Primary central nervous system lymphoma MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Contrast-enhanced MRI is the imaging modality of choice for primary central nervous system lymphoma. Findings on MRI suggestive of primary central nervous system lymphoma include solitary to multiple, 3-5 cm ring-enhancing lesions in almost any location, but usually deep in the white matter, which are typically hypointense on T1-weighted images and iso- to hypointense on T2-weighted images.

MRI

MRI usually shows multiple (1 to 3) 3- to 5-cm ring-enhancing lesions in almost any location, but usually deep in the white matter. The major differential diagnosis is cerebral toxoplasmosis, which is also prevalent in AIDS patients and also presents with a ring-enhanced lesion, although the contrast enhancement is more pronounced in toxoplasmosis and it presents with more lesions.

• Contrast-enhanced MRI is the imaging modality of choice for primary central nervous system lymphoma.
• Findings on MRI suggestive of primary central nervous system lymphoma include:

MRI component	Findings
T1	Typically hypointense to white matter
T2	Variable Majority are iso- to hypointense Isointense: 33% Hypointense: 20% Hyperintense: 15-47%, more common in tumors with necrosis
T1 with gadolinium contrast	Typical high grade tumors demonstrate intense homogeneous enhancement while low-grade tumors have absent to moderate enhancement Peripheral ring enhancement may be observed in immunocompromised patients (HIV/AIDS)
Diffusion-weighted imaging/apparent diffusion coefficient (DWI/ADC)	Typical restricted diffusion More restricted diffusion and lower ADC values compared to high-grade gliomas and metastases

Gallery

• 

  _{Brain magnetic resonance imaging demonstrating primary central nervous system B-cell non-Hodgkin lymphoma of the sella turcica and hypothalamus, continuing to the tectum (intensely white areas in the middle).}

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