The utility of multiparametric MRI in reducing diagnostic uncertainty for primary central nervous system lymphoma

Aimee Goel; Robert Flintham; Ute Pohl; Santhosh Nagaraju; Sara Meade; Paul Sanghera; Helen Benghiat; Ismail Ughratdar; Victoria Wykes; Vijay Sawlani

doi:10.1016/j.wneu.2024.05.037

The utility of multiparametric MRI in reducing diagnostic uncertainty for primary central nervous system lymphoma

World Neurosurg. 2024 May 11:S1878-8750(24)00790-3. doi: 10.1016/j.wneu.2024.05.037. Online ahead of print.

Authors

Affiliations

¹ Department of Imaging, Neurosurgery, Neuro-oncology and Haematology, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK B15 2WB.
² Department of Imaging, Neurosurgery, Neuro-oncology and Haematology, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK B15 2WB; University of Birmingham.
³ Department of Imaging, Neurosurgery, Neuro-oncology and Haematology, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK B15 2WB; University of Birmingham. Electronic address: vijay.sawlani@uhb.nhs.uk.

PMID: 38740086
DOI: 10.1016/j.wneu.2024.05.037

Abstract

Aim: A key limitation in the early 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 inconclusive biopsy. We highlight the importance of multiparametric MRI (MPMRI), which incorporates diffusion weighted imaging (DWI), dynamic susceptibility contrast-enhanced perfusion weighted imaging (DSC-PWI) and proton magnetic resonance spectroscopy (¹H-MRS) in addition to standard MRI sequences in resolving diagnostic uncertainty for PCNSL.

Materials and methods: We present a consecutive series of 10 patients at our centre with histology-proven PCNSL (specifically, diffuse large B-cell lymphoma of the CNS) who underwent multiparametric MRI. We retrospectively analyse the qualitative and semi-quantitative parameters and assess their radiological concordance for this diagnosis.

Results: We note overall low apparent diffusion coefficient on DWI (mean ADC_min of 0.74), high percentage signal recovery on perfusion weighted imaging (mean 170%), a high choline-creatine ratio and a high-grade lipid peak on MRS giving a "twin-tower" appearance. Nine of ten patients had MRMRI findings concordant for PCNSL, defined as at least 3 of 4 parameters being consistent for PCNSL.

Conclusion: We propose that 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.

Keywords: Primary central nervous system lymphoma; multiparametric MRI.