants were significantly lower than those in healthy participants (right side P = 0.011; left side P = 0.008). In the left basal ganglia, the mean α values in HIV-positive participants were significantly lower than that in healthy participants ( P = 0.013). Conclusion Multi-b value DWI could reflect the early characteristics of water molecule diffusion in HIV infections.
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Affiliation(s)
- Da-Zhen Jiang
- Key Laboratory of Artificial Micro- & Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, PR China
| | - Ding-Yi Zhou
- Key Laboratory of Artificial Micro- & Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, PR China
| | - Wei-Qing Wu
- Key Laboratory of Artificial Micro- & Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, PR China
| | - Guang-Yao Wu
- Medical Imaging department of the Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Hong Quan
- Key Laboratory of Artificial Micro- & Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, PR China
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Brandão LA, Castillo M. Adult Brain Tumors: Clinical Applications of Magnetic Resonance Spectroscopy. Magn Reson Imaging Clin N Am 2017; 24:781-809. [PMID: 27742117 DOI: 10.1016/j.mric.2016.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Proton magnetic resonance spectroscopy (H-MRS) may be helpful in suggesting tumor histology and tumor grade and may better define tumor extension and the ideal site for biopsy compared with conventional magnetic resonance (MR) imaging. A multifunctional approach with diffusion-weighted imaging, perfusion-weighted imaging, and permeability maps, along with H-MRS, may enhance the accuracy of the diagnosis and characterization of brain tumors and estimation of therapeutic response. Integration of advanced imaging techniques with conventional MR imaging and the clinical history help to improve the accuracy, sensitivity, and specificity in differentiating tumors and nonneoplastic lesions.
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Affiliation(s)
- Lara A Brandão
- Clínica Felippe Mattoso, Av. Das Américas 700, sala 320, Barra da Tijuca, Rio de Janeiro 30112011, Brazil; Clínica IRM- Ressonância Magnética, Rua Capitão Salomão 44 Humaitá, Rio de Janeiro 22271040, Brazil.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Room 3326, Old Infirmary Building, Manning Drive, Chapel Hill, NC 27599-7510, USA
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Ambady P, Fu R, Netto JP, Kersch C, Firkins J, Doolittle ND, Neuwelt EA. Patterns of relapse in primary central nervous system lymphoma: inferences regarding the role of the neuro-vascular unit and monoclonal antibodies in treating occult CNS disease. Fluids Barriers CNS 2017; 14:16. [PMID: 28577579 PMCID: PMC5457655 DOI: 10.1186/s12987-017-0064-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/22/2017] [Indexed: 12/22/2022] Open
Abstract
Background and purpose The radiologic features and patterns of primary central nervous system lymphoma (PCNSL) at initial presentation are well described. High response rates can be achieved with first-line high-dose methotrexate (HD-MTX) based regimens, yet many relapse within 2 years of diagnosis. We describe the pattern of relapse and review the potential mechanisms involved in relapse. Methods We identified 78 consecutive patients who attained complete radiographic response (CR) during or after first-line treatment for newly diagnosed PCNSL (CD20+, diffuse large B cell type). Patients were treated with HD-MTX based regimen in conjunction with blood–brain barrier disruption (HD-MTX/BBBD); 44 subsequently relapsed. Images and medical records of these 44 consecutive patients were retrospectively reviewed. The anatomical location of enhancing lesions at initial diagnosis and at the time of relapse were identified and compared. Results 37/44 patients fulfilled inclusion criteria and had new measureable enhancing lesions at relapse; the pattern and location of relapse of these 37 patients were identified. At relapse, the new enhancement was at a spatially distinct site in 30 of 37 patients. Local relapse was found only in seven patients. Discussion Unlike gliomas, the majority of PCNSL had radiographic relapse at spatially distinct anatomical locations within the brain behind a previously intact neurovascular unit (NVU), and in few cases outside, the central nervous system (CNS). This may suggest either (1) reactivation of occult reservoirs behind an intact NVU in the CNS (or ocular) or (2) seeding from bone marrow or other extra CNS sites. Conclusion Recognizing patterns of relapse is key for early detection and may provide insight into potential mechanisms of relapse as well as help develop strategies to extend duration of complete response.
