Distinctive magnetic resonance imaging features in primary central nervous system lymphoma:A case report

BACKGROUND Primary central nervous system lymphoma(PCNSL)is a rare malignant tumor originating from the lymphatic hematopoietic system.It exhibits unique imaging manifestations due to its biological characteristics.CASE SUMMARY Magnetic resonance imaging(MRI)with diffusion-weighted imaging(DWI),perfusion-weighted imaging(PWI),and magnetic resonance spectroscopy was performed.The imaging findings showed multiple space-occupying lesions with low signal on T1-weighted imaging,uniform high signal on T2-weighted imaging,and obvious enhancement on contrast-enhanced scans.DWI revealed diffusion restriction,PWI demonstrated hypoperfusion,and spectroscopy showed elevated choline peak and decreased N-acetylaspartic acid.The patient's condition significantly improved after hormone shock therapy.CONCLUSION This case highlights the distinctive imaging features of PCNSL and their importance in accurate diagnosis and management.

Magnetic Resonance Imaging of Central Nervous System Lesions in HIV/AIDS: About 35 Cases in Libreville (Gabon)

Background: Sub-Saharan Africa is the region most affected by the Human Immunodeficiency Virus (HIV) with an increasing prevalence of related cognitive impairments. Magnetic Resonance Imaging (MRI) plays an important role in the early detection of lesions. This work aimed to describe the MRI aspects of different brain lesions occurred in HIV positive patients in our practice. Methods: This was a descriptive cross-sectional study that took place from June 2014 to July 2016 in the medical imaging department of the EL RAPHA private Polyclinic in Libreville, Gabon. It included all patients referred for imaging for the exploration of a Central Nervous System (CNS) lesions at MRI, based on clinical and/or paraclinical arguments. Results: Among the 39 patients included, 19 (48.7%) had a previous brain CT scan, 11 of which were normal (28.2%). Thirty-five (89.74%) patients had a pathological MRI. The main etiologies found were toxoplasmosis (37.14%), tuberculosis (17.14%), cerebral atrophy (17.14%) and HIV encephalitis (14.28%). Among the eleven patients with a normal Computer Tomography scan, the MRI found 7 abnormalities including 1 case of toxoplasmosis, 3 cases of HIV encephalitis and 3 cases of Progressive Multifocal Leukoencephalopathy (PML). Conclusion: MRI played an important role in the diagnosis of CNS disorders in HIV-infected individuals. It can be used to differentiate and characterize various brain lesions. Improving its accessibility in sub-Saharan Africa should contribute to better care for people living with HIV.

The Diagnostic Value of Brain Magnetic Resonance Imaging in Detecting CNS Diseases Among Advanced AIDS Patients

Objective To investigate the diagnostic value of brain magnetic resonance imaging in detecting central nervous system diseases among AIDS patients of different levels of T cells. Methods Total of 164 AIDS patients who did not receive antiviral treatment were divided into 2 groups according to their baseline CD4+ T cell counts. Group A had CD4+ T cell below or equal to 50 cells/μl(n = 81) and group B had CD4+ T cells over 50 cells/μl(n = 83). All patients underwent brain MRI scan. Imaging analysis and the prevalence of the central nervous system disorders were compared between two groups. Results Among them 48 cases were found of abnormal brain MRI, group A was higher than group B(35.8% vs. 22.9%) although without statistical significance(P = 0.065). Altogether 48 cases were diagnosed as AIDS related central nervous system disorders based on clinical symptoms, signs and laboratory findings. The prevalence of CNS disorders was higher in group A than in group B(41.9% vs. 16.8%) with statistical significance(P < 0.01). Conclusions The patients with CD4+ T cell count less than or equal to 50 cells/μl had high prevalence of CNS diseases. Brain MRI plays an important role in the diagnosis and differentiation of CNS diseases in advanced AIDS patients. This study suggests patients with low CD4+ T cell count(≤ 50/μl) should routinely undergo MRI examination.

