Learning objectives
To describe and illustrate the various imaging manifestations of CNS involvement by haematological malignancies and other key differentials in this patient population.
Background
Haematological malignancies are a heterogeneous group of disorders characterised by the clonal proliferation of various blood cells or their precursors[1]. Central nervous system (CNS) involvement by haematological malignancies is uncommon, and is generally associated with a poor prognosis, but differentiation from other processes such as infection and treatment-related toxicity is critical.
Imaging findings OR Procedure details
CNS lymphoma
Lymphoma can involve the CNS in isolation (primary CNS lymphoma, PCNSL) or as part of more extensive systemic disease (secondary CNS lymphoma, SCNSL). PCNSL typically involves the brain parenchyma[2], most commonly as a single lesion, though multiple lesions occur in 20-40% of patients[3,4]. The cerebral hemispheres, corpus callosum and deep grey nuclei are the most common sites involved[5] (Figure 1). [Fig 1]
Lesions usually contact the cerebrospinal fluid spaces, but radiologically evident leptomeningeal involvement is uncommon[4-6]. Characteristically, lesions demonstrate hyperdensity on pre-contrast CT...
Conclusion
CNS involvement can occur in a variety of haematological malignancies and is generally associated with a poor prognosis. The typical sites of involvement vary depending on the specific disorder, but there is some overlap in the imaging appearances. In the post-treatment context, it is important to distinguish between disease relapse and treatment-related effects.
References
Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, Bloomfield CD, Cazzola M, Vardiman JW (2016) The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 127 (20):2391-2405. doi:10.1182/blood-2016-03-643544
Haldorsen IS, Espeland A, Larsson EM (2011) Central nervous system lymphoma: characteristic findings on traditional and advanced imaging. AJNR American journal of neuroradiology 32 (6):984-992. doi:10.3174/ajnr.A2171
Keraliya AR, Krajewski KM, Giardino AA, Tirumani SH, Shinagare AB, Ramaiya NH, Jagannathan JP (2015) Imaging of Nervous System Involvement...