Stella Blasel1, Rieke Vorwerk2, Makoto Kiyose2,3, Michel Mittelbronn4,5,6,7,8, Uta Brunnberg9, Hanns Ackermann10, Martin Voss11, Patrick N Harter4,12,13, Elke Hattingen2,14. 1. Institute of Neuroradiology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. Stella.Blasel@kgu.de. 2. Institute of Neuroradiology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. 3. Epilepsy Center Frankfurt Rhine-Main, Institute of Neurology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. 4. Edinger Institute, Institute of Neurology, Goethe-University Frankfurt, Heinrich Hoffmann Strasse 7, 60528, Frankfurt, Germany. 5. Luxembourg Centre of Neuropathology (LCNP), 3555, Dudelange, Luxembourg. 6. Department of Pathology, Laboratoire National de Santé (LNS), 3555, Dudelange, Luxembourg. 7. Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 4361, Esch-sur-Alzette, Luxembourg. 8. NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health (L.I.H.), 1526, Luxembourg, Luxembourg. 9. Department of Hematology and Oncology, Goethe-University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. 10. Institute of Biostatistics and Mathematical Modelling, Goethe-University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. 11. Dr. Senckenberg Institute of Neurooncology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. 12. German Cancer Consortium DKTK Partner Site, Frankfurt/Mainz, Germany. 13. German Cancer Research Center DKFZ, Heidelberg, Germany. 14. Neuroradiology, Radiology, University Clinics Bonn, Sigmund-Freud Strasse 25, 53127, Bonn, Germany.
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.
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.
Authors: Torstein R Meling; Anna Latysheva; Michele Da Broi; Guro Jahr; Harald Holte; Klaus Beiske; Kyrre Eeg Emblem Journal: Neuroradiology Date: 2018-05-27 Impact factor: 2.804