Imaging of hemorrhagic primary central nervous system lymphoma: A case report

BACKGROUND A primary central nervous system lymphoma(PCNSL)presenting with massive hemorrhage is a rare occurrence that is difficult to distinguish from a high-grade glioblastoma.Comprehensive descriptions of the imaging characteristics of such tumors have not yet been reported.Herein,we reported a case of a PCNSL with massive hemorrhage by presenting the imaging features of computed tomography(CT)imaging and structural and perfusion magnetic resonance imaging(MRI).CASE SUMMARY A 48-year-old man presented with headache lasting for 10 d.CT of the brain showed a round,heterogeneous,high-density lesion with surrounding edema in the right temporal lobe.For further diagnosis,a series of MRI examinations of the brain were subsequently performed,and a hemorrhagic lesion with ring-like enhancement was determined.The whole lesion was relatively hypoperfused on arterial spin labeling images.Surgical resection of the lesion and histopathological examination confirmed that the lesion was a diffuse large B-cell lymphoma with massive hemorrhage.CONCLUSION PCNSLs with hemorrhage occur very rarely,and structural and perfusion MRI examinations are requested exceedingly rarely.This case provided insight into some characteristics of a hemorrhagic lymphoma on CT and MRI examinations.Perfusion MRI examination may be useful for the differential diagnosis of PCNSLs and other brain tumors.

The Clinical Application Value of Susceptibility Weighted Imaging in the Central Nervous System

Susceptibility weighted imaging(SWI)is a relatively new magnetic resonance imaging(MRI)technique that uses the difference in tissue magnetic susceptibility to image,and has unique value compared to traditional magnetic resonance imaging.This article summarizes its application in the central nervous system and provides a reference for imaging diagnosis and clinical treatment.

Fetal central nervous system anomalies: comparison of magnetic resonance imaging and ultrasonography for diagnosis

Background Evaluation of fetal central nervous system （CNS） agenesis by ultrasonography （US） is frequently limited, but magnetic resonance imaging （MRI） has its own advantages and is gaining popularity in displaying suspected fetal anomalies. The purpose of this study was to explore the value of MRI in detecting fetal CNS agenesls. Methods Thirty-four women （aged from 22 to 35 years, average 27 years） with complicated pregnancies （16-- 39 weeks of gestation, average 30 weeks） were examined with a 1.5 T superconductive MR unit within 24 hours after ultrasonography. Half-Fourier acquisition single-shot turbo spin-echo （HASTE） T2-weighted imaging （T2WI） sequence were performed in all patients, and fast low angle shot （FLASH） T1-weighted imaging （T1WI） sequence were applied sequentially in seven of them. Comparison of the results was made between the MRI and US findings as well as autopsy or postnatal follow-up MRI findings. Results The gyms, sulcus, corpus callosum, thalamus, cerebellum, brainstem, and spinal cord of fetus were shown more clearly on T2-weighted MR images than on T1-weighted MR images. MRI corrected the diagnosis of US in 10 cases （10/34, 29.41%） and the diagnosis was missed only in 1 case （1/34, 2.94%）. Conclusion MRI has advantages to US in detecting fetal CNS anomalies and is a supplement to US in complicated pregnancies.

Comparison and Correlation of Magnetic Resonance Imaging and Clinical Severity in Nonhuman Immunodeficiency Virus Patients with Cryptococcal Infection of Central Nervous System

