Villanueva-Castro Eliezer, Muñuzuri-Camacho Marco Antonio, Rodríguez-Hernández Luis A, Cacho-Díaz Bernardo, Guerrero-Juarez Vicente, Hernández Reséndiz Rebeca, Moncada-Habib Tomas, Villalobos-Díaz Rodolfo, Flores-Vázquez José Guillermo, Coutinho-Thomas Domingo J, Garcia-Gutierrez Jorge Omar, Gutierrez-Aceves Guillermo A, González-Aguilar Alberto
Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, USA.
Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX.
Cureus. 2025 Jul 22;17(7):e88495. doi: 10.7759/cureus.88495. eCollection 2025 Jul.
Introduction Primary central nervous system lymphoma (PCNSL) is a rare type of malignancy confined to the central nervous system. While histopathological analysis remains the gold standard for diagnosis, it is invasive and not always feasible. Percentage signal recovery (PSR) derived from perfusion-weighted magnetic resonance imaging (MRI) has emerged as a promising non-invasive biomarker for PCNSL. Objective This study aims to evaluate the diagnostic accuracy of PSR and relative cerebral blood volume (rCBV) in distinguishing PCNSL from other CNS mass lesions using perfusion MRI. Methods We conducted a retrospective study using the neuro-oncology database of a national referral center in Mexico. Patients with histopathological confirmation and available perfusion MRI were included in the analysis. Results From a total of 16,198 patients, 700 met the inclusion criteria and were classified as follows: PCNSL (n = 86), high-grade gliomas (HGGs; n = 435), metastases (n = 80), neuroinfections (n = 80), and pseudotumoral demyelinating disorders (PDDs) (n = 19). Mean rCBV for PCNSL was 1.1, HGGs 3.9, metastases 3.0, neuroinfections 0.5, and PDDs 0.9, while mean PSR for PCNSL was 176%, HGGs 92%, metastases 81%, neuroinfections 95%, and PDDs 91%, with a statistically significant difference for PCNSL (p ≤ 0.0003). Receiver operating characteristic (ROC) curve analysis showed that PSR was the only parameter with robust diagnostic performance. A PSR threshold of >110 yielded 98% sensitivity (95% CI: 90.7-100) and 99% specificity (95% CI: 91.3-100) for the diagnosis of PCNSL. Conclusion PSR demonstrated high diagnostic accuracy in differentiating PCNSL from other enhancing brain lesions and may be particularly valuable in patients with atypical presentations, multiple comorbidities, or nondiagnostic or contraindicated biopsies. PSR is a promising non-invasive imaging biomarker that warrants further prospective validation.
引言
原发性中枢神经系统淋巴瘤（PCNSL）是一种局限于中枢神经系统的罕见恶性肿瘤。虽然组织病理学分析仍然是诊断的金标准，但它具有侵入性，且并非总是可行。灌注加权磁共振成像（MRI）得出的百分比信号恢复（PSR）已成为一种有前景的PCNSL非侵入性生物标志物。
目的
本研究旨在评估PSR和相对脑血容量（rCBV）在使用灌注MRI区分PCNSL与其他中枢神经系统肿块病变中的诊断准确性。
方法
我们使用墨西哥一家国家转诊中心的神经肿瘤数据库进行了一项回顾性研究。分析纳入了经组织病理学证实且有可用灌注MRI的患者。
结果
在总共16198例患者中，700例符合纳入标准并分类如下：PCNSL（n = 86）、高级别胶质瘤（HGGs；n = 435）、转移瘤（n = 80）、神经感染（n = 80）和假瘤性脱髓鞘疾病（PDDs）（n = 19）。PCNSL的平均rCBV为1.1，HGGs为3.9，转移瘤为3.0，神经感染为0.5，PDDs为0.9，而PCNSL的平均PSR为176%，HGGs为92%，转移瘤为81%，神经感染为95%，PDDs为91%，PCNSL有统计学显著差异（p≤0.0003）。受试者操作特征（ROC）曲线分析表明，PSR是唯一具有强大诊断性能的参数。PSR阈值>110时，诊断PCNSL的敏感性为98%（95%CI：90.7 - 100），特异性为99%（95%CI：91.3 - 100）。
结论
PSR在区分PCNSL与其他强化脑病变方面显示出高诊断准确性，在表现不典型、有多种合并症或活检无诊断意义或禁忌的患者中可能特别有价值。PSR是一种有前景的非侵入性成像生物标志物，值得进一步进行前瞻性验证。