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Affiliation(s)
- Prakash Ambady
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA.,Portland Veterans Affairs Medical Center, Portland, OR, USA
| | - Rongwei Fu
- School of Public Health, Oregon Health & Science University, Portland, OR, USA.,Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Joao Prola Netto
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA.,Department of Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Cymon Kersch
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA
| | - Jenny Firkins
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA
| | - Nancy D Doolittle
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA. .,Portland Veterans Affairs Medical Center, Portland, OR, USA. .,Department of Neurosurgery, Oregon Health & Science University, Portland, OR, USA.
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Yang M, Sun J, Bai HX, Tao Y, Tang X, States LJ, Zhang Z, Zhou J, Farwell MD, Zhang P, Xiao B, Yang L. Diagnostic accuracy of SPECT, PET, and MRS for primary central nervous system lymphoma in HIV patients: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e6676. [PMID: 28489744 PMCID: PMC5428578 DOI: 10.1097/md.0000000000006676] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We performed a systematic review and meta-analysis to assess the roles of SPECT, PET, and MRS in distinguishing primary central nervous system lymphoma (PCNSL) from other focal brain lesions (FBLs) in human immunodeficiency virus (HIV)-infected patients. METHODS PubMed, Scopus, and Medline were systematically searched for eligible studies from 1980 to 2016. Two authors extracted characteristics of patients and their lesions using predefined criteria. RESULTS Eighteen studies on SPECT containing 667 patients, 6 studies on PET containing 108 patients, and 3 studies on MRS containing 96 patients were included. SPECT had a pooled sensitivity of 0.92 (95% CI: 0.85-0.96) and specificity of 0.84 (95% CI: 0.74-0.90) in differentiating PCNSL from other FBLs. For the 6 studies that used only pathology and/or serology as the gold standard, the pooled sensitivity was 0.85 (95% CI: 0.72-0.97) and the pooled specificity was 0.73 (95% CI: 0.54-0.92). CONCLUSION SPECT has good diagnostic accuracy for discriminating PCNSL from other FBL-causing disorders in HIV patients. However, the actual sensitivity and specificity of SPECT may be lower than expected if only pathology and/or serology was used as the gold standard. PET may be superior but has less supporting clinical data and is more expensive.
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Affiliation(s)
- Mo Yang
- Department of Neurology, The Second Xiangya Hospital, Changsha City, Hunan Province, China
| | - James Sun
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Harrison X. Bai
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Yongguang Tao
- Cancer Research Institute, Central South University, Changsha City, Hunan Province, China
| | - Xiangqi Tang
- Department of Neurology, The Second Xiangya Hospital, Changsha City, Hunan Province, China
| | - Lisa J. States
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Zishu Zhang
- Department of Radiology, The Second Xiangya Hospital
| | - Jianhua Zhou
- Department of Pathology, The First Xiangya Hospital, Changsha City, Hunan Province, China
| | - Michael D. Farwell
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Zhang
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Bo Xiao
- Department of Neurology, The First Xiangya Hospital, Changsha City, Hunan Province, China
| | - Li Yang
- Department of Neurology, The Second Xiangya Hospital, Changsha City, Hunan Province, China
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Korfel A, Schlegel U, Johnson DR, Kaufmann TJ, Giannini C, Hirose T. Case-based review: primary central nervous system lymphoma. Neurooncol Pract 2017; 4:46-59. [PMID: 31386044 DOI: 10.1093/nop/npw033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Indexed: 11/14/2022] Open
Abstract
Primary CNS lymphoma (PCNSL) is a rare diffuse large B-cell lymphoma originating within the central nervous system. The overall incidence of PCNSL is rising, particularly in the elderly population. Immunosuppression is a strong risk factor, but most patients with this tumor are apparently immunocompetent. Diagnosis of PCNSL can be challenging. Non-invasive or minimally invasive tests such as ophthalmological evaluation and spinal fluid analysis may be useful, but the majority of patients require tumor biopsy for definitive diagnosis. Our knowledge concerning optimum treatment of PCNSL is fragmentary due to paucity of adequately sized trials. Most patients are now initially treated with high-dose-methotrexate-based chemotherapy alone, as the addition of whole-brain radiotherapy at standard doses has not been shown to increase survival and does increase the risk of neurological toxicity. Ongoing trials are addressing issues such as the roles of reduced-dose radiotherapy, the addition of the CD20 antibody rituximab to chemotherapy, high-dose chemotherapy followed by autologous stem cell transplantation, and maintenance therapy in the primary management of PCNSL.