Background:The incidence of cryptococcal meningitis among immunocompetent patients increases,especially in China and imaging plays an important role.The current study was to find the correlation between magnetic resonance imaging (MRI)manifestation and clinical severity in nonhuman immunodeficiency virus patients with cryptococcal infection of central nervous system (CNS). Methods:A total of 65 patients with CNS cryptococcal infection from August 2014 to October 2016 were retrospectively included in this study.All the patients had MRI data and clinical data.The patients were divided into two groups according to whether the patients were confirmed with identifiable underlying disease.Comparison and correlation of MRI and clinical data in both groups were investigated using independent sample t-test,Chi-square test,Mann-Whitney test and Spearman rank correlation analysis. Results:In all 65 patients,41 cases (41/65,63.1%;Group 1)had normal immunity and 24 cases (24/65,36.9%;Group 2)had at least one identifiable underlying disease.Fever,higher percentage of neutrophil (NEUT)in white blood cell (WBC),and increased cell number of cerebral spinal fluid (CSF)were much common in patients with underlying disease (Group 1 vs.Group 2:Fever:21/41 vs.21/24,x^2 =8.715,P =0.003;NEUT in WBC:73.15%vs.79.60%,Z=-2.370,P =0.018;cell number of CSF:19 vs.200,Z=-4.298,P <0.001;respectively).Compared to the patients with normal immunity,the lesions are more common in the basal ganglia among patients with identifiable underlying disease (Group 1 vs.Group 2:20/41 vs.20/24,x^2 =7.636,P =0.006).The number of the involved brain areas in patients with identifiable underlying disease were well correlated with the number of cells and pressure of CSF (r =-0.472,P =0.031,r =0.779,P =0.039;respectively). Conclusions:With the increased number of the involved brain areas in patients with identifiable underlying disease,the body has lower immunity against the organism which might result in higher intracranial pressure and more severe clinical status.

Imaging Analysis of Primary Malignant Intracranial Lymphoma

OBJECTIVE To investigate the images characteristics of primary malignant intracranial lymphoma. METHODS Retrospective study was conducted on CT/MRI imaging characteristics of 9 cases with primary malignant intracranial lymphoma. RESULTS The patients had lesions mostly in the supratentorial region, including the parts of deep white matter, para-ependymal regions, and corpus callosum. The shapes of the lesions were round or irregular. CT scan showed equal or slightly high density of the tumor images, compared with the normal tissue in the brain. The TIWI of MRI scan on the tumor showed low signal and the T2WI showed equal or slightly high signal. The MRI signals were homogenous. Cystic lesion, calcification, and hemorrhage were rarely seen in MRI. Edema around tumor and its occupational effect was lessened. Edema around tumor shown in MRI was not in accordance with the true volume of the tumor mass. Enhanced scan on the lesions showed homogenous enhancement, and the pia mater invaded and/or the spread along ependyma. CONCLUSION Images of primary malignant intracranial lymphoma have specific characteristics that are useful in its diagnosis and differential diagnosis.

agnetic Resonance Imaging Characteristics of Primary Central Nervous System T-cell Lymphoma

Primary central nervous system lymphomas （PCNSLs） are rare non-Hodgkin tumors defined as lymphomas of the central nervous system （CNS） without primary tumor elsewhere. It was reported that PCNSLs represented only 3-7% of primary brain tumors and 1-5% of all lymphomas. Most of PCNSLs are B-cell lymphomas, while T-cell PCNSL （T-PCNSL） is extremely rare, the majority of the reported T-PCNSL cases are clinically sporadic that focus on the treatment, and its imaging features have rarely been described. Herein, we report a case of T-PCNSL and comprehensively summarize its magnetic resonance imaging （MRI） characteristics. It is the first time in China to locus on the MRI diagnosis of T-PCNSL.

MRI in central nervous system infections: A simplified patterned approach

Recognition and characterization of central nervous system infections poses a formidable challenge to the neuro-radiologist.Imaging plays a vital role,the lesions typically being relatively inaccessible to tisue sampling.The results of an accurate diagnosis are endlessly re-warding,given the availability of excellent pharmaco-logical regimen.The availability of numerous magnetic resonance(MR)sequences which provide functional and molecular information is a powerful tool in the hands of the radiologist.However,the plethora of se-quences and the possibilities on each sequence is also intimidating,and often confusing as well as time con-suming.While a large number of reviews have already described in detail the possible imaging findings in each infection,we intend to classify infections based on their imaging characteristics.In this review we describe an algorithm for first classifying the imaging findings into patterns based on basic MR sequences(T1,T2 and enhancement pattern with Gadolinium),and then sub-classify them based on more advanced molecular and functional sequences(Diffusion,Perfusion,Susceptibili-ty imaging,MR Spectroscopy).This patterned approachis intended as a guide to radiologists in-training and in-practice for quickly narrowing their list of differentials when faced with a clinical challenge.The entire content of the article has also been summarised in the form of flow-charts for the purpose of quick reference.

