Department of Neurooncology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Inserm, CNRS, UMR S 1127, ICM, IHU, Paris, France.
Department of Neuroradiology, APHP Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
J Neurooncol. 2024 Aug;169(1):51-60. doi: 10.1007/s11060-024-04694-3. Epub 2024 Jun 12.
Immunosuppression is a well-established risk factor for primary central nervous system lymphomas (PCNSLs), which present in this context distinct radiological characteristics. Our aim was to describe the radiological evolution of treated PCNSL in immunocompromised patients and suggest adapted MRI response criteria.
We conducted a multicenter retrospective study of patients from the French LOC, K-Virogref and CANCERVIH network databases and enrolled adult immunocompromised patients with newly diagnosed PCNSL.
We evaluated the baseline, intermediate, end-of-treatment and follow-up MRI data of 31 patients (9 living with HIV, 16 with solid organ transplantation and 6 with an autoimmune disease under chronic immunosuppressive therapy). At baseline, 23/30 (77%) patients had necrotic lesions with ring enhancement and 28% of the lesions were hemorrhagic. At the end of the first-line treatment, 12/28 (43%) patients could not be classified according to the IPCG criteria. Thirteen of 28 (46%) patients still harbored contrast enhancement, and 11/28 (39%) patients had persistent large necrotic lesions with a median diameter of 15 mm. These aspects were not associated with a pejorative outcome and progressively diminished during follow-up. Six patients relapsed; however, we failed to identify any neuroimaging risk factors on the end-of-treatment MRI.
In immunocompromised patients, PCNSLs often harbor alarming features on end-of-treatment MRI, with persistent contrast-enhanced lesions frequently observed. However, these aspects seemed to be related to the necrotic and hemorrhagic nature of the lesions and were not predictive of a pejorative outcome. Specific response criteria for this population are thereby proposed.
免疫抑制是原发性中枢神经系统淋巴瘤（PCNSL）的一个公认的危险因素，在这种情况下，PCNSL 具有独特的放射学特征。我们的目的是描述免疫抑制患者中治疗后 PCNSL 的放射学演变，并提出适应性 MRI 反应标准。
我们对法国 LOC、K-Virogref 和 CANCERVIH 网络数据库中的患者进行了一项多中心回顾性研究，并纳入了新诊断为 PCNSL 的成年免疫抑制患者。
我们评估了 31 名患者的基线、中期、治疗结束和随访 MRI 数据（9 名 HIV 感染者、16 名实体器官移植患者和 6 名自身免疫性疾病慢性免疫抑制治疗患者）。在基线时，23/30（77%）患者有坏死性病变伴环状增强，28%的病变为出血性。在一线治疗结束时，12/28（43%）患者根据 IPCG 标准无法分类。13/28（46%）患者仍有对比增强，11/28（39%）患者仍有大的坏死性病变，直径中位数为 15 毫米。这些方面与不良结局无关，并在随访过程中逐渐减少。6 名患者复发；然而，我们未能在治疗结束时的 MRI 上识别出任何神经影像学危险因素。
在免疫抑制患者中，PCNSL 在治疗结束时的 MRI 上常具有令人担忧的特征，常观察到持续的增强病变。然而，这些方面似乎与病变的坏死和出血性质有关，并不预示不良结局。因此，提出了针对该人群的特定反应标准。
