Abstract
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 infiltration with associated infarctions, necrosis, congestion, demyelination, vasculitis, and tumor cell extravasation. 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.
Highlights
Nonspecific white matter lesions were defined as poorly margined hyperintense lesions on T2WI without mass effect or abnormal enhancement
The patients’ characteristics, symptoms, primary cerebral MR imaging findings, and changes in findings on follow-up MR imaging studies are summarized in On-line Table
Infarctlike lesions were observed in only 2 patients in our study (2/11), 4 of the 5 postmortem examinations, including those of 2 patients without infarctlike lesions on MR imaging, revealed multiple infarctions and severe vascular occlusions by tumor cells
Summary
The Institutional Committee for Medical Research Ethics approved this retrospective study and waived informed consent. We retrospectively reviewed cerebral MR imaging of 11 consecutive patients who were diagnosed pathologically with IVL between 1998 and 2009. Three of 9 patients who were diagnosed by tissue biopsy underwent. Three radiologists reviewed the cerebral MR imaging, and findings were categorized as follows: 1) infarctlike lesions, 2) nonspecific white matter lesions, 3) meningeal enhancement, 4) masslike lesions, or 5) hyperintense lesions in the pons on T2WI. The criterion for infarctlike lesions was hyperintense areas on T2WI with diffusion restriction. Nonspecific white matter lesions were defined as poorly margined hyperintense lesions on T2WI without mass effect or abnormal enhancement. The criterion for meningeal enhancement was abnormal enhancement along the surface of the cortex with a piaarachnoid pattern extending Ͼ1 gyrus in Ͼ2 planes on postcontrast T1-weighted images. The criterion used for masslike lesions was intraparenchymal focal areas with contrast enhancement
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