Intravascular lymphoma: magnetic resonance imaging correlates of disease dynamics within the central nervous system

BACKGROUND

Intravascular lymphoma (IVL) is a rare non-Hodgkin's lymphoma with relative predilection for the central nervous system. In the absence of extraneural manifestations, the disease is not recognised until autopsy in the majority of cases underlining the need for new clinical markers.

METHODS

This is a retrospective series of five patients with IVL seen at a single institution over three years. An advanced magnetic resonance imaging (MRI) protocol was performed at various time points prior to diagnosis and during treatment.

RESULTS

MRI revealed multiple lesions scattered throughout the cerebral hemispheres; the brainstem, cerebellum, and spinal cord were less frequently involved. On initial presentation, hyperintense lesions were seen on diffusion weighted images suggestive of ischaemia in three of four patients in whom the images were obtained at that time point. In four patients lesions were also identifiable as hyperintense areas on fluid attenuated inversion recovery (FLAIR) sequences. Initial contrast enhancement was encountered in three cases. Diffusion weighted imaging lesions either vanished or followed the typical pattern of an ischaemic small vessel stroke with evolution of abnormal FLAIR signal followed by enhancement with gadolinium in the subacute stage and tissue loss in the chronic stage. Diffusion weighted imaging and FLAIR abnormalities proved to be partially reversible, correlating with the response to chemotherapy.

CONCLUSION

We provide the first detailed description of the dynamic pattern of diffusion weighted MRI in IVL. These patterns in combination with systemic findings may facilitate early diagnosis and serve as a new tool to monitor treatment response.

Clivus and cervical spinal osteomyelitis with epidural abscess presenting with multiple cranial neuropathies

A 65-year-old diabetic man with a history of otitis was admitted with headache, neck and shoulder pain and cranial nerve abnormalities including sixth, seventh and twelfth nerve palsies, hearing loss and ptosis. Lumbar puncture revealed an elevated CSF protein and pleocytosis. Imaging procedures demonstrated osteomyelitis of the clivus that involved the epidural space and extended within the prevertebral space to the cervical spine. The patient improved after treatment with antibiotics and immobilization of the neck. This case illustrates the importance of recognizing infections of the clivus in patients with cranial nerve abnormalities.

MR of the head and neck: comparison of fast spin-echo and conventional spin-echo sequences

PURPOSE

To compare conspicuousness of head and neck lesions on fast spin-echo sequences and conventional spin-echo sequences.

METHODS

Forty consecutive patients with 61 head and neck lesions were evaluated. Lesion conspicuousness was qualitatively compared on conventional spin-echo and fast spin-echo sequences, using both spin-density and T2-weighted images. Thirty-six lesions had surgical or pathologic confirmation, and 25 were assigned a presumptive diagnosis based on clinical evaluation and imaging findings seen on conventional spin-echo T1- and T2-weighted sequences. Forty lesions were related to neoplasms; 21 lesions consisted of infectious, vascular, or inflammatory abnormalities.

RESULTS

Fast spin-echo sequences provided improved lesion conspicuousness in 91% of spin-density images, in 77% of T2-weighted images, and in 84% of the combined spin-density and T2-weighted images.

CONCLUSION

By providing shorter imaging times and equal or superior lesion conspicuousness, long-repetition-time fast spin-echo sequences can replace long-repetition-time conventional spin-echo sequences in evaluation of the head and neck.

Inversion-recovery fast spin-echo MR imaging: efficacy in the evaluation of head and neck lesions

To compare the efficacies of fast spin-echo (FSE) and inversion-recovery FSE (IRFSE) magnetic resonance (MR) imaging in evaluating head and neck disorders, the authors evaluated 46 lesions in 23 consecutive patients. Twenty-seven lesions were related to neoplasms; 19 lesions resulted from infectious, allergic, or radiation-induced inflammation. Conventional T1-weighted, FSE, and IRFSE images were obtained in all patients. The FSE and IRFSE images were qualitatively compared in an unblinded manner for conspicuity of lesion margins and extent. IRFSE imaging improved conspicuity of 22 lesions (48%) and showed equal conspicuity of 18 (39%). IRFSE imaging proved most useful for small lesions with long T2 relaxation times that were surrounded by fat. IRFSE imaging improved visibility of small optic nerve gliomas, salivary gland inflammation, peripheral nerve tumors, and small lymph nodes. Early changes secondary to spread of tumor across fascial planes were also well visualized with IRFSE sequences. In six lesions (13%) that did not have long T2 relaxation times, the FSE images provided better conspicuity. The authors conclude that by improving conspicuity of small lesions adjacent to or surrounded by fat, IRFSE sequences can supplement FSE sequences in imaging the head and neck.