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CT, conventional, and functional MRI features of skull lymphoma: a series of eight cases in a single institution

  • Zhen Xing
  • Hongjie Huang
  • Zebin Xiao
  • Xiefeng Yang
  • Yu Lin
  • Dairong Cao
Scientific Article

Abstract

Objective

With the hypothesis that the combination of CT, conventional, and functional MRI can indicate a possible diagnosis of skull lymphoma, this study aimed to systematically explore CT, conventional, and functional MRI features of this rare entity.

Materials and methods

This retrospective study included eight patients with pathologically confirmed skull lymphomas. CT and conventional MRI findings, including the location, size, attenuation/signal intensity, cystic/necrosis, hemorrhage, calcification, enhancement, skull change, brain parenchyma edema and adjacent structure invasion, were reviewed. We also reviewed multi-parametric functional MR imaging features obtained from diffusion-weighted imaging (DWI, n = 4), susceptibility-weighted imaging (SWI, n = 3) and dynamic susceptibility-weighted contrast-enhanced perfusion-weighted imaging (DSC-PWI, n = 1).

Results

The eight patients in this series consisted of five males and three females, with a mean age of 51.1 years. All skull lymphomas showed the tumors extending to extra- and intra-cranial spaces with permeative destruction of the intervening skull. Intratumoral cystic/necrosis was seen in one case. Hemorrhage or calcification was absent. Dural mater infiltration was detected in all cases. Two clivus lymphomas encased internal carotid artery without narrowing the lumen. Three cases invaded brain parenchyma with moderate edema. The tumors demonstrated high signal on DWI with low ADC values comparing to muscles. SWI images showed little intratumoral hemorrhage and vessel. Low relative cerebral blood volume (rCBV) value was detected.

Conclusions

Skull lymphomas commonly presented as a homogenous solid tumor extending either intra- or extra-cranially with permeative bone destruction. Restricted diffusion, little intratumoral susceptibility signal, and lower perfusion may indicate a specific diagnosis. Multi-parametric functional MRI may be a promising tool for the diagnosis of skull lymphomas.

Keywords

Skull lymphoma DWI DSC-PWI SWI 

Notes

Authors’ contributions

Z.X. carried out the statistical analyses and image post-processing. H.H. performed the study and drafted the manuscript. Z.X. and X.Y. performed the scanning sequences. Y.L. analyzed the case histories. D.C. conceived the study idea, participated in its design, and helped in drafting the manuscript. All authors read and approved of the final manuscript.

Funding

This study was funded by the Leading Project of the Department of Science and Technology of Fujian Province (No. 2016Y0042), and the Special Funds of Provincial Finance of Fujian Province (No. BPB-CDR2013).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and local Ethical Committee, and with the 1964 Helsinki Declaration and its later amendments. For this type of study formal consent is not required.

Informed consent

For this type of study formal consent is not required.

