Arendt Christophe T, Löhlau Marie, Röder Linda, Burger Michael C, Hattingen Elke, Weidauer Stefan
Institute of Neuroradiology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany.
Dr. Senckenberg Institute of Neurooncology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany.
J Neurooncol. 2025 Jul 12. doi: 10.1007/s11060-025-05124-8.
The prevalence of susceptibility effects (SE) on T2*-weighted imaging (WI) and susceptibility-WI (SWI) in primary large B-cell lymphoma (IP-LBCL) of the central nervous system (CNS) and diffuse LBCL (DLBCL) with secondary CNS lymphoma (SCNSL) remains debated. This study aimed to clarify SE prevalence and their associations with primary versus secondary manifestations, immune status, corticosteroid treatment, and structural MRI features.
This retrospective, single-center study included histologically confirmed DLBCL cases (WHO ICD-10 C83.3) with intracerebral involvement (March 2011-November 2023). Subjects without cranial MRI or diagnostic susceptibility-based sequences were excluded. T2*WI and SWI were independently reviewed by two neuroradiologists for presence or absence of SE. Identified SE were classified into five types: punctate, linear, confluent, conglomerate, and/or ring-like. Lesion focality and morphology were assessed on T2WI and contrast-enhanced T1WI. Clinical data included extracranial lymphoma history, immune status, and corticosteroid initiation.
Among 128 cases (median age: 70 years [58-75]; 65 men), 119 (93%) had IP-LBCL and 9 (7%) had SCNSL. 110 (85.9%) subjects were immunocompetent. T2WI was available in 90 (70.3%) datasets and SWI in 38 (29.7%). SE detection was higher on SWI (71.1%) than T2WI (47.8%; P = 0.03). No association was found between SE and lymphoma type (P = 1.00). In IP-LBCL, immunosuppression was significantly associated with SE presence (P = 0.001; OR = 16.1, 95% CI: 2.89-304.79), while age, gender, and corticosteroid use (18.5%) were not. SE showed no significant associations with structural imaging features, including necrosis.
SE are common in both IP-LBCL and SCNSL, particularly on SWI, and present with variable patterns unrelated to structural MRI features. In IP-LBCL, immunosuppression, but not pre-existing corticosteroid treatment, is significantly associated with the presence of SE.
中枢神经系统原发性大B细胞淋巴瘤（IP-LBCL）以及伴有继发性中枢神经系统淋巴瘤（SCNSL）的弥漫性大B细胞淋巴瘤（DLBCL）在T2*加权成像（WI）和磁敏感加权成像（SWI）上的磁敏感效应（SE）发生率仍存在争议。本研究旨在阐明SE的发生率及其与原发性和继发性表现、免疫状态、皮质类固醇治疗以及结构磁共振成像特征之间的关联。
这项回顾性单中心研究纳入了组织学确诊的伴有脑内受累的DLBCL病例（世界卫生组织国际疾病分类第10版C83.3）（2011年3月至2023年11月）。排除没有头颅磁共振成像或基于诊断性磁敏感序列的受试者。由两名神经放射科医生独立评估T2*WI和SWI上是否存在SE。识别出的SE分为五种类型：点状、线状、融合状、团块状和/或环状。在T2WI和对比增强T1WI上评估病变的局灶性和形态。临床数据包括颅外淋巴瘤病史、免疫状态和皮质类固醇的起始使用情况。
在128例患者中（中位年龄：70岁[58 - 75岁]；65名男性），119例（93%）患有IP-LBCL，9例（7%）患有SCNSL。110例（85.9%）受试者免疫功能正常。90例（70.3%）数据集有T2WI，38例（29.7%）有SWI。SWI上SE的检出率（71.1%）高于T2WI（47.8%；P = 0.03）。未发现SE与淋巴瘤类型之间存在关联（P = 1.00）。在IP-LBCL中，免疫抑制与SE的存在显著相关（P = 0.001；OR = 16.1，95% CI：2.89 - 304.79），而年龄、性别和皮质类固醇的使用（18.5%）则无此关联。SE与包括坏死在内的结构成像特征无显著关联。
SE在IP-LBCL和SCNSL中均很常见，尤其是在SWI上，并且呈现出与结构磁共振成像特征无关的多种模式。在IP-LBCL中，免疫抑制而非预先存在的皮质类固醇治疗与SE的存在显著相关。