A case of primary angiitis of the central nervous system diagnosed and treated based on HR-MRI

Objective:To summarize the clinical features,imaging manifestations,therapeutic options,and prognosis of the primary angiitis of the central nervous system(PACNS)and to explore the role of high-resolution magnetic resonance imaging(HR-MRI)in the PACNS diagnosis and treatment.Methods:One patient with PACNS treated by HR-MRI was retrospectively analyzed and summarized by combining relevant literature.Results:The patient was a young female who was hospitalized with progressive cerebral infarction and multiple intracranial arterial stenosis.HR-MRI indicated vasculitic changes.After excluding other diseases,hormone shock combined with immunosuppression was given,followed by long-term rehabilitation treatment.The patient’s condition tended to stabilize,and the prognosis was satisfactory.Conclusion PACNS is challenging to diagnose and is characterized by poor prognosis and easy recurrence.HR-MRI plays an important role in the clinical diagnosis and treatment adjustment for PACNS.

多参数磁共振机器学习模型鉴别诊断原发性中枢神经系统淋巴瘤与不典型胶质母细胞瘤的价值

目的 基于多参数MRI采用6种机器学习分类算法构建预测不典型胶质母细胞瘤与原发性中枢神经系统淋巴瘤的模型,比较不同机器学习模型的诊断效能。资料与方法 回顾性分析2013年1月—2023年12月解放军总医院77例(125个病灶)原发性中枢神经系统淋巴瘤,以及解放军总医院和公共数据库的90例(108个病灶)不典型胶质母细胞瘤的临床及影像资料。按7∶3随机分为训练集163例和验证集70例。选取T1WI、T2WI及增强T1WI序列进行感兴趣区分割,并从每个感兴趣区中提取1 132个影像特征。采用组内相关系数(ICC)进行一致性检验,筛选出ICC≥0.85的影像特征。依次通过ICC、递归消除法筛选出最佳特征。在6种分类器中对3个单序列特征组、3个双序列组与1个多序列特征组进行训练及验证。绘制受试者工作特征曲线评估模型的诊断效能。结果 SVM_rbf分类器与多序列特征组的组合模型是鉴别原发性中枢神经系统淋巴瘤与不典型胶质母细胞瘤的最优模型,训练集与验证集的曲线下面积分别为0.969、0.913,准确度均为0.886。结论 无创提取多参数MRI特征结合机器学习算法可有效鉴别原发中枢神经系统淋巴瘤与不典型胶质母细胞瘤,为制订个体化治疗方案提供支持。

原发性中枢神经系统淋巴瘤MRI图像参数与分子病理的关联性分析

目的:研究原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)MRI图像参数与分子病理的关联性。方法:回顾性分析2020年1月至2023年6月就诊于哈尔滨医科大学附属第一医院26例PCNSL患者资料,根据细胞来源、BCL-2表达、Ki-67指数,MAP+布鲁顿酪氨酸激酶抑制剂(Bruton's tyrosine kinase inhibitor,BTKi)治疗反应性将患者归纳至非生发中心B细胞(non-germinal center B-cell,non-GCB)组和生发中心B细胞(germinal center B-cell,GCB)组、Ki-67≥75%组和Ki-67<75%组、BCL-2+组和BCL-2-组、对MAP+BTKi方案治疗有反应组和无反应组。提取患者基线期MRI图像一阶参数如平均值、标准差、方差、变异系数、偏度、峰度、熵,比较其在两组间的差异。结果:方差、峰度、偏度、变异系数等4个参数在组间差异无统计学意义;平均数、标准差、熵这3个参数在Ki-67表达、BCL-2表达组间的差异具有统计学意义;平均数、熵这两个参数在细胞来源、治疗是否有反应性两组间差异具有统计学意义(P<0.05);对于Ki-67指数,3个参数的曲线下面积(AUC)分别为0.731、0.831、0.913;对于BCL-2表达,平均数、标准差的曲线下面积(AUC)分别为0.889和0.938。多参数联合分析时其鉴识效果较利用单个纹理分析定量参数更高。结论:平均值、标准差、熵等3个MRI参数有助于预测PCNSL患者Ki-67、BCL-2的表达,对于治疗具有一定评估作用,有利于术前无创性评估肿瘤的恶性程度并为预后和治疗提供新的依据。

