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Case No. 712
2025-02-01~2025-02-28
출제자 : 최혜정
Hit : 538
| Period | 2025-02-01~2025-02-28 |
|---|---|
| Diagnosis | Primary CNS lymphoma |
| Gender |
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| Age | 64 |
| Clinical information | 64 세 남자환자의 brain MRI 이다. 진단은? |
| Discussion | "BLE" (beaded linear enhancement) on contrast-enhanced MRI (CE-MRI) is a highly specific finding for CNS lymphoma (CL), aiding in its differentiation from other pathologies, such as high-grade gliomas (HGG). Key Findings: 1. BLE was more visible on sagittal and coronal views of 3D-CE-T1WI than axial views, emphasizing careful imaging assessment. 2. A lack of BLE was noted in non-mass-forming lesions with perivascular enhancement, characteristic of other lymphoproliferative disorders. 3. BLE is thought to result from infiltration of small round cells along the white matter while sparing the gray matter, though the exact cause remains unclear. 4. BLE is extremely rare in non-CL cases, with one exception in radiation necrosis and no findings in gliomas or small round cell tumors, such as cerebellar metastases from small cell lung cancer. Comparison to Other Imaging Findings: • Common CL findings include diffusion restriction (81%), high-density areas on CT (93%), and high FDG uptake on PET (90%), though these are not specific to CL. • Streak-like edema, observed in 82% of CL cases, can also appear in hemangioblastomas and metastases, limiting its specificity. Reference 1. Yokoyama, K., Oyama, J., Tsuchiya, J. et al. Branch-like enhancement on contrast enhanced MRI is a specific finding of cerebellar lymphoma compared with other pathologies. Sci Rep 12, 3591 (2022). https://doi.org/10.1038/s41598-022-07581-x |
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