Silverman Rebecca F, Abramson David H, Canestraro Julia, Grommes Christian, Francis Jasmine H
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA.
Br J Ophthalmol. 2025 Mar 20;109(4):504-509. doi: 10.1136/bjo-2024-325999.
BACKGROUND/AIMS: To determine if patients with vitreoretinal lymphoma (VRL) and concomitant central nervous system lymphoma (CNSL) may present without brain MRI findings, but possess cerebrospinal fluid (CSF) suspicious for lymphoma.
This was a retrospective, single-centre, observational study evaluating patients with a diagnosis or suspicion of VRL seen at Memorial Sloan Kettering Cancer Center between 2006 and 2024. Patients were included if the final diagnosis was biopsy-proven CNSL and both MRI brain with and without contrast±CSF evaluation (obligatory for inclusion if MRI negative) were performed at the initial diagnostic workup. Patients were excluded if CNS disease treatment (brain, spine or CSF) preceded ocular disease. Patients with prior extra-CNS disease were included. Clinical records and radiographic imaging were retrospectively reviewed and relevant data were recorded for each patient. We evaluated the proportion of patients with MRI negative and CSF suspicious for lymphoma. Subgroup analysis included imaging features, pathology, treatment and disease course.
We identified 65 patients. Of the 65 patients at the presentation of VRL, 30 had negative MRI brain and CSF, 16 had positive brain MRI and negative CSF and 8 had both positive MRI brain and CSF. 11 (16.9%) had CSF suspicious for lymphoma without positive findings on MRI of the brain. In this subgroup, the median age was 66 years (range 49-82) and 36% were female. 86% of these patients were asymptomatic neurologically. 73% underwent systemic treatment. At a mean 3 years follow-up, 91% of patients were living.
In patients with suspected VRL, it is possible to have CSF test positive for lymphoma in the context of negative brain MRI. This suggests, when evaluating VRL patients for concomitant CNS disease, CSF evaluation leads to earlier detection and systemic treatment, even when MRI brain findings are negative. In our cohort, an absence of CSF evaluation in the context of negative brain MRI could have missed 16.9% of patients with CNS lymphoma.
背景/目的：确定玻璃体视网膜淋巴瘤（VRL）合并中枢神经系统淋巴瘤（CNSL）的患者是否可能在脑部MRI检查无异常发现，但脑脊液（CSF）检查结果可疑为淋巴瘤。
这是一项回顾性、单中心观察性研究，评估2006年至2024年期间在纪念斯隆凯特琳癌症中心诊断或疑似患有VRL的患者。如果最终诊断为经活检证实的CNSL，且在初始诊断检查时进行了有对比剂和无对比剂的脑部MRI检查以及CSF评估（如果MRI为阴性则必须进行以纳入研究），则纳入患者。如果中枢神经系统疾病治疗（脑部、脊柱或CSF）先于眼部疾病，则排除患者。有既往中枢神经系统外疾病的患者纳入研究。对临床记录和影像学检查进行回顾性分析，并记录每位患者的相关数据。我们评估了MRI阴性且CSF检查结果可疑为淋巴瘤的患者比例。亚组分析包括影像学特征、病理学、治疗和病程。
我们共纳入65例患者。在VRL初诊时的65例患者中，30例脑部MRI和CSF检查均为阴性，l6例脑部MRI阳性但CSF检查阴性，8例脑部MRI和CSF检查均为阳性。11例（16.9%）患者CSF检查结果可疑为淋巴瘤，但脑部MRI未发现阳性结果。在该亚组中，中位年龄为66岁（范围49 - 82岁），36%为女性。这些患者中86%无神经系统症状。73%接受了全身治疗。平均随访3年时，91%的患者仍存活。
在疑似VRL的患者中，脑部MRI检查阴性时CSF检查结果仍可能为淋巴瘤阳性。这表明，在评估VRL患者是否合并中枢神经系统疾病时，即使脑部MRI检查结果为阴性，CSF评估也能实现更早的检测和全身治疗。在我们的队列中，脑部MRI检查阴性时未进行CSF评估可能会漏诊16.9%的中枢神经系统淋巴瘤患者。
