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Type:
Educational Exhibit
Keywords:
Neuroradiology brain, MR, MR-Diffusion/Perfusion, MR-Spectroscopy, Diagnostic procedure, Lymphoma, Dementia
Authors:
L. Farras Roca1, J. J. Sánchez Fernández1, P. Puyalto2, L. Aja Rodriguez1, A. Pons Escoda1, D. E. Nova Vaca1, M. Pérez Rubiralta1, I. García Duitama1, C. Aguilera Grijalvo1; 1Barcelona/ES, 2Badalona/ES
DOI:
10.1594/ecr2016/C-1355
Findings and procedure details
We performed a retrospective review of 7 cases in order to depict the typical radiologic presentation of this disease.
At MRI,
LC shows hyperintense T2 and FLAIR signal lesions involving the cerebral subcortex and occasionally extend to involve basal ganglia,
thalamus and brainstem (Fig.2,3,4),
reflecting widespread infiltration of the cerebral white matter by lymphomatous cells without contrast enhancement (Fig.5).
However,
subtle or patchy enhancements may be seen in some cases,
in our series 3 of the 7 patients showed contrast enhancement (Fig.6,7).
On diffusion sequences,
restriction was seen in 66,
7% (Fig.
8).
In our 7 patients,
95% showed bilateral hemispheric involvement and 54% infratentorial spread.
Spinal cord MRI performed in 6 patients,
showed medullar lesions in four,
based on a signal abnormality in the spinal cord (Fig.9).
MRI - spectroscopy was performed in five patients and showed a peak of choline in 4,
lactate in 2 and lipids in 1 patient (Fig.
10).
Due to the symmetrical distribution of white matter changes,
to the prevalent infra-tentorial involvement and the absence of contrast enhancement,
the differential diagnosis included hypertensive encephalopathy,
acute disseminated encephalomyelitis (ADEM),
toxic-metabolic diseases,
neoplastic (gliomatosis cerebri) (Fig.11),
and other infectious and autoimmune encephalitis.