Cetinoglu Yusuf Kenan, Sinci Kazım Ayberk, Horoz Merve, Gelal Fazıl
Department of Radiology, Health Science University Dr. Behçet Uz Children Disease and Surgery Training and Research Hospital, İzmir, Türkiye.
Department of Radiology, Kanuni Sultan Suleyman Education and Research Hospital, İstanbul, Türkiye.
Neuroradiology. 2025 Mar 17. doi: 10.1007/s00234-025-03594-1.
Differentiating between primary CNS lymphomas (PCNSL) and secondary CNS lymphomas (SCNSL) remains a challenge in imaging. The aim of this study was to differentiate histopathologically-proven PCNSL and SCNSL by using 25 qualitative VASARI and five other MRI features.
MRIs of 31 cases (19 PCNSL and 12 SCNSL) obtained between January 2010 and February 2022 were retrospectively reviewed. Two blinded readers independently evaluated images without knowledge of clinical data or whether CNS lymphoma was primary or secondary. The findings of each reader were recorded to assess interreader agreement. The results of two readers were evaluated by a senior neuroradiologist to reach a consensus. A statistical analysis was performed on the collected data.
Most VASARI features showed no statistically significant differences between the two groups, except for two features. Tumor location exhibited a statistically different distribution between PCNSL and SCNSL groups (p = 0.036). Proportion of edema was greater in the PCNSL group compared to the SCNSL group (p = 0.049). Among other MRI features, infratentorial involvement was more frequent in the SCNSL group (p = 0.014), while notch sign was more commonly detected in the PCNSL group (p = 0.027). Inter-reader agreement for VASARI features ranged from moderate to almost perfect, and for other MRI features, it ranged from fair to almost perfect.
Despite the challenges in distinguishing imaging features of PCNSL and SCNSL; frontal lobe location, a higher proportion of edema and the presence of a notch sign may indicate PCNSL, while infratentorial involvement may suggest SCNSL.
在影像学上区分原发性中枢神经系统淋巴瘤（PCNSL）和继发性中枢神经系统淋巴瘤（SCNSL）仍然是一项挑战。本研究的目的是通过使用25种定性的VASARI特征和其他五种MRI特征，在组织病理学证实的PCNSL和SCNSL之间进行鉴别。
回顾性分析2010年1月至2022年2月期间获得的31例病例（19例PCNSL和12例SCNSL）的MRI图像。两名不知情的阅片者在不了解临床数据以及中枢神经系统淋巴瘤是原发性还是继发性的情况下独立评估图像。记录每位阅片者的发现以评估阅片者间的一致性。由一位资深神经放射科医生评估两位阅片者的结果以达成共识。对收集到的数据进行统计分析。
除了两个特征外，大多数VASARI特征在两组之间没有统计学上的显著差异。肿瘤位置在PCNSL组和SCNSL组之间表现出统计学上不同的分布（p = 0.036）。与SCNSL组相比，PCNSL组的水肿比例更大（p = 0.049）。在其他MRI特征中，幕下受累在SCNSL组中更常见（p = 0.014），而切迹征在PCNSL组中更常被检测到（p = 0.027）。VASARI特征的阅片者间一致性从中度到几乎完美，而其他MRI特征的阅片者间一致性从一般到几乎完美。
尽管在区分PCNSL和SCNSL的影像学特征方面存在挑战，但额叶位置、较高的水肿比例和切迹征的存在可能提示PCNSL，而幕下受累可能提示SCNSL。