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Affiliation(s)
- Agnieszka Korfel
- Department of Hematology, Oncology and Tumor Immunology, Charite University Medicine, Berlin, Germany (A.K.)
| | - Uwe Schlegel
- Department of Neurology, University Hospital Bochum Knappschaftskrankenhaus, Bochum, Germany (U.S.)
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.K.)
| | | | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (C.G.)
| | - Takanori Hirose
- Department of Pathology, Kobe University Hospital, Kobe City, Japan (T.H.)
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Dibble EH, Boxerman JL, Baird GL, Donahue JE, Rogg JM. Toxoplasmosis versus lymphoma: Cerebral lesion characterization using DSC-MRI revisited. Clin Neurol Neurosurg 2016; 152:84-89. [PMID: 27940418 DOI: 10.1016/j.clineuro.2016.11.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/21/2016] [Accepted: 11/30/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE CNS toxoplasmosis and lymphoma are often indistinguishable by conventional contrast-enhanced MRI. There is limited literature on the diagnostic efficacy of dynamic susceptibility contrast (DSC) MRI for differentiating these entities. This study assesses the clinical utility of relative cerebral blood volume (rCBV) for making a diagnosis and determines rCBV thresholds for differentiation using contemporary DSC-MRI. PATIENTS AND METHODS Thirteen patients with 25 lesions (13 toxoplasmosis and 12 lymphoma) and pre-treatment DSC-MRI were identified retrospectively. Volumetric regions of interest of segmented enhancement were used to extract mean rCBV normalized to normal-appearing white matter for each lesion. We compared average mean rCBV between all toxoplasmosis and lymphoma lesions using a general mixed model. Three models were also compared for evaluating rCBV-based disease status in each patient: 1) mean rCBV of each lesion using a generalized estimating equation, 2) volume-weighted mean rCBV, and 3) maximum mean rCBV of all lesions using logistic regression. RESULTS The average mean rCBV for all toxoplasmosis lesions was 0.98 (95% CI 0.55-1.41) compared to 2.07 (95% CI 1.71-2.43) for all lymphoma lesions, a significant difference (1.09, 95% CI 0.53-1.65, p=0.0013). For the three models used to evaluate rCBV-based disease status in each patient, a significant relationship was observed, with an optimal rCBV threshold of approximately 1.5 for distinguishing lymphoma from toxoplasmosis in each model. CONCLUSION RCBV derived from contemporary DSC-MRI is helpful for distinguishing between cerebral toxoplasmosis and cerebral lymphoma on an individual patient basis and may facilitate more timely initiation of appropriate directed therapy.
