Assessment of Secondary Central Nervous System Involvement in Patients With Lymphoma; MR Imaging Findings

Abstract

Secondary central nervous system (CNS) involvement of lymphoma is a rare but critical complication of aggressive systemic lymphomas. We aimed to evaluate the incidence of CNS involvement and the value of magnetic resonance imaging (MRI) of neuroaxis in patients with systemic lymphoma. A total of 205 (93 women, 112 men) patients who have biopsy proven systemic lymphoma and underwent MRI for brain and spinal screening have included into this retrospective study. Based on patient data age, gender, histologic type of lymphoma, duration from initial diagnosis, survey of patients, brain and spinal MRI findings were determined. Secondary CNS involvement observed on 37 patients (18%). There were two HL patient with nodular sclerosing subtype (5.4%) and 35 NHL patients (94.5) were with diffuse large B-cell lymphoma (DLBCL), Burkitt’s lymphoma, mantle cell lymphoma, T-cell lymphoma and B-cell lymphoma subtypes. Nodal disease was 59.4% and extranodal focus of NHL was 31.6%. MRI findings revealed 35 % brain parenchymal lesion, 35% dural enhancement, 29.7% leptomeningeal enhancement, 21.6% cranial nerve enhancement, 13.5% spinal pial-nerve root enhancement, 5.4% ependymal enhancement, 5.4 % hydrocephalus and 2.7% spinal cord lesion. Dural enhancement was significantly higher in nasopharynx (p=0.034) and nodal NHL (p=0.021). Brain leptomeningeal (p=0.021) and spinal pial (p=0.009) enhancement was significantly higher in DLBCL patients. MRI of whole neuroaxis with contrast media is a quite beneficial technique for detecting parenchymal, leptomeningeal, cranial and peripheral nerve involvement in both primary diagnosis and follow-up survival processes of lymphoma.