Sasaki Goh, Uetani Hiroyuki, Kuroda Jun-Ichiro, Kitajima Mika, Ishiuchi Soichiro, Sato Kanako, Wang Yi, Mukasa Akitake, Hirai Toshinori
Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Neuroradiology. 2025 Mar;67(3):541-551. doi: 10.1007/s00234-024-03511-y. Epub 2024 Dec 19.
In the 2016 WHO Classification of Lymphoid Tissue Neoplasms, co-expression of MYC and BCL2 is newly designated as double expressor lymphoma. Patients with primary central nervous system lymphoma with double expressor (DE-PCNSL) have been reported to have a higher risk of recurrence and a worse prognosis than those with PCNSL without double expressor (non-DE-PCNSL). The aim of this study was to determine whether DE-PCNSL has characteristic clinical and MR imaging features compared to non-DE-PCNSL.
This study included 36 immunocompetent patients with PCNSL, including 16 with double expressor and 20 without double expressor. The enhancement pattern and the values of apparent diffusion coefficient (ADC), relative cerebral blood volume (rCBV), leakage-corrected rCBV, and K2 at enhancing lesions were compared between the DE-PCNSL and non-DE-PCNSL groups. The mean and minimum values from the ROI on ADC maps were designated as ADC and ADC, respectively. The data of rCBV, leakage-corrected rCBV and K2 were obtained from dynamic susceptibility contrast (DSC) perfusion MRI. The Kaplan-Meier method was used to estimate progression-free survival (PFS) differences.
DE-PCNSL was significantly more common in women (12 of 16 patients, 75%) compared to non-DE-PCNSL (7 of 20 patients, 35%; P =.02). The rCBV ratio and leakage-corrected rCBV ratio were significantly lower in DE-PCNSL compared to non-DE-PCNSL (P =.02 and P =.03, respectively). There was no significant difference in the enhancement pattern and ADC, ADC and K2 values between the two groups. DE-PCNSL tended to have a shorter PFS than non-DE-PCNSL, although the difference was not significant.
rCBV and leakage-corrected rCBV may help differentiate double-expressor from non-double-expressor subtypes in PCNSL.
在2016年世界卫生组织淋巴组织肿瘤分类中，MYC和BCL2的共表达被新定义为双表达淋巴瘤。据报道，原发性中枢神经系统双表达淋巴瘤（DE-PCNSL）患者的复发风险高于无双表达的原发性中枢神经系统淋巴瘤（PCNSL）患者（非DE-PCNSL），且预后更差。本研究的目的是确定与非DE-PCNSL相比，DE-PCNSL是否具有特征性的临床和磁共振成像特征。
本研究纳入了36例免疫功能正常的PCNSL患者，其中16例为双表达患者，20例为无双表达患者。比较DE-PCNSL组和非DE-PCNSL组增强病灶的强化方式以及表观扩散系数（ADC）、相对脑血容量（rCBV）、渗漏校正rCBV和K2值。ADC图上感兴趣区的平均值和最小值分别定义为ADC和ADC。rCBV、渗漏校正rCBV和K2的数据来自动态磁敏感对比（DSC）灌注磁共振成像。采用Kaplan-Meier法估计无进展生存期（PFS）差异。
与非DE-PCNSL（20例患者中的7例，35%；P = 0.02）相比，DE-PCNSL在女性中更为常见（16例患者中的12例，75%）。与非DE-PCNSL相比，DE-PCNSL的rCBV比值和渗漏校正rCBV比值显著更低（分别为P = 0.02和P = 0.03）。两组之间的强化方式以及ADC、ADC和K2值无显著差异。DE-PCNSL的PFS往往比非DE-PCNSL短，尽管差异不显著。
rCBV和渗漏校正rCBV可能有助于区分PCNSL中的双表达亚型和非双表达亚型。
