CLINICAL REPORT Characteristics of Intravascular Large B-Cell Lymphoma on Cerebral MR Imaging

SUMMARY: IVL is characterized by a propensity for intravascular tumor cell proliferation. Premortem diagnosis of IVL is difficult because of its nonspecific clinical, laboratory, and imaging manifestations. This study examined cerebral MR imaging patterns of IVL and their changes with and without chemotherapy. Nine of 11 patients studied presented with abnormal findings. We define 5 patterns of abnormal MR imaging findings: 1) infarctlike lesions, 2) nonspecific white matter lesions, 3) meningeal enhancement, 4) masslike lesions, and 5) hyperintense lesions in the pons on T2WI. Seven patients presented with only 1 pattern, while 2 patients presented with multiple patterns. Lesions in 7 treated patients responded to chemotherapy. Pathologic specimens revealed intravascular tumor cell infiltra-tion with associated infarctions, necrosis, congestion, demyelination, vasculitis, and tumor cell extrav-asation. We conclude that MR imaging patterns can be possible manifestations of intravascular-dominant infiltration by tumor cells with associated occlusion or inflammation, depending on the level of affected vessels. ABBREVIATIONS: IVL intravascular large B-cell lymphoma; PRES posterior reversible enceph-alopathy syndrome; R-CHOP rituximab with cyclophosphamide, vincristine, doxorubicin, and prednisolon