Abstract：
BACKGROUND: A key limitation in treatment initiation in primary central nervous system lymphoma (PCNSL) is the diagnostic delay caused by lack of recognition of a lesion as a possible lymphoma, steroid initiation, and lesion involution, often resulting in an inconclusive biopsy result. We highlight the importance of multiparametric magnetic resonance imaging (MRI), which incorporates diffusion-weighted imaging, dynamic susceptibility contrast-enhanced perfusion-weighted imaging, and proton magnetic resonance spectroscopy in addition to standard MRI sequences in resolving diagnostic uncertainty for PCNSL.
METHODS: At our center, a consecutive series of 10 patients with histology-proven PCNSL (specifically, diffuse large B-cell lymphoma of the central nervous system) underwent multiparametric MRI. We retrospectively analyzed qualitative and semiquantitative parameters and assessed their radiological concordance for this diagnosis.
RESULTS: We noted overall low apparent diffusion coefficient on diffusion-weighted imaging (mean minimum apparent diffusion coefficient of 0.74), high percentage signal recovery on perfusion-weighted imaging (mean 170%), a high choline-to-creatine ratio, and a high-grade lipid peak on proton magnetic resonance spectroscopy giving an appearance of twin towers. Of 10 patients, 9 had MRI findings concordant for PCNSL, defined as at least 3 of 4 parameters being consistent for PCNSL.
CONCLUSIONS: Concordance between these imaging multiparametric modalities could be used as a radiological predictor of PCNSL, reducing diagnostic delays, providing a more accurate biopsy target, and resulting in quicker treatment initiation.
METHODS: At our center, a consecutive series of 10 patients with histology-proven PCNSL (specifically, diffuse large B-cell lymphoma of the central nervous system) underwent multiparametric MRI. We retrospectively analyzed qualitative and semiquantitative parameters and assessed their radiological concordance for this diagnosis.
RESULTS: We noted overall low apparent diffusion coefficient on diffusion-weighted imaging (mean minimum apparent diffusion coefficient of 0.74), high percentage signal recovery on perfusion-weighted imaging (mean 170%), a high choline-to-creatine ratio, and a high-grade lipid peak on proton magnetic resonance spectroscopy giving an appearance of twin towers. Of 10 patients, 9 had MRI findings concordant for PCNSL, defined as at least 3 of 4 parameters being consistent for PCNSL.
CONCLUSIONS: Concordance between these imaging multiparametric modalities could be used as a radiological predictor of PCNSL, reducing diagnostic delays, providing a more accurate biopsy target, and resulting in quicker treatment initiation.
摘要：
目的：原发性中枢神经系统淋巴瘤（PCNSL）早期治疗的一个关键限制是由于未将病变识别为可能的淋巴瘤而导致的诊断延迟，类固醇起始，和病变退化，经常导致活检不确定。我们强调了多参数磁共振成像(MPMRI)的重要性，结合了扩散加权成像(DWI)，除标准MRI序列外，动态磁化率对比增强灌注加权成像（DSC-PWI）和质子磁共振波谱（1H-MRS）可解决PCNSL的诊断不确定性。
方法：我们在我们中心连续展示了10例经组织学证实的PCNSL患者（特别是，中枢神经系统的弥漫性大B细胞淋巴瘤）接受了多参数MRI。我们回顾性分析定性和半定量参数，并评估其诊断的放射学一致性。
结果：我们注意到DWI上的表观扩散系数总体较低（平均ADCmin为0.74），灌注加权成像的高信号恢复百分比(平均170%)，高胆碱-肌酸比率和MRS上的高级脂质峰，呈现“双塔”外观。10例患者中有9例的MRMRI表现与PCNSL一致，定义为4个参数中至少有3个与PCNSL一致。
结论：我们建议这些成像多参数模式之间的一致性可以用作PCNSL的放射学预测因子，减少诊断延迟，提供更准确的活检目标，并导致更快的治疗开始。
方法：我们在我们中心连续展示了10例经组织学证实的PCNSL患者（特别是，中枢神经系统的弥漫性大B细胞淋巴瘤）接受了多参数MRI。我们回顾性分析定性和半定量参数，并评估其诊断的放射学一致性。
结果：我们注意到DWI上的表观扩散系数总体较低（平均ADCmin为0.74），灌注加权成像的高信号恢复百分比(平均170%)，高胆碱-肌酸比率和MRS上的高级脂质峰，呈现“双塔”外观。10例患者中有9例的MRMRI表现与PCNSL一致，定义为4个参数中至少有3个与PCNSL一致。
结论：我们建议这些成像多参数模式之间的一致性可以用作PCNSL的放射学预测因子，减少诊断延迟，提供更准确的活检目标，并导致更快的治疗开始。
