Imaging finding and analysis of brain lymphoma in contrast-enhanced fluid attenuated inversion recovery sequence. Issue 155 (October 2022)

• Record Type: Journal Article
• Authors: Chul Lee, Yoon; Suh, Sangil; Ryoo, Inseon; Jung, Hyena; Joo, Leehi
• Is Part Of: European journal of radiology. Issue 155(2022)
• Publication Date: 2022-10
• Subjects: Contrast-enhanced fluid attenuated inversion recovery -- CE-FLAIR -- Brain lymphoma -- CNS lymphoma -- Semi-automatic segmentation; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2022.110490
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: The purpose of this study was to investigate the image findings of contrast-enhanced fluid-attenuated inversion recovery (CE-FLAIR) sequence of lymphoma in the brain. Brain lymphomas showed relatively poor and homogeneous enhancement on CE-FLAIR sequence, when compared to CE-T1WI sequence. The image findings of brain lymphoma on CE-FLAIR sequence may be useful in diagnosing brain lymphomas. Abstract: Objective: The purpose of this retrospective study was to report and analyze the image findings of contrast-enhanced fluid-attenuated inversion recovery (CE-FLAIR) sequence of lymphoma in the brain. Material and Methods: Thirty-two immunocompetent patients with biopsy-proven diffuse large B-cell type lymphoma in the brain were evaluated with pre-treatment MRI examinations from August 2014 to April 2020. As stereotactic studies on the day of biopsy, FLAIR and T1-weighted axial images were acquired in 2 mm thickness, before and after administrating gadolinium-based contrast agents, with 3.0 Tesla MR machines. Respective subtraction images were also obtained for both CE-FLAIR and contrast-enhanced T1-wieghted image (CE-T1WI) sequences. The imaging findings, especially the enhancement pattern on CE-FLAIR sequence, were analyzed qualitatively and quantitatively, using semi-automatic segmentation. Results: On CE-FLAIR images, brain lymphomas were poorly enhanced, while showing peripheral rim enhancement (54 of 58 lesions, 93.1 %) and central enhancing foci (40 of 58 lesions, 69.0 %). Seventy percent of central enhancing foci were correlated to areas with low signal intensity on CE-T1WI. In quantitative analysis, the mean signal intensity of CE-T1WI subtraction was 490.44 and that of FLAIR subtraction was 206.13. The standard deviation of all signal intensity values in CE-T1WI subtraction sequence was 143.45, while that of CE-FLAIR subtraction sequence was 118.41. Conclusion: On CE-FLAIR, brain lymphomas showed relatively poor and homogeneous enhancement, when compared to CE-T1WI. Most brain lymphomas displayed peripheral rim enhancement and central enhancing foci.