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Research ArticleAdult Brain

Diffuse Large B-Cell Epstein-Barr Virus–Positive Primary CNS Lymphoma in Non-AIDS Patients: High Diagnostic Accuracy of DSC Perfusion Metrics

A. Pons-Escoda, A. García-Ruíz, P. Naval-Baudin, F. Grussu, M. Viveros, N. Vidal, J. Bruna, G. Plans, M. Cos, R. Perez-Lopez and C. Majós
American Journal of Neuroradiology November 2022, 43 (11) 1567-1574; DOI: https://doi.org/10.3174/ajnr.A7668
A. Pons-Escoda
aFrom the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
dNeurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
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  • ORCID record for A. Pons-Escoda
A. García-Ruíz
eRadiomics Group (A.G.-R., F.G., R.P.-L.), Vall d’Hebron Institut d’Oncologia, Barcelona, Spain
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P. Naval-Baudin
aFrom the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
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  • ORCID record for P. Naval-Baudin
F. Grussu
eRadiomics Group (A.G.-R., F.G., R.P.-L.), Vall d’Hebron Institut d’Oncologia, Barcelona, Spain
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M. Viveros
aFrom the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
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N. Vidal
bPathology (N.V.)
dNeurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
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J. Bruna
dNeurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
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G. Plans
cNeurosurgery (G.P.), Hospital Universitari de Bellvitge, Barcelona, Spain
dNeurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
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M. Cos
aFrom the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
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R. Perez-Lopez
eRadiomics Group (A.G.-R., F.G., R.P.-L.), Vall d’Hebron Institut d’Oncologia, Barcelona, Spain
fDepartment of Radiology (R.P.-L.), Hospital Universitari Vall d’Hebron, Barcelona, Spain
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C. Majós
aFrom the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
dNeurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
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    FIG 1.

    Visual summary of MR imaging features in 4 patients with pathology-confirmed DLBC EBV-positive CNS lymphoma. One patient in each row: CE-T1WI, TSE-T2WI, GE-T2*WI, and DWI at b = 1000. Regular thin ring enhancement of a subcortical lesion in A, irregular thick ring enhancement of a basal-ganglia lesion in B. The solid walls of lesions show homogeneous TSE-T2WI low signal and restricted diffusion. Incidental right frontal chronic infarct in D. Irregular thick ring enhancement in cortico-subcortical lesions: frontal in C, parietal in D. Heterogeneous signal on TSE-T2WI: hypointense in C, iso- to hyperintense in D. Intermediate heterogeneous signal on DWI. Different amounts of hemorrhage in all cases are depicted by the GE-T2*WI. Note the TSE-T2WI heterogeneous iso- to hypointense signal of the nonenhancing central content of tumors in A–C, especially in B and C.

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    FIG 2.

    Average nTIC of DLBC EBV-positive CNS lymphoma, PCNSL (EBV-negative), metastasis, and glioblastoma. Few differences may be seen between DLBC EBV-positive CNS lymphoma and PCNSL. The most relevant visual differences between DLBC EBV-positive CNS lymphoma and metastasis or glioblastoma are seen around the maximal-signal-intensity drop and the signal-recovery segments of the curves.

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    FIG 3.

    Boxplots depicting the results of the nTIC algorithms to differentiate PCNSL versus glioblastoma (upper left) and PCNSL versus metastasis (upper right) for each tumor subtype. Lower row: Boxplots depicting PSR and rCBV values for each tumor subtype.

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    Table 1:

    Clinical overview of the included patients with pathology-confirmed DLBC EBV-positive CNS lymphoma

     Age (yr)SexUnderlying ConditionsRadiologic DiagnosisaDiagnostic-Therapeutic Initial Management
    P 166MaleKidney transplantMultiple metastasesbBiopsy: reason, multiple lesions
    P 276MaleChronic myeloproliferative disorder; essential thrombocythemiaGlioblastomaBiopsy: reason, patient basal clinical status
    P 374MaleLiver transplantSingle metastasiscBiopsy: reason, second-look radiologic opinion
    P 462FemaleSystemic sclerosis and discoid cutaneous lupusGlioblastomaMaximal safe surgical resection
    P 570FemaleImmunosenescenceMultiple metastases or multifocal glioblastomaBiopsy: reason, multiple lesions
    P 663MaleAutoimmune hepatitisMetastasis or glioblastomaMaximal safe surgical resection
    P 778FemaleKidney transplantSingle metastasisMaximal safe surgical resection
    • Note:—P indicates patient.

    • ↵a Based on a radiologic report from our neuro-oncology reference tertiary university hospital.

    • ↵b Atypical infection was considered, but as an unlikely option.

    • ↵c A second-look opinion raised the possibility of atypical lymphoma.

    • View popup
    Table 2:

    Radiologic overview of the included patients with pathology-confirmed large B-cell EBV-positive primary CNS lymphoma

    No.LocationNecrosisCE-T1WI RingT2WI Solid PartsT2*WI HemorrhageDWI Solid Parts
    P 1MultipleBilateral basal ganglia and cortico-subcorticalYesIrregular thick and nodularHeterogeneous hyperintenseModerateHeterogeneous restricted
    P 2SingleParietal corticosubcorticalYesIrregular thickHeterogeneous intermediateSubtleHeterogeneous intermediate
    P 3SingleFrontal cortico-subcorticalYesIrregular thickHeterogeneous hypointenseModerateHeterogeneous restricted
    P 4SingleParietal cortico-subcorticalYesIrregular thickHeterogeneous hyperintenseProminentHeterogeneous restricted
    P 5MultipleCortico-subcortical unilateralYesIrregular thinHeterogeneous hypointenseProminentHeterogeneous intermediate
    P 6SingleBasal gangliaYesIrregular thickHomogenous hypointenseProminentHeterogeneous restricted
    P 7SingleFrontal subcorticalYesRegular thinHomogenous hypointenseModerateHomogeneous restricted
    • View popup
    Table 3:

    Summary of results

    PaAUC
    nTIC algorithms
     vs glioblastoma<.0010.984
     vs metastasis<.0010.898
    PSR
     vs glioblastoma.0060.833
     vs metastasis.0020.873
    rCBV
     vs glioblastoma.0030.855
     vs metastasis.1220.687
    • ↵a Statistical significance, Mann-Whitney U test.

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American Journal of Neuroradiology: 43 (11)
American Journal of Neuroradiology
Vol. 43, Issue 11
1 Nov 2022
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High Accuracy of DSC Metrics for CNS Lymphoma
A. Pons-Escoda, A. García-Ruíz, P. Naval-Baudin, F. Grussu, M. Viveros, N. Vidal, J. Bruna, G. Plans, M. Cos, R. Perez-Lopez, C. Majós
American Journal of Neuroradiology Nov 2022, 43 (11) 1567-1574; DOI: 10.3174/ajnr.A7668
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A. Pons-Escoda, A. García-Ruíz, P. Naval-Baudin, F. Grussu, M. Viveros, N. Vidal, J. Bruna, G. Plans, M. Cos, R. Perez-Lopez, C. Majós
Diffuse Large B-Cell Epstein-Barr Virus–Positive Primary CNS Lymphoma in Non-AIDS Patients: High Diagnostic Accuracy of DSC Perfusion Metrics
American Journal of Neuroradiology Nov 2022, 43 (11) 1567-1574; DOI: 10.3174/ajnr.A7668

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