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Lymphocytic Vasculitis Mimicking Aggressive Multifocal Cerebral Neoplasm: MR Imaging and MR Spectroscopic Appearance

Neeraj J. Panchala, Soheil Nikua and Steven G. Imbesia

a From the Department of Radiology, University of California, San Diego Medical Center, San Diego, CA



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  		FIG 1. Lymphocytic vasculitis, MR imaging.

A and B, Axial T2-weighted MR images reveal multifocal regions of T2 hyperintensity with surrounding diffuse vasogenic edema limited to the right cerebral hemisphere resulting in mild right to left midline shift.

C and D, Axial T1-weighted postgadolinium MR images with fat saturation depict multifocal enhancing tumefactive lesions, primarily at the subcortical gray-white matter junction and basal ganglia, throughout the right cerebral hemisphere with sparing of the left cerebral hemisphere.



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  		FIG 2. Lymphocytic vasculitis, MR spectroscopy.

A, 2 x 2 x 2 cm single voxel spectroscopy performed over a right high parietal enhancing lesion.

B, Spectrum obtained with a PRESS sequence using a short echo time of 30 ms shows slight elevation of the choline peak (Cho, 3.2 ppm) compared with the creatine peak (Cr, 3.0 ppm), marked elevation of the glutamate and glutamine peaks (Glx, 2.1–2.5 ppm), and marked elevation of the lipid peak (Lipid, 0.9–1.5 ppm). NAA, N-acetylaspartate (2.0 ppm).



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  		FIG 3. Lymphocytic vasculitis histopathologic results. Photomicrograph of the biopsy specimen reveals multifocal regions of angiocentric and angioinvasive vascular infiltration by lymphocytes as well as necrosis, findings compatible with lymphocytic vasculitis. Hematoxylin and eosin stain.



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  		FIG 4. Lymphatic vasculitis, MR imaging post-treatment.

A and B, Axial T2-weighted images 5 months after therapy show resolution of edema and mass effect with residual foci of gliosis and extensive atrophy of the right cerebral hemisphere.

C and D, Axial T1-weighted postgadolinium images with fat saturation demonstrate interval resolution of the previously seen enhancing masses. Craniotomy defect is evident in the right frontal region from the previous biopsy.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X