Lorenzo Valentina, Ribeiro João, Bernardini Marco, Mínguez Juan J, Moral Meritxell, Blanco Carlos, Loncarica Tina, Gamito Araceli, Pumarola Martí
Neurología Veterinaria, Getafe, Madrid, Spain.
Referência Veterinária, Cascais, Portugal.
Front Vet Sci. 2022 Oct 20;9:980414. doi: 10.3389/fvets.2022.980414. eCollection 2022.
This multicentric retrospective study describes the clinical and MRI features and pathological studies of spinal lymphoma in 27 cats. MRI characteristics and their possible correlations with histopathological findings were studied. The most frequent neurological signs were rapidly progressive paraparesis (62.9%) or paraplegia (22.2%). Bimodal age distribution was found with 40.7% of cats aged ≤2.5 years (63.6% of them FeLV positive), and 44.4% of cats aged ≥8 years (16.7% of them FeLV positive). Spinal lymphoma was generally presented on MRI as an ill-defined epidural focal lesion with moderate to severe spinal cord compression, expanding more than one vertebral body. MRI lesions were typically localized in the lumbar vertebral segment ( = 0.01), circumferential to the spinal cord ( = 0.04), hyperintense on T2-weighted sequences ( = 4.3e-06), and isointense on T1-weighted sequences ( = 8.9e-07). The degree and pattern of contrast enhancement were variable. Other morphological patterns included paravertebral masses with extension into the vertebral canal and lesions centered in the spinal nerve roots. Involvement of vertebrae and adjacent spinal soft tissues was present in 74% of cases when present vertebral involvement was characterized by cortical sparing. When follow-up MRI studies ( = 4) were performed after treatment new lesions of similar nature but different localizations and extension were observed. Confirmation of spinal lymphoma was performed by CSF analysis in 4/27 (14.8%) of cases, by FNA in 6/27 (22.2%) of cases, by surgical biopsy in 10/27 (37%) of cases, by FNA and surgical biopsy in 1/27 (3.7%) of cases, by CSF, FNA, surgical biopsy and postmorten examination in 1/27 (3.7%) of cases, and postmorten studies in 5/27 (18.5%) of cases. Antemortem diagnosis was achieved in 22/27 (81.5%) cats. The presence of necrosis in histopathological studies as an unfavorable prognostic indicator of survival was significantly more probable when lesions were not hyperintense on T2-weighted sequences ( = 0.017). Spinal lymphoma in cats is a complex entity with heterogeneous imaging and histopathological appearance. However, certain MRI features may support a tentative diagnosis, which in a group of cases can be confirmed when combined with the CSF findings. For the rest of the cases, tissue sampling assisted by imaging findings remains necessary for definitive diagnosis.
这项多中心回顾性研究描述了27只猫脊柱淋巴瘤的临床、MRI特征及病理研究情况。研究了MRI特征及其与组织病理学结果的可能相关性。最常见的神经症状是快速进展性轻截瘫（62.9%）或截瘫（22.2%）。发现年龄呈双峰分布，40.7%的猫年龄≤2.5岁（其中63.6%为猫白血病病毒阳性），44.4%的猫年龄≥8岁（其中16.7%为猫白血病病毒阳性）。脊柱淋巴瘤在MRI上通常表现为边界不清的硬膜外局灶性病变，伴有中度至重度脊髓压迫，累及一个以上椎体。MRI病变通常位于腰椎节段（ = 0.01），围绕脊髓（ = 0.04），在T2加权序列上呈高信号（ = 4.3e - 06），在T1加权序列上呈等信号（ = 8.9e - 07）。对比增强的程度和模式各不相同。其他形态学模式包括椎旁肿块延伸至椎管以及以脊神经根为中心的病变。当存在椎体受累时，74%的病例出现椎体和相邻脊柱软组织受累，其特征为皮质未受累。治疗后进行随访MRI检查（ = 4）时，观察到性质相似但定位和范围不同的新病变。27例中有4例（14.8%）通过脑脊液分析确诊脊柱淋巴瘤，6例（22.2%）通过细针穿刺抽吸活检确诊，10例（37%）通过手术活检确诊，1例（3.7%）通过细针穿刺抽吸活检和手术活检确诊，1例（3.7%）通过脑脊液、细针穿刺抽吸活检、手术活检及死后检查确诊，5例（18.5%）通过死后研究确诊。27只猫中有22只（81.5%）实现了生前诊断。当病变在T2加权序列上不呈高信号时，组织病理学研究中坏死作为生存不良预后指标的可能性显著更高（ = 0.017）。猫脊柱淋巴瘤是一个复杂的实体，具有异质性的影像学和组织病理学表现。然而，某些MRI特征可能支持初步诊断，在一组病例中，结合脑脊液检查结果可得到证实。对于其余病例，为明确诊断，借助影像学结果进行组织采样仍然是必要的。
