Magnetic resonance imaging (MRI) and dynamic MRI evaluation of extranodal non-hodgkin lymphoma in the oral and maxillofacial regions.  A systematic review.

Sebastin Varghese  Paul; Dr. Dharanidharan  G. D; Karthik  Shunmugavelu

doi:10.51168/sjhrafrica.v7i3.2476

Authors

Dr. Sebastin Varghese Paul Associate Professor, Department of Radiology, Dr. SMCSI Medical College and Research Institute, Karakonam, Thiruvananthapuram District, Kerala, India
Dr. Dharanidharan G. D Mediscan Systems, No. 197, Dr. Natesan Road, Mylapore, Chennai 600004, Tamil Nadu, India
Dr. Karthik Shunmugavelu Assistant Professor, Department of Dentistry, PSP Medical College Hospital and Research Institute, Tambaram–Kanchipuram Main Road, Oragadam, Panruti, Kanchipuram District, Tamil Nadu 631604, India

DOI:

https://doi.org/10.51168/sjhrafrica.v7i3.2476

Keywords:

Apparent diffusion coefficient, Diagnostic imaging, Diffusion-weighted imaging, Dynamic contrast-enhanced MRI, Extranodal non-Hodgkin lymphoma, Head and neck malignancies, Magnetic resonance imaging, Oral and maxillofacial region

Abstract

Background:
Extranodal non-Hodgkin lymphoma (NHL) in the oral and maxillofacial region often mimics squamous cell carcinoma (SCC), complicating diagnosis. Magnetic resonance imaging (MRI) and dynamic contrast-enhanced MRI (DCE-MRI) offer detailed soft-tissue and functional assessment. This review evaluated their role in identifying characteristic imaging features of extranodal NHL.

Methods:
Conducted per PRISMA 2020 and registered in PROSPERO (CRD420251178334), a comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar (up to 2025) was performed. Studies on histopathologically confirmed extranodal NHL assessed using MRI or DCE-MRI were included. Data on imaging features, apparent diffusion coefficient (ADC), enhancement kinetics, and diagnostic performance were extracted. Study quality was evaluated using QUADAS-2, and findings were synthesized qualitatively.

Results:
Seven studies (2004–2018) involving ~250 patients were included. NHL typically showed intermediate-to-low T1 and intermediate-to-high T2 signal intensity, homogeneous contrast enhancement, and submucosal spread with preserved mucosa. DCE-MRI demonstrated a Type II (plateau) enhancement curve, while diffusion-weighted imaging revealed low ADC values (0.68–0.90 × 10⁻³ mm²/s), consistent with high cellularity. SCC showed heterogeneous enhancement, necrosis, and higher ADC values. Combined DWI and DCE-MRI achieved diagnostic accuracies >90%, with sensitivities of 92–96% and specificities of 88–93%.

Conclusion:
Extranodal NHL exhibits consistent MRI characteristics correlating with histopathology. Multiparametric MRI aids pre-biopsy differentiation from carcinoma and supports treatment planning. Standardized imaging protocols and validated ADC thresholds are needed to improve diagnostic precision.

Author Biographies

Dr. Sebastin Varghese Paul, Associate Professor, Department of Radiology, Dr. SMCSI Medical College and Research Institute, Karakonam, Thiruvananthapuram District, Kerala, India

is an Associate Professor of Radiology with expertise in cross-sectional imaging and head and neck radiologic diagnostics. His academic work includes advanced MRI applications in oncologic imaging.

Dr. Dharanidharan G. D, Mediscan Systems, No. 197, Dr. Natesan Road, Mylapore, Chennai 600004, Tamil Nadu, India

is a clinician in private practice with an interest in diagnostic imaging and maxillofacial pathology, focusing on radiologic–pathologic correlation in head and neck diseases.

Dr. Karthik Shunmugavelu, Assistant Professor, Department of Dentistry, PSP Medical College Hospital and Research Institute, Tambaram–Kanchipuram Main Road, Oragadam, Panruti, Kanchipuram District, Tamil Nadu 631604, India

is an academic oral and maxillofacial pathologist with advanced training in oral medicine, diagnostic pathology and research methodology. His research interests include head and neck oncology, imaging correlation and translational diagnostic sciences.

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