References

  1. 1.
    Hans FJ, Reinges MH, Nolte K, Reipke P, Krings T. Primary lymphoma of the skull base. Neuroradiology. 2005;47(7):539–42.CrossRefGoogle Scholar
  2. 2.
    El Asri AC, Akhaddar A, Baallal H, et al. Primary lymphoma of the cranial vault: case report and a systematic review of the literature. Acta Neurochir. 2012;154(2):257–65.CrossRefGoogle Scholar
  3. 3.
    Fukushima Y, Oka H, Utsuki S, Nakahara K, Fujii K. Primary malignant lymphoma of the cranial vault. Acta Neurochir. 2007;149(6):601–4.CrossRefGoogle Scholar
  4. 4.
    Da RA, Da RT, Da SC, et al. Cranial vault lymphoma: a systematic review of five patients. J Neuro-Oncol. 2010;100(1):9–15.CrossRefGoogle Scholar
  5. 5.
    Muin IA, Saffari HM, Hasimah YN. Primary non-Hodgkin's lymphoma of the cranial vault mimicking a meningioma: a case report. Med J Malaysia. 1997;52(1):86–8.PubMedGoogle Scholar
  6. 6.
    Wang L, Lin S, Zhang J, Wang C. Primary non-Hodgkin's lymphoma of the skull base: a case report and literature review. Clin Neurol Neurosurg. 2013;115(2):237–40.CrossRefGoogle Scholar
  7. 7.
    Ko MJ, Hwang SN, Park YS, Nam TK. Primary malignant lymphoma of the cranial vault with extra- and intracranial extension. Brain Tumor Res Treat. 2013;1(1):32–5.CrossRefGoogle Scholar
  8. 8.
    Tashiro R, Kanamori M, Suzuki H, et al. Diffuse large B cell lymphoma of the cranial vault: two case reports. Brain Tumor Pathol. 2015;32(4):275–80.CrossRefGoogle Scholar
  9. 9.
    Choi HK, Cheon JE, Kim IO, et al. Central skull base lymphoma in children: MR and CT features. Pediatr Radiol. 2008;38(8):863–7.CrossRefGoogle Scholar
  10. 10.
    Jung C, Zimmermann M, Seifert V. Clivus lymphoma. Acta Neurochir. 2004;146(5):533–4.CrossRefGoogle Scholar
  11. 11.
    Nakamura A, Toyoda K, Shozawa Y, et al. Primary non-Hodgkin lymphoma of the skull base presenting with Garcin syndrome: MRI manifestations. J Neuroimaging. 2009;19(3):295–7.CrossRefGoogle Scholar
  12. 12.
    Aronson PL, Reilly A, Paessler M, Kersun LS. Burkitt lymphoma involving the clivus. J Pediatr Hematol Oncol. 2008;30(4):320–1.CrossRefGoogle Scholar
  13. 13.
    Ochiai H, Kawano H, Miyaoka R, et al. Primary diffuse large B-cell lymphomas of the temporoparietal dura mater and scalp without intervening skull bone invasion. Neurol Med Chir. 2010;50(7):595–8.CrossRefGoogle Scholar
  14. 14.
    Han MH, Chang KH, Kim IO, Kim DK, Han MC. Non-Hodgkin lymphoma of the central skull base: MR manifestations. J Comput Assist Tomogr. 1993;17(4):567–71.CrossRefGoogle Scholar
  15. 15.
    Isla A, Alvarez F, Gutiérrez M, et al. Primary cranial vault lymphoma mimicking meningioma. Neuroradiology. 1996;38(3):211–3.CrossRefGoogle Scholar
  16. 16.
    Kickingereder P, Wiestler B, Sahm F, et al. Primary central nervous system lymphoma and atypical glioblastoma: multiparametric differentiation by using diffusion-, perfusion-, and susceptibility-weighted MR imaging. Radiology. 2014;272(3):843–50.CrossRefGoogle Scholar
  17. 17.
    Haldorsen IS, Espeland A, Larsson EM. Central nervous system lymphoma: characteristic findings on traditional and advanced imaging. AJNR Am J Neuroradiol. 2011;32(6):984–92.CrossRefGoogle Scholar
  18. 18.
    Wu X, Pertovaara H, Dastidar P, et al. ADC measurements in diffuse large B-cell lymphoma and follicular lymphoma: a DWI and cellularity study. Eur J Radiol. 2013;82(4):e158–64.CrossRefGoogle Scholar
  19. 19.
    Ozgen B, Oguz KK, Cila A, Diffusion MR. Imaging features of skull base osteomyelitis compared with skull base malignancy. AJNR Am J Neuroradiol. 2011;32(1):179–84.CrossRefGoogle Scholar
  20. 20.
    Tu Z, Xiao Z, Zheng Y, et al. Benign and malignant skull-involved lesions: discriminative value of conventional CT and MRI combined with diffusion-weighted MRI. Acta Radiol. 2018:284185118773541.Google Scholar
  21. 21.
