Intravascular lymphomatosis: Contribution of cerebral MRI findings to diagnosis

Intravascular lymphomatosis (It) is a rare variant of non-Hodgkin's lymphom a with an unusual predilection for the central nervous system (CNS). Most c ases are not diagnosed until postmortem because of variable clinical presen tation and nonspecific laboratory findings. Neuroimaging findings vary wide ly and range from diffuse involvement of the deep while matter to infarct-l ike lesions. Cerebral magnetic resonance imaging (MRI) may show parenchymal and meningeal gadolinium enhancement. The authors describe brain MRI findi ngs of linear, punctate, and patchy enhancement suggestive of CNS IL in two patients confirmed by brain biopsy/histologic studies. High index of clini cal suspicion and careful interpretation of MRI (including gadolinium contr ast studies) may contribute to premortem diagnosis and early intervention o f this often-missed disease.