Primary central nervous system lymphomas are aggressive, high-cell-density tumors. There is recent increase in their incidence in immunocompetent patients. Knowledge of imaging findings on computed tomography and conventional MR imaging is important to suggest the diagnosis. Moreover, information obtained from advanced MR imaging techniques, such as diffusion-weighted imaging, diffusion tensor imaging, MR spectroscopy, perfusion-weighted imaging, and dynamic contrast-enhanced studies, increases diagnostic confidence and helps distinguish them from other aggressive intracranial tumors. This article discusses typical imaging findings of primary and secondary central nervous system lymphomas on computed tomography and conventional MR imaging, advanced MR imaging techniques, and changes related to steroid therapy.
Restricted diffusion may not be demonstrated in lymphoma after steroid therapy.
Restricted diffusion may not be demonstrated in lymphoma after steroid therapy.
The peak age for CNS lymphoma in the non-AIDS population is during the sixth decade of life with men affected more than women.
Restricted ADC may resolve after steroids.
When PCNSL is suspected, contrast-enhanced MR imaging is the technique of choice. Secondary CNS lymphomas present as meningeal metastases in two-thirds of patients and as parenchymal metastases in one-third. In PCNSL, almost all patients have parenchymal lesions. Parenchymal lymphomas have a predilection for the periventricular and superficial regions, often abutting the ventricular or meningeal surfaces.
Although CNS lymphomas may have characteristic imaging findings on traditional MR imaging, no technique unequivocally differentiates CNS lymphoma from other brain lesions. Advanced MR imaging techniques, such as DWI, DTI, MRS, PWI, and DCE studies, help establish a diagnosis of CNS lymphoma and distinguish lymphomas from other aggressive primary brain tumors, such as GBM. If ADC suggests high cellular density and no elevation of rCBV is seen, consider lymphoma as the main diagnosis.
Following administration of steroids, lymphomas may partially or completely regress, restricted ADC may resolve, and a previously hyperperfused lesion may demonstrate low rCBV.
Funding Sources: None.
Conflict of Interest: None.
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