Decoding MRI Presentation of Primary Central Nervous System Diffuse Large B Cell Lymphoma: A Novel Subgroup Perspective.
1/5 보강
[BACKGROUND AND PURPOSE] Primary central nervous system Epstein-Barr Virus-negative diffuse large B-cell lymphoma (PCNSL) of immunocompetent patients is an aggressive extranodal lymphoma with challeng
- p-value p=0.02
APA
Bonacchi R, Calimeri T, et al. (2026). Decoding MRI Presentation of Primary Central Nervous System Diffuse Large B Cell Lymphoma: A Novel Subgroup Perspective.. AJNR. American journal of neuroradiology. https://doi.org/10.3174/ajnr.A9274
MLA
Bonacchi R, et al.. "Decoding MRI Presentation of Primary Central Nervous System Diffuse Large B Cell Lymphoma: A Novel Subgroup Perspective.." AJNR. American journal of neuroradiology, 2026.
PMID
41771734
Abstract
[BACKGROUND AND PURPOSE] Primary central nervous system Epstein-Barr Virus-negative diffuse large B-cell lymphoma (PCNSL) of immunocompetent patients is an aggressive extranodal lymphoma with challenging imaging features. In a large histopathologically-confirmed cohort, we aimed to update conventional MRI characteristics of PCNSL, identify radiological subtypes, and explore early survival differences across subgroups.
[MATERIALS AND METHODS] We retrospectively evaluated the consecutive cohort of immunocompetent patients diagnosed with PCNSL who presented to our Lymphoma Unit between 2010 and 2023, enrolling patients with available pre-biopsy 1.5T or 3.0T brain MRI including T1-weighted, T2-weighted, FLAIR, DWI, and post-contrast T1 sequences. Two neuroradiologists independently assessed lesion characteristics (number, location, morphology, volume, signal).Unsupervised hierarchical clustering was applied to identify radiologically-homogeneous subgroups. Associations between subgroup and progression-free/overall survival were assessed using Cox regression in prespecified models adjusted for age, sex, International Extranodal Lymphoma Study Group (IELSG) score and induction regimen.
[RESULTS] We enrolled 100 patients (median age 63.9 years, 51% female). Lesions were multifocal in 55% and involved only supratentorial brain in 66%, both supratentorial and infratentorial compartments in 28% and only infratentorial in 6%. Morphology was predominantly mass-like (75%). Median volume was 5.5 mL (IQR 2.0 - 14.9). Relative to brain cortex, T2 signal was hypointense in 63%, isointense in 21%, and hyperintense in 16%; T1 was isointense in 50%, hypointense in 44%, and hyperintense in 6%. Enhancement was solid in 74%, patchy in 7%, closed-ring in 4%, mixed solid-patchy in 15%. Hierarchical clustering identified four subgroups according to radiological characteristics: 1) classical mass-forming (40%): supratentorial, T2-hypointense, solidly enhancing masses; 2) CSF surface-predominant (22%): ependymal, intraventricular, or cortical-pial locations with homogeneous enhancement; 3) infiltrative (20%): small enhancing foci with extensive T2/FLAIR hyperintensity and perivascular enhancement; and 4) atypical mass-forming (18%): large, heterogeneous lesions enriched in necrosis and haemorrhage. Adjusted overall survival differed across subgroups in exploratory analyses (p=0.02), with higher mortality in CSF surface-predominant and infiltrative patterns and lower mortality in the atypical mass-forming group compared with classical mass-forming.
[CONCLUSION] This study updates MRI features of PCNSL and identifies four radiological subgroups, offering a basis for future molecular correlations and prognostic stratification.
[MATERIALS AND METHODS] We retrospectively evaluated the consecutive cohort of immunocompetent patients diagnosed with PCNSL who presented to our Lymphoma Unit between 2010 and 2023, enrolling patients with available pre-biopsy 1.5T or 3.0T brain MRI including T1-weighted, T2-weighted, FLAIR, DWI, and post-contrast T1 sequences. Two neuroradiologists independently assessed lesion characteristics (number, location, morphology, volume, signal).Unsupervised hierarchical clustering was applied to identify radiologically-homogeneous subgroups. Associations between subgroup and progression-free/overall survival were assessed using Cox regression in prespecified models adjusted for age, sex, International Extranodal Lymphoma Study Group (IELSG) score and induction regimen.
[RESULTS] We enrolled 100 patients (median age 63.9 years, 51% female). Lesions were multifocal in 55% and involved only supratentorial brain in 66%, both supratentorial and infratentorial compartments in 28% and only infratentorial in 6%. Morphology was predominantly mass-like (75%). Median volume was 5.5 mL (IQR 2.0 - 14.9). Relative to brain cortex, T2 signal was hypointense in 63%, isointense in 21%, and hyperintense in 16%; T1 was isointense in 50%, hypointense in 44%, and hyperintense in 6%. Enhancement was solid in 74%, patchy in 7%, closed-ring in 4%, mixed solid-patchy in 15%. Hierarchical clustering identified four subgroups according to radiological characteristics: 1) classical mass-forming (40%): supratentorial, T2-hypointense, solidly enhancing masses; 2) CSF surface-predominant (22%): ependymal, intraventricular, or cortical-pial locations with homogeneous enhancement; 3) infiltrative (20%): small enhancing foci with extensive T2/FLAIR hyperintensity and perivascular enhancement; and 4) atypical mass-forming (18%): large, heterogeneous lesions enriched in necrosis and haemorrhage. Adjusted overall survival differed across subgroups in exploratory analyses (p=0.02), with higher mortality in CSF surface-predominant and infiltrative patterns and lower mortality in the atypical mass-forming group compared with classical mass-forming.
[CONCLUSION] This study updates MRI features of PCNSL and identifies four radiological subgroups, offering a basis for future molecular correlations and prognostic stratification.