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Affiliation(s)
- Elizabeth H Dibble
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Jerrold L Boxerman
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Grayson L Baird
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - John E Donahue
- Rhode Island Hospital, Department of Neuropathology, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Jeffrey M Rogg
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
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Schob S, Meyer J, Gawlitza M, Frydrychowicz C, Müller W, Preuss M, Bure L, Quäschling U, Hoffmann KT, Surov A. Diffusion-Weighted MRI Reflects Proliferative Activity in Primary CNS Lymphoma. PLoS One 2016; 11:e0161386. [PMID: 27571268 PMCID: PMC5003362 DOI: 10.1371/journal.pone.0161386] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022] Open
Abstract
Purpose To investigate if apparent diffusion coefficient (ADC) values within primary central nervous system lymphoma correlate with cellularity and proliferative activity in corresponding histological samples. Materials and Methods Echo-planar diffusion-weighted magnetic resonance images obtained from 21 patients with primary central nervous system lymphoma were reviewed retrospectively. Regions of interest were drawn on ADC maps corresponding to the contrast enhancing parts of the tumors. Biopsies from all 21 patients were histologically analyzed. Nuclei count, total nuclei area and average nuclei area were measured. The proliferation index was estimated as Ki-67 positive nuclei divided by total number of nuclei. Correlations of ADC values and histopathologic parameters were determined statistically. Results Ki-67 staining revealed a statistically significant correlation with ADCmin (r = -0.454, p = 0.038), ADCmean (r = -0.546, p = 0.010) and ADCmax (r = -0.515, p = 0.017). Furthermore, ADCmean correlated in a statistically significant manner with total nucleic area (r = -0.500, p = 0.021). Conclusion Low ADCmin, ADCmean and ADCmax values reflect a high proliferative activity of primary cental nervous system lymphoma. Low ADCmean values—in concordance with several previously published studies—indicate an increased cellularity within the tumor.
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Affiliation(s)
- Stefan Schob
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | - Jonas Meyer
- Department of Radiology, Martin Luther University of Halle-Wittenberg, Halle-Wittenberg, Germany
| | - Matthias Gawlitza
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Wolf Müller
- Department of Neuropathology, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Preuss
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Lionel Bure
- Department of Radiology, McGill University Health Center, Montreal General Hospital, Montreal, Canada
| | - Ulf Quäschling
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
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Huang WY, Wen JB, Wu G, Yin B, Li JJ, Geng DY. Diffusion-Weighted Imaging for Predicting and Monitoring Primary Central Nervous System Lymphoma Treatment Response. AJNR Am J Neuroradiol 2016; 37:2010-2018. [PMID: 27390318 DOI: 10.3174/ajnr.a4867] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/11/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Whether ADC value predicts the therapy response and outcomes of primary central system lymphoma remains controversial. This study assessed the minimum ADC correlated with treatment response in patients with primary central nervous system lymphoma undergoing methotrexate-based chemotherapy. MATERIALS AND METHODS Thirty-five patients with primary central nervous system lymphoma underwent conventional MR imaging and DWI before chemotherapy and after 1 and 5 cycles of chemotherapy. Treatment response was determined according to the International PCNSL Collaborative Group criteria and was classified as a complete response, partial response, or progressive disease. Pretreatment minimum ADC, minimum ADC after 1 cycle, minimum ADC after 5 cycles, and change in minimum ADC were compared among the different response groups. The Pearson correlation test was calculated between these ADC parameters and tumor response. RESULTS The pretreatment minimum ADC of the progressive disease group was lower than that of the complete response and partial response groups, but there was no significant difference among them. The minimum ADC after 1 cycle and minimum ADC after 5 cycles were statistically significantly higher than the pretreatment minimum ADC. A comparison among groups showed that minimum ADC after 1 cycle, minimum ADC after 5 cycles, minimum ADC change, and the percentage of minimum ADC change were all significantly different among the 3 groups. A significant positive correlation was observed between the percentage of minimum ADC after 1 cycle of chemotherapy and the size reduction percentage after 5 cycles of chemotherapy. The minimum ADC change and the percentage of minimum ADC change performed better in the differentiation of the final treatment response, specifically in complete response and partial response from progressive disease. CONCLUSIONS The minimum ADC after 1 cycle and minimum ADC changes were better correlated with the treatment response than the pretreatment minimum ADC. Minimum ADC after early therapy may potentially to be used to predict and monitor the response of primary central nervous system lymphoma to chemotherapy.
