Differentiation of Acquired Immune Deficiency Syndrome Related Primary Central Nervous System Lymphoma from Cerebral toxoplasmosis with Use of Susceptibility-Weighted Imaging and Contrast Enhanced 3D-T1WI

Jingjing Li,Ming Xue,Zhibin Lv,Chunshuang Guan,Shunxing Huang,Shuo Li,Bo Liang,Xingang Zhou,Budong Chen,Ruming Xie

doi:10.1016/j.ijid.2021.10.023

Jingjing Li, Ming Xue + Show 8 more

Open Access

https://doi.org/10.1016/j.ijid.2021.10.023

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Abstract

BackgroundWe aimed to investigate whether susceptibility-weighted imaging (SWI) and contrast-enhanced 3D-T1WI can differentiate Acquired Immune Deficiency Syndrome-Related Primary Central Nervous System Lymphoma (AR-PCNSL) from cerebral toxoplasmosis. MethodsThis was a prospective cohort study. 20 AIDS patients were divided into AR-PCNSL group (13 cases) and cerebral toxoplasmosis group (7 cases) based on pathology results. We analyzed the appearance of lesions on SWI and enhanced 3D T1WI and ROC curves in the diagnosis of AR-PCNSL and cerebral toxoplasmosis. ResultsCerebral toxoplasmosis was more likely to show annular enhancement (p = 0.002) and complete smooth ring enhancement (p = 0.002). It was also more likely to present a complete, smooth low signal intensity rim (LSIR) (p = 0.002) and an incomplete, smooth LSIR (p = 0.019) on SWI. AR-PCNSL was more likely to present an incomplete, irregular LSIR (p < 0.001) and irregular central low signal intensity (CLSI) (p<0.001) on SWI. The areas under the ROC curve of the SWI-ILSS grade and enhanced volume on 3D-T1WI were 0.872 and 0.862, respectively. ConclusionA higher SWI-ILSS grade and larger 3D-T1WI volume enhancement were diagnostic for AR-PCNSL. SWI and CE 3D-T1WI were useful in the differential diagnosis of AR-PCNSL and cerebral toxoplasmosis.

Highlights

Cerebral toxoplasmosis is the most common cause of expansive brain lesions in people living with HIV/AIDS (Vidal, 2019), and the incidence may be as high as 40% (Lee SB and Lee TG, 2017)
In lymphoma group, all patients underwent systemic examination, and no evidence of lymphoma was found except the central nervous system
We found that cerebral toxoplasmosis was more prone to a low signal intensity at the center on T2WI (p value = 0.035), which might be associated with coagulation necrosis

Summary

Introduction

Cerebral toxoplasmosis is the most common cause of expansive brain lesions in people living with HIV/AIDS (Vidal, 2019), and the incidence may be as high as 40% (Lee SB and Lee TG, 2017). The initial diagnosis of cerebral toxoplasmosis is usually made empirically if multiple ring-enhancing lesions are present on brain MRI, the blood serology is positive for Toxoplasma gondii, and clinic-radiological improvement after anti-Toxoplasma therapy is observed (Benson et al, 2018). If a diagnosis of AR-PCNSL and cerebral Toxoplasma gondii can be confirmed before the operation, unnecessary brain biopsy can be avoided. AR-PCNSL and toxoplasmosis may present as multiple ring enhancement lesions at the same location on MRI (Kasamon and Ambinder, 2005; Bowen et al, 2016). Researchers have found that DWI/ADC (Camacho et al, 2003; Schroeder et al, 2006), MRS (Elicer, 2020) and DSC-MRI (dynamic susceptibility-weighted contrast-enhanced imaging) (Dibble et al, 2017) can help differentiate toxoplasmosis and lymphoma in AIDS patients. SWI-ILSS and contrast-enhanced 3D-T1WI are rare in the differential diagnosis of AR-PCNSL and cerebral toxoplasmosis

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