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AJNR - American Journal of Neuroradiology

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A Case of Intravascular Lymphoma with Increased Regional Cerebral Blood Flow in I-123 IMP Single-Photon Emission CT

Chihoko Miyazaki^a, Masaya Mukai^b, Yuriko Kawaai^a, Miki Takeda^a, Norio Katoh^a, Syunsuke Nagano^a, Kozoh Kubo^a and Michifumi Kohno^b

^a Department of Medical Imaging, Sapporo City General Hospital, Sapporo, Japan
^b Department of Clinical Immunology and Hematology, Sapporo City General Hospital, Sapporo, Japan

View larger version (117K): [in a new window]   FIG 1. Images were obtained at the initial admission before chemotherapy began. Axial T2-weighted (3500/90) MR images (A) reveal minimum high-signal-intensity lesions in the both thalamus and putamen bilaterally. Coronal T1-weighted (458/14) MR image (B) shows that relatively thick meninges and bone marrow of the skull are enhanced after contrast material administration.

View larger version (58K): [in a new window]   FIG 2. rCBF images at three different sections calculated by the I-123 IMP ARG method before the first course of chemotherapy (A), after the first course of chemotherapy (B), 2 hours after the recovery from the left hemiparesis (C), and 2 months before death (D) are shown. The same color scale is used to display quantitative rCBF images through four sequential I-123 IMP SPECT studies.

View larger version (102K): [in a new window]   FIG 3. Images obtained on February 6, 2001, 10 hours after the onset of right hemiparesis. Postcontrast head CT shows that the vascular structures in the left cerebrum are enhanced as compared with those in the other side through the level of the third ventricle (A) and the body of the lateral ventricles (B).

View larger version (109K): [in a new window]   FIG 4. Histologic specimens (Hematoxylin-eosin stain) reveal infiltration of neoplastic lymphoid cells within the lumen of a small vessel of the brain parenchyma (A, x400), especially concentrated in the Virchow-Robin perivascular space (B, x200), and in the brain parenchyma (C, x200).