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Affiliation(s)
- W-Y Huang
- From the Departments of Radiology (W.-Y.H., J.-J.L.)
| | - J-B Wen
- Department of Radiology (J.-B.W., B.Y., D.-Y.G.), Huashan Hospital, Fudan University, Shanghai, China
| | - G Wu
- Radiotherapy (G.W.), Hainan General Hospital, Haikou, Hainan, China
| | - B Yin
- Department of Radiology (J.-B.W., B.Y., D.-Y.G.), Huashan Hospital, Fudan University, Shanghai, China
| | - J-J Li
- From the Departments of Radiology (W.-Y.H., J.-J.L.)
| | - D-Y Geng
- Department of Radiology (J.-B.W., B.Y., D.-Y.G.), Huashan Hospital, Fudan University, Shanghai, China.
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Rabah F, Elmanzalawy A, Bhuyan D, El-Banna N, Beshlawi I. A Demyelinating Disease; What Lies Beneath? Indian J Pediatr 2016. [PMID: 26204979 DOI: 10.1007/s12098-015-1849-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Fatma Rabah
- Department of Child Health, Sultan Qaboos University Hospital, PO Box: 38 Alkhoud, PC 123, Muscat, Oman.
| | | | - Dipali Bhuyan
- Department of Pediatric Oncology, Royal Hospital, Muscat, Oman
| | - Nagwa El-Banna
- Department of Pediatric Oncology, Royal Hospital, Muscat, Oman
| | - Ismail Beshlawi
- Department of Child Health, Sultan Qaboos University Hospital, PO Box: 38 Alkhoud, PC 123, Muscat, Oman
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Jiang DZ, Zhong Y, Zhou DY, Wu WQ, Wu GY, Quan H. Application of brain multi-b-value diffusion-weighted imaging (DWI) in adolescent orphans from AIDS families. Br J Radiol 2016; 89:20150732. [PMID: 26892165 DOI: 10.1259/bjr.20150732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the application value of multi-b-value diffusion-weighted imaging (DWI) with mono-exponential model and stretched-exponential model in the diagnosis of HIV-positive patients. METHODS Multi-b-value (0, 50, 150, 200, 400, 600, 800 s mm(-2)) DWI was performed in 23 adolescent orphans from AIDS families, including 15 HIV-positive subjects and 8 HIV-negative healthy subjects. Apparent diffusion coefficient (ADC) values were fitted by mono-exponential model; distribution diffusion coefficient (DDC) values and heterogeneity index (α) values were fitted by stretched-exponential model in bilateral basal ganglia, then non-parametric tests were performed. RESULTS The signal intensity attenuation in multi-b-value DWI could be well described by both mono-exponential model and stretched-exponential model. In the left basal ganglia, mean α-values in HIV-positive subjects (α = 0.848 ± 0.068) were significantly lower than that in healthy subjects (α = 0.923 ± 0.050, p = 0.013). There was no statistical difference of α-values between HIV-positive subjects and healthy control subjects in the right basal ganglia. Apart from these, there were also no statistical differences of DDC values or ADC values between two groups in bilateral basal ganglia (all p > 0.05). In bilateral basal ganglia, DDC values were positively correlated with ADC values in HIV-positive patients (right basal ganglia: r = 0.832, p = 0.000; left basal ganglia: r = 0.770, p = 0.001) as well as in healthy cases (right basal ganglia: r = 0.927, p = 0.001; left basal ganglia: r = 0.878, p = 0.004). Receiver operating characteristic (ROC) curve analysis yielded area under the ROC curve (Az) values of 0.817 (p = 0.014 < 0.05) in the left basal ganglia. The sensitivity and specificity were 62.5% and 86.7%, respectively. CONCLUSION Through the study of asymptomatic HIV-positive subjects when b < 1000 s mm(-2), we can see stretched-exponential model DWI can provide more information than mono-exponential model DWI. ADVANCES IN KNOWLEDGE Multi-b-value DWI was performed in subjects with HIV. DWI measurements could be neuroimaging biomarkers of cerebral injury in the course of HIV infection.
