What are findings of MRI in the workup of primary central nervous system lymphoma (PCNSL)?

Updated: Jan 19, 2018
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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MRI of the brain shows a hypointense lesion or lesions on long TR-weighted images, which enhance densely and homogeneously after contrast administration. Lesions are multifocal in 50% of patients with AIDS, whereas only 25% of immunocompetent patients have multifocal disease at presentation. MRI also gives information about leptomeningeal enhancement, hydrocephalus, and concurrent alternative diagnoses, such as infections in patients with AIDS.

Patients with focal spinal, root, or cord symptoms should undergo MRI of the spine with and without contrast to localize the deposits of lymphoma. These lesions, when found, may be amenable to radiation therapy.

Goyal et al. found that the enhancing component of CNS lymphomas were found to have significantly lower mean relative cerebral blood volume ( rCBV) compared to the enhancing component of GBM (1.2 versus 4.3; P<0.001), metastasis (1.2 versus 2.7; P<0.001), and anaplastic-enhancing gliomas (1.2 versus 2.4; P<0.001). Also, the maximum rCBV of the enhancing component of lymphoma were significantly lower than GBM (3.1 versus 6.5; P<0.001) and metastasis (3.1 versus 4.9; P<0.013), and not significantly lower than anaplastic enhancing gliomas (3.9 versus 4.2; P<0.08). The researchers conclude that  enhancement-perfusion (E-P) mismatch in dynamic susceptibility weighted magnetic resonance perfusion (DSC-MR) (i.e., low mean rCBV in an enhancing portion of the tumor) is strongly suggestive of lymphoma and should allow differentiation of CNS lymphoma from other enhancing malignant lesions. [15]

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