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Journal of Neurology

, Volume 265, Issue 3, pp 647–658 | Cite as

New MR perfusion features in primary central nervous system lymphomas: pattern and prognostic impact

  • Stella BlaselEmail author
  • Rieke Vorwerk
  • Makoto Kiyose
  • Michel Mittelbronn
  • Uta Brunnberg
  • Hanns Ackermann
  • Martin Voss
  • Patrick N. Harter
  • Elke Hattingen
Original Communication

Abstract

Purpose

Some MR perfusion features predict overall survival (OS) and progression-free survival (PFS) in glioblastomas. Prognostic value of MR perfusion in primary CNS lymphomas (PCNSL) remains unexplored being the aim of this investigation.

Methods

We retrospectively analyzed 3Tesla dynamic susceptibility contrast MR perfusion in 37 pre-surgical PCNSL for normalized regional cerebral blood volume rCBVmean and rCBVmax and for a PCNSL-typical shoulder-like increase of the time–signal intensity curve (“TSIC-shoulder”), indicating moderate vessel permeability. These MR perfusion features, tumor and edema size, number of lesions and patient characteristics were correlated with OS and PFS.

Results

Only patient’s age was prognostic for OS (p = 0.0037) and PFS (p = 0.0088). 23 PCNSL had the TSIC-shoulder, a middle-sized diameter (39.5 ± 10.8 mm), volume (15.7 ± 11.3 ml), peritumoral edema (23 ± 8.7 mm) and moderately increased rCBVmean and rCBVmax (1.7 ± 0.5; 3.9 ± 1.2). Seven PCSNL with the TSIC-shoulder presented a sun-like pattern (“rCBV-sun”) with a rim of marginally high rCBV. These unifocal PCNSL were larger (43 ± 11.2 mm; 25.62 ± 19.2 ml), with more peritumoral edema (32.8 ± 7.6 mm) and lower CBVmean (0.8 ± 0.3) and rCBVmax (2.2 ± 0.7), compared to the remaining six multifocal PCNSL without the TSIC-shoulder (26.3 ± 8.3 mm; 4.7 ± 4 ml; 16.3 ± 6.4 mm; 2.4 ± 1.6; 4.4 ± 2.3).

Conclusions

Only patient age was predictive for OS and PFS of PCNSL; MR perfusion parameters and features were not. Most PCNSL revealed the TSIC-shoulder, moderate size, peritumoral edema and rCBV increase. However, larger, solitary PCNSL additionally had a rCBV-sun pattern and more edema, maybe due to a centrifugal vessel proliferation, whereas smaller, multifocal PCNSL contain apparently more concentrated and less permeable blood vessels represented by higher rCBV, no TSIC-shoulder and less edema.

Keywords

Primary CNS lymphoma MR perfusion rCBV Overall survival Progression-free survival Prognostic value 

Notes

Acknowledgements

M.M. would like to thank the Luxembourg National Research Fond (FNR) for the support (FNR PEARL P16/BM/11192868 Grant).

Funding

The study was not funded by external sources.

Compliance with ethical standards

Conflicts of interest

The authors declared that they have no conflict of interest.

Ethical standard statement

This study was approved by the institutional review board at Frankfurt Goethe University and was performed in accordance with the ethical standards for human subjects research. For this type of study formal consent is not required.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Stella Blasel
    • 1
    Email author
  • Rieke Vorwerk
    • 1
  • Makoto Kiyose
    • 1
    • 3
  • Michel Mittelbronn
    • 5
    • 8
    • 9
    • 10
    • 11
  • Uta Brunnberg
    • 12
  • Hanns Ackermann
    • 13
  • Martin Voss
    • 4
  • Patrick N. Harter
    • 5
    • 6
    • 7
  • Elke Hattingen
    • 1
    • 2
  1. 1.Institute of NeuroradiologyGoethe-University Hospital FrankfurtFrankfurtGermany
  2. 2.Neuroradiology, RadiologyUniversity Clinics BonnBonnGermany
  3. 3.Epilepsy Center Frankfurt Rhine-Main, Institute of NeurologyGoethe-University Hospital FrankfurtFrankfurtGermany
  4. 4.Dr. Senckenberg Institute of NeurooncologyGoethe-University Hospital FrankfurtFrankfurtGermany
  5. 5.Edinger Institute, Institute of NeurologyGoethe-University FrankfurtFrankfurtGermany
  6. 6.German Cancer Consortium DKTK Partner SiteFrankfurt/MainzGermany
  7. 7.German Cancer Research Center DKFZHeidelbergGermany
  8. 8.Luxembourg Centre of Neuropathology (LCNP)DudelangeLuxembourg
  9. 9.Department of PathologyLaboratoire National de Santé (LNS)DudelangeLuxembourg
  10. 10.Luxembourg Centre for Systems Biomedicine (LCSB)University of LuxembourgEsch-sur-AlzetteLuxembourg
  11. 11.NORLUX Neuro-Oncology Laboratory, Department of OncologyLuxembourg Institute of Health (L.I.H.)LuxembourgLuxembourg
  12. 12.Department of Hematology and OncologyGoethe-University Hospital FrankfurtFrankfurtGermany
  13. 13.Institute of Biostatistics and Mathematical ModellingGoethe-University Hospital FrankfurtFrankfurtGermany

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