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Central Nervous System Lymphoma Characterization by Diffusion‐Weighted Imaging and MR Spectroscopy
Author(s) -
Zacharia T. Thomas,
Law Meng,
Naidich Thomas P.,
Leeds Norman E.
Publication year - 2008
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2007.00231.x
Subject(s) - medicine , in vivo magnetic resonance spectroscopy , characterization (materials science) , diffusion imaging , diffusion mri , diffusion , lymphoma , central nervous system , nuclear magnetic resonance , nuclear medicine , pathology , radiology , magnetic resonance imaging , optics , physics , thermodynamics
PURPOSE The characterization and differentiation of central nervous system (CNS) lymphoma has important diagnostic, therapeutic, and prognostic significance. The purpose of this study is to characterize the diffusion‐weighted imaging (DWI) and MR spectroscopic (MRS) findings in CNS lymphoma.MATERIALS AND METHODS Twenty consecutive patients (male [ n = 12], female [ n = 8]) with histopathologically proven CNS lymphoma were retrospectively evaluated during this study from July 2005 to April 2007. Patients included immunocompromised ( n = 9) and immunocompetent ( n = 11) individuals. MR Imaging (pretreatment n = 13), pre‐ and post‐treatment ( n = 7) included DWI ( n = 20) (b = 1000s/mm2) and ADC (apparent diffusion coefficient) maps of all patients. MRS was performed ( n = 10) with PRESS (point‐resolved spectroscopy) sequence (multivoxel n = 8, single voxel n = 2) with a TE of 144 msec. All patients were histopathologically confirmed to have lymphoma by biopsy.RESULTS Areas of restricted diffusion were observed in 90 % ( n = 18/20) on pretreatment scans. The diffusion restriction was variable on post‐treatment scans. Median metabolite ratios in 10 patients were Cho/Cr‐ 2.12, NAA/Cho ‐ .49, and NAA/Cr ‐ 1.64. Presence of lactate or lipid was noted in 90 % ( n = 9/10). Sites of lesion location were subcortical white matter ( n = 6), basal ganglia ( n = 4), corpus callosum ( n = 3), extra‐axial space including cavernous sinus ( n = 5), cerebellum ( n = 1), and lateral ventricle ( n = 1).CONCLUSION Restricted diffusion is a consistent imaging finding in CNS lymphoma in immunocompetent patients. Spectroscopy is helpful in initial imaging diagnosis and post‐treatment surveillance. These lesions are usually paraventricular in location. MR imaging appearances differ among immunocompetent and immunosuppressed individuals in most cases.