Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Eur J Neurol. 2022 Aug;29(8):2499-2504. doi: 10.1111/ene.15365. Epub 2022 May 4.
Central nervous system (CNS) B-cell lymphoma-mimicking demyelinating diseases creates a diagnostic dilemma. This study aimed to determine the specific magnetic resonance imaging (MRI) features of CNS B-cell lymphoma to facilitate the early identification of the disease.
We retrospectively reviewed the brain MRI of biopsy-confirmed CNS B-cell lymphoma patients. They were initially diagnosed with CNS demyelination, and these images were compared with those of actual patients with demyelinating diseases.
A total of 20 patients with CNS B-cell lymphoma and 12 patients with demyelination were included in this study. Cohesive enhancement with satellite enhancing foci surrounded by prominent non-enhancing areas of oedema is the major contrast-enhancing pattern of lymphoma patients, accounting for 81% (13) of patients with primary diffuse large B-cell lymphoma (DLBCL). This imaging pattern revealed a sensitivity of 81% and a specificity of 75% for lymphoma in the differential diagnosis between primary DLBCL and demyelinating disease in our cohort. Among these lesions, most of the nodules were located deeply, which yielded a specificity of 100% and a sensitivity of 69% for primary DLBCL. Enhancement in a single pattern (mainly ring-like, patchy or punctate; 57%) and no enhancement (30%) were commonly observed in demyelinating lesions, distinct from primary DLBCL (p < 0.05).
Lesions with cohesive enhancement and satellite foci on T1 contrast-enhanced imaging could be a specific hallmark of CNS B-cell lymphoma, suggesting the need to withdraw steroidal therapy and biopsy confirmation.
中枢神经系统（CNS）B 细胞淋巴瘤样脱髓鞘疾病造成诊断困境。本研究旨在确定 CNS B 细胞淋巴瘤的特定磁共振成像（MRI）特征，以帮助早期识别该疾病。
我们回顾性分析了经活检证实的 CNS B 细胞淋巴瘤患者的脑部 MRI。这些患者最初被诊断为 CNS 脱髓鞘疾病，并将这些图像与实际的脱髓鞘疾病患者的图像进行比较。
本研究共纳入 20 例 CNS B 细胞淋巴瘤患者和 12 例脱髓鞘患者。团块状强化伴卫星强化灶，周围环绕明显的水肿非强化区，是淋巴瘤患者的主要强化模式，占原发性弥漫性大 B 细胞淋巴瘤（DLBCL）患者的 81%（13 例）。这种影像学模式在我们的队列中，对原发性 DLBCL 和脱髓鞘疾病之间的鉴别诊断，对淋巴瘤的敏感性为 81%，特异性为 75%。在这些病变中，大多数结节位于深部，对原发性 DLBCL 的特异性为 100%，敏感性为 69%。脱髓鞘病变中常见单一强化模式（主要为环形、斑片状或点状；57%）和无强化（30%），与原发性 DLBCL 不同（p < 0.05）。
T1 对比增强成像上具有团块状强化和卫星灶的病变可能是 CNS B 细胞淋巴瘤的特异性标志，提示需要停用类固醇治疗并进行活检证实。
