ESİN KURTULUŞ ÖZTÜRK, Saffet ÖZTÜRK, Suzan ŞAYLISOY, UĞUR TOPRAK, Hava ÜSKÜDAR TEKE, Eren GÜNDÜZ, Neslihan ANDIÇ

Santral Sinir Sistemi Lenfomaları: Klinik ve Manyetik Rezonans Görüntüleme Bulguları

Öz: Santral sinir sistemi (SSS) lenfomaları primer ve sistemik tutulumun eşlik ettiği sekonder lenfomalar olarak ikiye ayrılır. Bu çalışmada SSS lenfomalarının klinik ve manyetik rezonans görüntüleme (MRG) bulgularını literatür bilgileri eşliğinde sunmayı amaçladık. Aralık 2011 ile Haziran 2017 arasında farklı histolojik subtiplere sahip SSS lenfoma tanısı olan hastaların klinik ve kontrastlı serebral MRG incelemeleri retrospektif değerlendirildi. Hastaların demografik özellikleri, lenfoma subtipleri, immünitesi, serum laktat dehidrogenaz değerleri, klinik ve MRG bulguları kaydedildi. MRG görüntülerde lezyon sayısı, lokalizasyonu, sinyal özellikleri, difüzyon özellikleri, kontrastlanma paterni, hemoraji ve kelebek görünümü varlığı değerlendirildi. Çalışmaya SSS lenfoma tutulumu olan 23 hasta dahil edildi. (erkek/kadın:9/14, yaş ortalaması 53.6±18.8 dağılımı 15-81) ve primer (n=3,%13) ve sekonder (n=20, %87) olarak iki gruba ayrıldı. Hastaların tümünde non-Hodgkin lenfoma ve subtip olarak en sık diffüz büyük B hücreli lenfoma (%65.2) saptandı. En sık semptom baş ağrısı ve halsizlikti. SSS lenfomalarında sıklıkla parankimal (%56.5) ve leptomeningeal (%47.8) tutulum izlendi. Primer SSS lenfomalarında parankimal tutulum bütün hastalarda izlenirken, leptomeningeal tutulum sekonder SSS lenfomalarında daha sık saptandı (%55). SSS lenfomalı 13 hastada 33 parankimal lezyon saptandı. Parankimal lezyonlar çoğunlukla supratentoryal (%87.9) ve lokalizasyon olarak da en sık beyaz cevher (%57.6) yerleşimliydi. Primer SSS lenfoma grubunda tüm lezyonlar T1 ağırlıklı görüntülerde (AG) hipointens, T2AG’de heterojen hipo-hiperintens ve difüzyon kısıtlaması izlenirken çoğunlukla homojen nodüler kontrastlanma mevcuttu(%83). Sekonder SSS lenfoma grubunda ise lezyonların çoğunda T1AG’de hipointens (%74.1), T2AG’de hiperintens (%51.9), difüzyon kısıtlaması (%96.3) ve çoğunlukla homojen nodüler (%55.6) kontrastlanma izlendi. SSS lefomalarında klinik ve radyolojik görüntüleme özelliklerinin bilinmesi; tanıda, prognozda, tedavi cevabını değerlendirmede ve sağkalımı belirlemede oldukça önemlidir.

Anahtar Kelimeler:

lenfoma, santral sinir sistemi, manyetik rezonans görüntüleme, non-Hodgkin lenfoma

Central Nervous System Lymphomas: Clinical and Magnetic Resonance Imaging Findings

Abstract: Central nervous lymphoma (CNS) is classifed into two sub-types: primary CNS lymphoma and secondary CNS involvement by systemic lymphoma. We aimed to evaluate clinical and magnetic resonance imaging (MRI) features of CNS lymphomas with literature. We retrospectively analyzed the clinical and MR findings of patients with the diagnosis of CNS lymphoma from December 2011 to June 2017. We documented demographic characteristics, lymphoma subtypes, immune status, serum lactat dehidrogenase levels, clinical and MRI findings. We evaluated the number, localization, signal characteristics, diffusion properties, enhancement pattern, presence of hemorrhage and presence of butterfly pattern on MRI. In this study twenty-three patients (male /female: 9/14; mean age: 54±18.years,; age range: 15-81 years) were included and classified as primary (n=3,13%) and secondary (n=20, 87%) CNS lymphoma group. All cases diagnosed as non-Hodgkin lymphoma (NHL) and diffuse large B-cell lymphoma was the most common subtype (65.2 %). The most common symptoms were headache and weakness. The CNS involvement of lymphomas were mostly located in brain parenchyma (56.5%) and leptomeninges (47.8%) All primary CNS lymphoma cases had parenchymal lesion and secondary CNS lymphomas tend to occur in leptomeninges (55%). In all cases 13 patients had 33 parenchymal lesions. The most common location is supratentorial (87.9%), with the most common site cerebral white matter (57.6%). In primary CNS lymphoma group all lesions (n=6) were hypointense on T1 weighted images (WI), heterogeneous hyperintense on T2WI and restricted diffusion on DWI but majority enhancement pattern was homogeneous nodular (83%). In Secondary CNS lymphoma group, lesions (n=27) were mostly hypointense (74.1%) on T1WI, hyperintense (51.9%) on T2WI, restricted diffusion on DWI (96.3%) and homogeneous nodular enhancement (55.6%). Knowledge of the clinical and radiologic features of CNS lymphomas is important in diagnosis, prognosis, assessment of treatment response and survival.

Keywords:

lymphoma, central nervous lymphoma, magnetic resonance imaging,

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