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Intravascular lymphoma: magnetic resonance imaging correlates of disease dynamics within the central nervous system

¹ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
² Department of Neurology, Columbia Presbyterian Medical Center, New York, NY, USA
³ Departments of Neurology and Neurosurgery, Yale University School of Medicine, New Haven, CT, USA (new affiliation)
⁴ Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA

Correspondence to:
Correspondence to:
F H Hochberg
Massachusetts General Hospital, Brain Tumor Center, Cox 315, Boston, MA 02114, USA; Fhochberg{at}partners.org

Background: Intravascular lymphoma (IVL) is a rare non-Hodgkin’s lymphoma with relative predilection for the central nervous system. In the absence of extraneural manifestations, the disease is not recognised until autopsy in the majority of cases underlining the need for new clinical markers.

Methods: This is a retrospective series of five patients with IVL seen at a single institution over three years. An advanced magnetic resonance imaging (MRI) protocol was performed at various time points prior to diagnosis and during treatment.

Results: MRI revealed multiple lesions scattered throughout the cerebral hemispheres; the brainstem, cerebellum, and spinal cord were less frequently involved. On initial presentation, hyperintense lesions were seen on diffusion weighted images suggestive of ischaemia in three of four patients in whom the images were obtained at that time point. In four patients lesions were also identifiable as hyperintense areas on fluid attenuated inversion recovery (FLAIR) sequences. Initial contrast enhancement was encountered in three cases. Diffusion weighted imaging lesions either vanished or followed the typical pattern of an ischaemic small vessel stroke with evolution of abnormal FLAIR signal followed by enhancement with gadolinium in the subacute stage and tissue loss in the chronic stage. Diffusion weighted imaging and FLAIR abnormalities proved to be partially reversible, correlating with the response to chemotherapy.

Conclusion: We provide the first detailed description of the dynamic pattern of diffusion weighted MRI in IVL. These patterns in combination with systemic findings may facilitate early diagnosis and serve as a new tool to monitor treatment response.

Abbreviations: ADC, apparent diffusion coefficient; DWI, diffusion weighted MRI; FLAIR, fluid attenuated inversion recovery; IVL, intravascular lymphoma; MRI, magnetic resonance imaging

Keywords: DWI; MRI; diffusion weighted imaging; intravascular lymphoma

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