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Affiliation(s)
- Da-Zhen Jiang
- 1 Key Laboratory of Artificial Micro- and Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Yang Zhong
- 1 Key Laboratory of Artificial Micro- and Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Ding-Yi Zhou
- 1 Key Laboratory of Artificial Micro- and Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Wei-Qing Wu
- 1 Key Laboratory of Artificial Micro- and Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Guang-Yao Wu
- 2 Medical Imaging Department of the Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Hong Quan
- 1 Key Laboratory of Artificial Micro- and Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China
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Performance of Apparent Diffusion Coefficient Values and Conventional MRI Features in Differentiating Tumefactive Demyelinating Lesions From Primary Brain Neoplasms. AJR Am J Roentgenol 2016; 205:1075-85. [PMID: 26496556 DOI: 10.2214/ajr.14.13970] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Tumefactive demyelinating lesions (TDLs) remain one of the most common brain lesions to mimic a brain tumor, particularly primary CNS lymphoma (PCNSL) and high-grade gliomas. The purpose of our study was to evaluate the ability of apparent diffusion coefficient (ADC) values and conventional MRI features to differentiate TDLs from PCNSLs and high-grade gliomas. MATERIALS AND METHODS Seventy-five patients (24 patients with TDLs, 28 with PCNSLs, and 23 with high-grade gliomas) with 168 brain lesions (70 TDLs, 68 PCNSLs, and 30 high-grade gliomas) who underwent DWI before surgery or therapy were included in the study. Minimum ADC (ADC(min)) and average ADC (ADC(avg)) values were calculated for each lesion. ANOVA and ROC analyses were performed. ROC analyses were also performed for the presence of incomplete rim enhancement and for the number of lesions. Multiple-variable logistic regression with ROC analysis was then performed to evaluate performance in multiple-variable models. RESULTS ADC(min) was statistically significantly higher (p < 0.01) in TDLs (mean, 0.886; 95% CI, 0.802-0.931) than in PCNSLs (0.547; 95% CI, 0.496-0.598) and high-grade gliomas (0.470; 95% CI, 0.385-0.555). (All ADC values in this article are reported in units of × 10(-3) mm(2)/s.) ADC(avg) was statistically significantly higher (p < 0.01) in TDLs (mean, 1.362; 95% CI, 1.268-1.456) than in PCNSLs (0.990; 95% CI, 0.919-1.061) but not in high-grade gliomas (1.216; 95% CI, 1.074-1.356). Multiple-variable models showed statistically significant individual effects and superior diagnostic performance on ROC analysis. CONCLUSION TDLs can be diagnosed on preoperative MRI with a high degree of specificity; MRI features of incomplete rim enhancement, high ADC values, and a large number of lesions individually increase the probability and diagnostic confidence that a lesion is a TDL.
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Mabray MC, Barajas RF, Villanueva-Meyer JE, Zhang CA, Valles FE, Rubenstein JL, Cha S. The Combined Performance of ADC, CSF CXC Chemokine Ligand 13, and CSF Interleukin 10 in the Diagnosis of Central Nervous System Lymphoma. AJNR Am J Neuroradiol 2016; 37:74-9. [PMID: 26381553 DOI: 10.3174/ajnr.a4450] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/12/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CXC chemokine ligand 13 and interleukin 10 have emerged as CSF biomarkers for the diagnosis of CNS lymphoma. Our hypothesis is that the combined use of ADC, CXC chemokine ligand 13, and interleukin 10 will result in increased diagnostic performance compared with the use of ADC values alone. MATERIALS AND METHODS Eighty-seven patients were included in this study, including 43 with CNS lymphoma and 44 without CNS lymphoma (21 metastases, 14 high-grade gliomas, 9 tumefactive demyelinating lesions) who had undergone CSF proteomic analysis and had a new enhancing mass on brain MR imaging. Average ADC was derived by contouring the contrast-enhancing tumor volume. Group means were compared via t tests for average ADC, CXC chemokine ligand 13, and interleukin 10. Receiver operating characteristic analysis was performed for each individual variable. Multiple-variable logistic regression with receiver operating characteristic analysis was performed, and the multiple-variable receiver operating characteristic was compared with single-variable receiver operating characteristics. RESULTS The average ADC was lower and CSF CXC chemokine ligand 13 and interleukin 10 values were higher in CNS lymphoma (P < .001). Areas under the curve ranged from 0.739 to 0.832 for single-variable ROC. Multiple-variable logistic regression yielded statistically significant individual effects for all 3 variables in a combined model. Multiple-variable receiver operating characteristics (area under the curve, 0.928) demonstrated statistically significantly superior diagnostic performance compared with the use of single variables alone. CONCLUSIONS The combined use of ADC, CSF CXC chemokine ligand 13, and interleukin 10 results in increased diagnostic performance for the diagnosis of CNS lymphoma. This finding highlights the importance of CSF analysis when the diagnosis of CNS lymphoma is considered on the basis of MR imaging.
