Article Figures & Data
Figures
- Fig 1.
Axial (A) and sagittal (B) T1-weighed contrast-enhanced MR images in a patient with CNS metastases from NHL show diffuse subependymal contrast enhancement (arrows) and 2 parenchymal lesions (open arrows) in the right basal ganglia (A) and left cerebellum (B).
- Fig 2.
Solitary lesions on a noncontrast CT scan (A), contrast-enhanced CT scans (B and C), and an MR image (D) in 3 patients with non-AIDS PCNSL. Note a hyperattenuated lesion in the frontal lobe on the noncontrast CT scan (A) with marked enhancement on the contrast series (B) and focal contrast-enhancing lesions in the left basal ganglia (C) and temporal lobe (D). One lesion has ring enhancement (D).
- Fig 3.
Multiple lesions on contrast-enhanced axial (B and D) and coronal (A and C) MR images in 4 patients with non-AIDS PCNSL. Note lesions in the basal ganglia (A), ventricles (B), frontal lobes (C), and cerebellar lobes (D).
- Fig 4.
Coronal (A) and axial (B) contrast-enhanced T1-weighted MR images and an axial DWI (C) and ADC map (D) in a patient with primary dural B-cell lymphoma (arrows) with tumor spread below the skull base (open arrow). The contrast-enhancing tumor at the caudal surface of the left temporal lobe (A and B) displaces the temporal lobe cranially and resembles a meningioma. DWI reveals restricted diffusion within the tumor with high signal intensity on DWI (C) and corresponding low signal intensity on the ADC map (D).
- Fig 5.
Contrast-enhancing lesions on CT scans (A–D) in 4 patients with AIDS-related PCNSL. Note irregularly enhancing lesions in the right parietal lobe (A), right occipital lobe (B), and right periventricular white matter (C and D); most of the lesions show ring enhancement (A, B, and C).
- Fig 6.
Axial contrast-enhanced T1-weighted MR image (A), sagittal T2-weighted MR image (B), axial DWI (C), an ADC map (D), and an rCBV map (E) in a patient with PCNSL. The periventricular contrast-enhancing tumor (A) in the left parietal lobe has restricted diffusion with high signal intensity on DWI (C) with corresponding low signal intensity on the ADC map (arrows, D). Perfusion MR imaging shows low perfusion within the contrast-enhancing tumor on the rCBV map (arrows, E).
- Fig 7.
Axial contrast-enhanced CT scan (A), coronal (B) and axial (C) contrast-enhanced T1-weighted MR images, and methionine PET (coronal, D, and axial, E) images in a patient with PCNSL. The contrast-enhancing tumor in the right temporal lobe (A–C) shows high uptake of methionine on PET (D and E).
Tables
Primary CNS lymphoma Secondary CNS Lymphoma Primary site of CNS involvement Brain parenchyma, ∼100% Brain parenchyma, ∼1/3; leptomeninges, ∼2/3 Parenchymal CNS lymphoma Leptomeningeal CNS lymphoma Typical location Periventricular and superficial brain regions Leptomeninges CT findings Iso- or hypodense lesions with marked CE Leptomeningeal, subependymal, dural, or cranial nerve CE; superficial cerebral lesion; communicating hydrocephalus MRI findings T1: hypo- or isointense lesions, moderate-marked CE Leptomeningeal, subependymal, dural, or cranial nerve CE; superficial cerebral lesion; communicating hydrocephalus T2: iso- or hyperintense lesions; often hypointense to gray matter Enhancement pattern Non-AIDS patients: homogeneous CE, ∼90%; ring-CE, ∼0%-13% Leptomeningeal, subependymal, dural, or cranial nerve CE AIDS patients: irregular CE common; ring-CE, ∼75% Imaging Method Findings in CNS Lymphoma Potential Value as Diagnostic Tool in CNS Lymphoma MRI/CT Diffusion MRI/diffusion tensor imaging Restricted diffusion in lesions (hyperintense on DWI and hypointense on ADC maps)40,44–47 Differentiation of CNS lymphoma and malignant glioma/metastases Decreased FA values in lesions47 Perfusion MRI/perfusion CT/permeability MRI Low maximum CBV40,41 Differentiation of CNS lymphoma and malignant glioma/metastases Characteristic intensity time curve related to leakage of contrast into the interstitial space41 Assessment of microvascular tumor permeability relevant for diagnosis, prognostication, and therapy MR spectroscopy Elevated lipid peaks and high Cho/Cr ratios29,42–44,59 Differentiation of CNS lymphoma and some gliomas and CNS lymphomas and toxoplasmosis/PML in AIDS patients High-resolution SWI Blood products and calcifications are rare findings14,27 Differentiation of CNS lymphoma and high-grade gliomas MRI with new contrast agents MRI with iron oxide nanoparticles: lesions enhance less than with gadolinium56 Differentiation of CNS lymphoma and MS Metabolic imaging PET FDG-PET, methionine PET: hypermetabolic lesions with increased uptake of FDG or methionine25,60,62 Differentiation of CNS lymphoma and gliomas/metastases/meningiomas Early evaluation of therapeutic response SPECT/SPET Hypermetabolic lesions with high N-isopropyl iodoamphetamine or thallium-201 uptake9,63,64 Differentiation of AIDS-related CNS lymphoma and infectious intracranial lesions
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