原发性中枢神经系统淋巴瘤多模态MRI不典型表现及其病理学基础的探讨

目的:探讨免疫功能正常的原发中枢神经系统淋巴瘤(PCNSL)患者不典型MRI表现及其相关病理学基础,以利于PCNSL的正确诊断。方法:回顾性分析2017年8月至2022年8月在我院经组织病理学诊断的PCNSL患者资料。所有患者在治疗前均接受MRI检查,实验室检查显示均无免疫功能缺陷,排除复发性中枢神经系统淋巴瘤及继发性淋巴瘤。由2名医师分别对MRI图像进行判读。结果:31例中枢神经系统淋巴瘤中19例符合入选标准,其中男性11例,女性8例,年龄为(63±9)岁。所有病例均经组织学病理诊断为B细胞淋巴瘤,15例为弥漫性大B细胞淋巴瘤。病灶单发7例,病灶2个4例,病灶3个及以上8例。不典型发病部位包括侧脑室、脑干、小脑半球。不典型影像表现包括:病灶信号不均匀,合并出血及坏死;增强无强化,多发片状、线状强化;呈高灌注;无明显弥散受限。结论:PCNSL表现不典型时容易误诊,多发病灶中更容易出现不典型表现,采用多模态MRI尤其是结合病变表观弥散系数值及磁共振波谱有利于疾病诊断。

Primary angiitis of the central nervous system： a case report

Primary angiitis of the central nervous system is a rare and difficult entity. Here we represented the clinical and pathological features of a patient with little response to steroid before definite diagnosis. The 50-year-old male had a fluctuating disease course for more than 3 years. He presented visual disorders, seizure, cognitive impairment, hypersomnia, unsteady gait, dysphasia, dysphagia, and incontinence. Magnetic resonance imaging showed multiple, supratentorial and infratentorial abnormal signals, while cerebrospinal fluid and cerebral angiography were normal. Magnetic resonance spectrum showed a decrease of N-acetyl-aspartate. Brain biopsy revealed nongranulomatous lymphatic vasculitis with reactive gliosis, cicatrization, demyelination and focal hemorrhages.

Primary Central Nervous System Lymphoma

Primary central nervous system lymphoma （PCNSL） is an aggressive non-Hodgkin Lymphoma, most frequently diffuse large B-cell lymphoma in immunocompetent patients, which is confined to the central nervous system. In the past two decades, its incidence has been steadily increasing.

原发性中枢神经系统淋巴瘤MRI影像特征及误诊分析

目的探讨原发性中枢神经系统淋巴瘤(PCNSL)的磁共振成像(MRI)影像特征及误诊原因。方法选取2020年7月至2023年2月20例PCNSL患者,其中10例误诊,通过分析误诊、未误诊患者的MRI影像学资料,探讨PCNSL患者易误诊的影像学原因。结果本组头痛15例、肢体无力11例、视力视野受损7例、头晕6例。20例共检出30个病灶,位于浅部脑组织19个,深部脑组织7个,脑室内4个;单发病灶14例,多发病灶6例;合并坏死6例。10例首诊误诊者纳入误诊组,误诊为转移瘤5例、脑胶质瘤5例。误诊时间10 d~2个月。诊断正确组和误诊组在多发病灶、出血、合并坏死方面比较差异有统计学意义(P<0.05)。后经立体定向活检手术对MRI增强扫描明显增强部位取材行病理检查后,确诊弥漫大B细胞型淋巴瘤,予大剂量甲氨蝶呤联合放疗。随访1年,病情稳定,无死亡病例。结论接诊PCNSL患者时,当MRI增强扫描未发现典型征象时,易误诊颅内其他疾病;颅内占位性多发病灶、出血、合并坏死是PCNSL影像学误诊的因素,仔细观察、认真鉴别,必要时多学科协作会诊并及早行手术病理检查有利于降低误诊率。

