Cheewadhanaraks Sunpob, Rapalino Otto
Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand.
J Neuroimaging. 2025 Jul-Aug;35(4):e70061. doi: 10.1111/jon.70061.
Intravascular lymphoma (IVL) is a rare and aggressive lymphoma subtype that poses diagnostic challenges due to its nonspecific clinical presentation. This study aimed to evaluate the imaging findings of this disease in the CNS and to assess the diagnostic potential of advanced imaging techniques, including dynamic susceptibility contrast (DSC) perfusion, magnetic resonance spectroscopy (MRS), and fluorine-18 fluorodeoxyglucose (FDG) PET.
Twenty-one pathologically confirmed cases of IVL with CNS involvement were evaluated. Two cases underwent DSC perfusion, three underwent MRS, and three underwent FDG PET.
Ninety percent of patients had intracranial imaging findings. The most common imaging pattern on brain MRI was infarct-like lesions (68%), followed by mass-like enhancement and nonspecific white matter changes (11% each). The remaining findings included enhancing lesions without mass effect and a central pontine T2/fluid-attenuated inversion recovery hyperintensity, each observed in one patient. T2* imaging abnormalities were found in 60% of cases. Vascular irregularity on noninvasive angiographic imaging was observed in 30% of cases. Spinal intradural involvement was found in four cases (19%), including three cases with nerve root enhancement and one case with spinal cord infarction. MRS showed variable choline/creatine ratios elevation in two out of three cases. No cases showed apparent cerebral blood volume elevation on DSC perfusion or increased uptake on FDG PET.
Several imaging findings can be observed in CNS IVL, with infarct-like lesions being the most common. Awareness of these imaging features is crucial for the accurate diagnosis of this challenging entity.
血管内淋巴瘤（IVL）是一种罕见且侵袭性的淋巴瘤亚型，因其临床表现不具特异性而带来诊断挑战。本研究旨在评估该疾病在中枢神经系统（CNS）中的影像学表现，并评估包括动态磁敏感对比（DSC）灌注、磁共振波谱（MRS）和氟代脱氧葡萄糖（FDG）PET在内的先进成像技术的诊断潜力。
对21例经病理证实累及CNS的IVL病例进行评估。2例接受DSC灌注，3例接受MRS检查，3例接受FDG PET检查。
90%的患者有颅内影像学表现。脑MRI上最常见的影像学模式为梗死样病变（68%），其次为肿块样强化和非特异性白质改变（各占11%）。其余表现包括无占位效应的强化病变和1例患者观察到的桥脑中央T2加权像/液体衰减反转恢复序列高信号。60%的病例发现T2*成像异常。30%的病例在无创血管造影成像上观察到血管不规则。4例（19%）发现脊髓硬膜内受累，包括3例神经根强化和1例脊髓梗死。MRS显示3例中有2例胆碱/肌酸比值升高。DSC灌注未发现明显脑血容量升高或FDG PET摄取增加的病例。
CNS-IVL可观察到多种影像学表现，梗死样病变最为常见。认识这些影像学特征对于准确诊断这一具有挑战性的疾病至关重要。
