Abstract
Deb K. Boruah
Central nervous system lymphoma is not an uncommon condition, but spinal lymphoma
with isolated involvement of the conus medullaris and cauda equina is a rare entity.
Our study aims to evaluate the various magnetic resonance imaging (MRI) features of
cauda equina and conus lymphoma. This retrospective study was carried out on nine
patients with histopathologically proven cauda equina and conus lymphoma, who were
presented at a tertiary care hospital between January 2018 and June 2020. All patients
underwent lumbar spine MRI scans using a 1.5 Tesla MR scanner. The clinical data and
different MRI findings were analyzed with an independent sample t-test and paired-samples t-test. Among the nine patients with cauda equina and conus lymphoma, three had primary
lymphoma and six had secondary lymphoma. Six patients (66.7%) showed a diffuse pattern
of involvement of cauda equina and conus medullaris, while three patients (33.3%)
showed a focal pattern. T2-weighted imaging (T2WI) hypo to isointense signal intensity
lesions were observed in six patients (66.7%) and T2WI iso to slight hyperintensities
in three patients (33.3%). Diffuse sheet-like thickening and postcontrast enhancement
of the thickened cauda equina nerve roots were observed in two patients of primary
and one patient with secondary lymphoma. The diagnosis of cauda equina and conus lymphoma
especially primary lymphoma is challenging and requires a high index of clinical suspicion
as distinguishing this entity from similar conditions is difficult solely on MRI.
Early diagnosis of this entity is important for early institution of treatment for
increasing the chances of survival and improvement of symptoms.
Keywords
non-Hodgkin lymphoma - magnetic resonance imaging (MRI) - cauda equina - diffusion-weighted
imaging - chemoradiotherapy