高分辨率磁共振血管壁成像在原发性中枢神经系统血管炎中的研究进展

原发性中枢神经系统血管炎是一种罕见病,可引起一系列中枢神经系统异常,是导致颅内动脉狭窄及缺血性卒中的重要原因,因此,早期诊断和治疗对该疾病的预后和结局至关重要。高分辨率磁共振血管壁成像对血管壁和管腔结构的改变具有独特的显示效果,对原发性中枢神经系统血管炎病因学诊断具有重要价值。随着临床实践中对颅内高分辨率磁共振血管壁成像的需求增加,作为放射科医师应了解成像参数对图像质量、临床适应证、评估结果的影响,探究破除图像局限性对原发性中枢神经系统血管炎诊断、预后和指导临床治疗决策的重要意义。本文就高分辨率磁共振血管壁成像对原发性中枢神经系统血管炎的成像方法、影像学表现及诊断价值展开综述。

原发性中枢神经系统淋巴瘤的MRI及^1H-MRS特点

目的探讨免疫功能正常人原发性中枢神经系统淋巴瘤(PCNSL)的常规MRI及多体素质子磁共振波谱(1H-MRS)表现。资料与方法对21例经手术病理证实的PCNSL的MRI和1H-MRS表现进行回顾分析。结果21例患者共检出33个病灶,其MRI及1H-MRS表现具有如下特点:(1)病灶T1WI多呈低或等信号,T2WI呈等或稍低信号,单发或多发,境界清晰。(2)轻中度瘤周水肿,并可见“火焰样”特征性水肿。(3)增强后病灶多明显均匀强化;“缺口征”、“尖角征”的出现具有特异性。(4)1H-MRS常表现为胆碱(Cho)峰升高,肌酸(Cr)降低,氮-乙酰天门冬氨酸(NAA)缺失,并出现高耸的脂质(Lip)峰。在实性肿瘤中出现明显升高的Lip峰对诊断PCNSL具有高度特异性。结论传统MRI在PCNSL的诊断中起着重要的作用,结合1H-MRS表现,可以提高MRI对PCNSL的诊断水平。

原发性中枢神经系统淋巴瘤磁共振及功能性成像特点

目的分析免疫功能正常人原发性中枢神经系统淋巴瘤的传统MRI征象、弥散加权成像(DWI)、灌注加权成像(PWI)及氢质子磁共振波谱(1H-MRS)表现,探讨其诊断价值。方法回顾分析12例经手术病理证实的原发性中枢神经系统淋巴瘤的MRI征象。结果12例患者均为B细胞淋巴瘤,共检出13个结节,11例为单发,1例为多发。病灶T1WI呈低或等信号影,T2WI呈等、稍高、高信号影,DWI呈高、低信号影;病灶的边界较清晰,周围可见轻中度水肿;病灶多呈明显均匀强化及"缺口征"、"尖突征";1H-MRS表现为N-乙酰天门冬氨酸(NAA)峰中度降低,胆碱(Cho)峰升高,肌酸(Cr)峰轻度降低,并可见巨大的脂质(Lip)峰。灌注加权成像提示病灶为低灌注结节。结论传统磁共振成像与弥散加权成像、灌注加权成像、1H-MRS的联合应用可以提高磁共振对原发性中枢神经系统淋巴瘤的诊断率。