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Affiliation(s)
- M C Mabray
- From the Departments of Radiology and Biomedical Imaging (M.C.M., R.F.B., J.E.V.-M., C.A.Z., F.E.V., S.C.)
| | - R F Barajas
- From the Departments of Radiology and Biomedical Imaging (M.C.M., R.F.B., J.E.V.-M., C.A.Z., F.E.V., S.C.)
| | - J E Villanueva-Meyer
- From the Departments of Radiology and Biomedical Imaging (M.C.M., R.F.B., J.E.V.-M., C.A.Z., F.E.V., S.C.)
| | - C A Zhang
- From the Departments of Radiology and Biomedical Imaging (M.C.M., R.F.B., J.E.V.-M., C.A.Z., F.E.V., S.C.) Epidemiology and Biostatistics (C.A.Z.)
| | - F E Valles
- From the Departments of Radiology and Biomedical Imaging (M.C.M., R.F.B., J.E.V.-M., C.A.Z., F.E.V., S.C.)
| | | | - S Cha
- From the Departments of Radiology and Biomedical Imaging (M.C.M., R.F.B., J.E.V.-M., C.A.Z., F.E.V., S.C.) Neurological Surgery (S.C.), University of California San Francisco, San Francisco, California
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Abstract
There is a wide variety of intra-axial primary and secondary brain neoplasms. Many of them have characteristic imaging features while other tumors can present in a similar fashion. There are peculiar posttreatment imaging phenomena that can present as intra-axial mass-like lesions (such as pseudoprogression or radiation necrosis), further complicating the diagnosis and clinical follow-up of patients with intracerebral tumors. The purpose of this chapter is to present a general overview of the most common intra-axial brain tumors and peculiar posttreatment changes that are very important in the diagnosis and clinical follow-up of patients with brain tumors.
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Affiliation(s)
- Otto Rapalino
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | - Tracy Batchelor
- Departments of Neurology and Radiation Oncology, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - R Gilberto González
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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50
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Abstract
The advances in diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and functional magnetic resonance imaging (fMRI) over the last 20 years have vastly contributed to improving the understanding of the brain structure and function in patients with many diseases of the central nervous system (CNS). DWI is commonly used, for instance, in the diagnostic workup of stroke, CNS neoplasia, and rapidly progressive dementia cases. The new DTI methods provide more specific information about the most destructive aspects of tumors, neurodegenerative dementia, and multiple sclerosis pathology and give a more complete picture of the complex pathologic mechanisms of these conditions. More recently, fMRI has provided insight to the mechanisms of brain adaptation and plasticity to damage related to many neurologic conditions and has further extended our ability to understand the functional significance of pathologic changes in these diseases. Although at present fMRI does not have a role in the diagnosis, routine assessment, and monitoring of neurologic diseases, significant efforts are under way in order to achieve harmonization of both acquisition and postprocessing procedures, which are likely to contribute to a significant change of the clinical scenario.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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