    Pinker K, Noebauer-Huhmann IM, Stavrou I, et al. High-field, high-resolution, susceptibility-weighted magnetic resonance imaging: improved image quality by addition of contrast agent and higher field strength in patients with brain tumors. Neuroradiology. 2008;50(1):9–16.CrossRefGoogle Scholar
  22. 22.
    Yi KS, Sohn CH, Yun TJ, et al. MR imaging findings of extraventricular neurocytoma: a series of ten patients confirmed by immunohistochemistry of IDH1 gene mutation. Acta Neurochir. 2012;154(11):1973–9.CrossRefGoogle Scholar
  23. 23.
    Heyning FH, Kroon HM, Hogendoorn PC, Taminiau AH, van der Woude HJ. MR imaging characteristics in primary lymphoma of bone with emphasis on non-aggressive appearance. Skelet Radiol. 2007;36(10):937–44.CrossRefGoogle Scholar
  24. 24.
    Greenfield GB, Warren DL, Clark RA. MR imaging of periosteal and cortical changes of bone. Radiographics. 1991;11(4):611–23.CrossRefGoogle Scholar
  25. 25.
    Kim EY, Weon YC, Kim ST, et al. Rhabdoid meningioma: clinical features and MR imaging findings in 15 patients. AJNR Am J Neuroradiol. 2007;28(8):1462–5.CrossRefGoogle Scholar
  26. 26.
    Douis H, Davies MA, Sian P. The role of diffusion-weighted MRI (DWI) in the differentiation of benign from malignant skeletal lesions of the pelvis. Eur J Radiol. 2016;85(12):2262–8.CrossRefGoogle Scholar
  27. 27.
    Lin Y, Xing Z, She D, et al. IDH mutant and 1p/19q co-deleted oligodendrogliomas: tumor grade stratification using diffusion-, susceptibility-, and perfusion-weighted MRI. Neuroradiology. 2017;59(6):555–62.CrossRefGoogle Scholar
  28. 28.
    Krishnan A, Shirkhoda A, Tehranzadeh J, et al. Primary bone lymphoma: radiographic-MR imaging correlation. Radiographics. 2003;23(6):1371–83.CrossRefGoogle Scholar
  29. 29.
    Murphey MD, Kransdorf MJ. Primary musculoskeletal lymphoma. Radiol Clin N Am. 2016;54(4):785–95.CrossRefGoogle Scholar
  30. 30.
    Maeda M, Maier SE, Sakuma H, Ishida M, Takeda K. Apparent diffusion coefficient in malignant lymphoma and carcinoma involving cavernous sinus evaluated by line scan diffusion-weighted imaging. J Magn Reson Imaging. 2006;24(3):543–8.CrossRefGoogle Scholar
  31. 31.
    Fong D, Bhatia KSS, Yeung D, King AD. Diagnostic accuracy of diffusion-weighted MR imaging for nasopharyngeal carcinoma, head and neck lymphoma and squamous cell carcinoma at the primary site. Oral Oncol. 2010;46(8):603–6.CrossRefGoogle Scholar
  32. 32.
    Doskaliyev A, Yamasaki F, Ohtaki M, et al. Lymphomas and glioblastomas: differences in the apparent diffusion coefficient evaluated with high b-value diffusion-weighted magnetic resonance imaging at 3T. Eur J Radiol. 2012;81(2):339–44.CrossRefGoogle Scholar
  33. 33.
    Koeller KK, Smirniotopoulos JG, Jones RV. Primary central nervous system lymphoma: radiologic-pathologic correlation. Radiographics. 1997;17(6):1497–526.CrossRefGoogle Scholar
  34. 34.
    Zhou L, Peng W, Wang C, et al. Primary adrenal lymphoma: radiological; pathological, clinical correlation. Eur J Radiol. 2012;81(3):401–5.CrossRefGoogle Scholar
  35. 35.
    Toh CH, Wei KC, Chang CN, et al. Assessment of angiographic vascularity of meningiomas with dynamic susceptibility contrast-enhanced perfusion-weighted imaging and diffusion tensor imaging. AJNR Am J Neuroradiol. 2014;35(2):263–9.CrossRefGoogle Scholar
  36. 36.
    Cerase A, Tarantino A, Gozzetti A, et al. Intracranial involvement in plasmacytomas and multiple myeloma: a pictorial essay. Neuroradiology. 2008;50(8):665–74.CrossRefGoogle Scholar
  37. 37.
    Lu Y, Xiong J, Geng D, Yin B. Prediction of the consistency of pituitary adenoma: a comparative study on diffusion-weighted imaging and pathological results. J Neuroradiol. 2016;43(3):186–94.CrossRefGoogle Scholar

Copyright information

© ISS 2018

Authors and Affiliations

  1. 1.Department of RadiologyFirst Affiliated Hospital of Fujian Medical UniversityFuzhouChina

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