Which MRI findings are characteristic of brain and CNS lymphoma?

Updated: Feb 28, 2019
  • Author: Djamil Fertikh, MD; Chief Editor: James G Smirniotopoulos, MD  more...
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The most common locations on MRI include periventricular white matter, basal ganglia, and corpus callosum, while cerebellum, brainstem, and spinal cord are less frequently involved. [25] The classic appearance of CNS lymphoma on nonenhanced T1-weighted MRIs is that of an isointense to isointense to hypointense nodule or mass. On T2-weighted MRIs, the appearance is that of an isointense-to-hyperintense mass. On postgadolinium-enhanced T1-weighted MRIs, lymphoma tends to enhance intensely and diffusely. In patients with AIDS-related immunosuppression, a ringlike enhancing pattern is seen most often (see the images below). Often, little or no surrounding vasogenic edema is demonstrated. [26, 17, 18, 19]

Axial gadolinium-enhanced T1-weighted MRI reveals Axial gadolinium-enhanced T1-weighted MRI reveals the rim-enhancing lesions typical of HIV infection.
Sagittal T1-weighted contrast-enhanced MRI reveals Sagittal T1-weighted contrast-enhanced MRI reveals 2 rim-enhancing lesions in this patient with HIV infection. The lesions extend to involve the corpus callosum.

Tumor lesions may cross the midline and may appear as a butterfly tumor involving both cerebral hemispheres. In 30% of patients, leptomeningeal involvement is encountered, usually in secondary systemic lymphoma; in such cases, meningeal involvement is typical. Involvement of the perivascular spaces with contrast enhancement is strongly suggestive of CNS lymphoma (in such cases, lymphoma must be differentiated from sarcoidosis and CNS tuberculosis); involvement of the corpus callosum is also strongly suggestive of CNS lymphoma (in such cases, lymphoma must be differentiated from glioma and metastatic neoplasm). Contrast-enhancing, thickened ependyma may be seen. If such findings are seen in patients with AIDS, lymphoma must be differentiated from cytomegalovirus ependymitis; if such findings are encountered in patients who do not have AIDS, lymphoma must be differentiated from metastatic neoplasm, such as carcinoma of the lung or breast. In addition, in patients with these findings, lymphoma must be differentiated from ependymal spread of anaplastic glioma. [17, 18, 19, 27]

Leptomeningeal extension is depicted better on enhanced MRI scans than on CT scans.


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