Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Neuroradiol J. 2023 Aug;36(4):479-485. doi: 10.1177/19714009231154681. Epub 2023 Jan 30.
Primary central nervous system lymphoma (PCNSL) lesions often show avid contrast enhancement on T1-weighted contrast-enhanced MRI sequences. However, several case reports and a clinical study have described PCNSL in patients with no contrast enhancement on MRI. We assessed whether overall survival (OS) time was related to any tumor characteristics (lesion location, volume, and number; contrast enhancement; necrosis; proximity to the subarachnoid space; and edema) on MRI in patients with PCNSL.
We retrospectively reviewed records (MRI features, pathology, and survival data) of all patients at our institution with PCNSL who had been seen from, 2007 through 2017, and had undergone pretreatment MRI.
We identified 79 patients (42 men, 37 women) with a mean age at diagnosis of 61.7 ± 10.4 years. The mean OS duration was 44.6 ± 41.7 months. The most common pathological diagnosis (74 patients) was diffuse large B-cell lymphoma. No associations were found between OS time and lesion location, volume, and number; contrast enhancement; necrosis; proximity to the subarachnoid space; or edema. However, a sole patient with non-enhancing PCNSL on MRI was found to have low-grade disease, with prolonged survival (>83 months). Several other patients with leptomeningeal disease had a mean OS time of 80 months. Patients with hemorrhagic lesions had a mean OS of 25.5 months.
The survival time for patients with PCNSL may be longer than previously thought, especially for patients with leptomeningeal seeding and lesions with hemorrhagic components Also, non-enhancing tumors may be less aggressive than enhancing tumors.
原发性中枢神经系统淋巴瘤（PCNSL）病变在 T1 加权对比增强 MRI 序列上常表现为明显的对比增强。然而，有几例病例报告和一项临床研究描述了 MRI 上无对比增强的 PCNSL 患者。我们评估了 PCNSL 患者的 MRI 上肿瘤特征（病变位置、体积和数量；对比增强；坏死；与蛛网膜下腔的接近程度；和水肿）与总生存时间（OS）是否有关。
我们回顾性地审查了 2007 年至 2017 年间在我们机构就诊的所有 PCNSL 患者的病历（MRI 特征、病理和生存数据），并进行了预处理 MRI。
我们确定了 79 名患者（42 名男性，37 名女性），诊断时的平均年龄为 61.7 ± 10.4 岁。平均 OS 持续时间为 44.6 ± 41.7 个月。最常见的病理诊断（74 例）为弥漫性大 B 细胞淋巴瘤。OS 时间与病变位置、体积和数量、对比增强、坏死、与蛛网膜下腔的接近程度或水肿之间无相关性。然而，有一位 MRI 上表现为无增强的 PCNSL 的单一患者被发现为低级别疾病，生存时间延长（>83 个月）。其他一些患有软脑膜疾病的患者平均 OS 时间为 80 个月。有出血性病变的患者平均 OS 为 25.5 个月。
PCNSL 患者的生存时间可能比以前认为的要长，尤其是患有软脑膜播散和具有出血成分的病变的患者。此外，无增强的肿瘤可能比增强的肿瘤侵袭性更小。
