Primary central nervous system lymphoma MRI: Difference between revisions

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{{Primary central nervous system lymphoma}}
{{Primary central nervous system lymphoma}}
{{CMG}}
{{CMG}}{{AE}}{{SR}}


==Overview==
==Overview==
'''Primary CNS lymphoma''' is a [[brain tumor|primary intracranial tumor]] usually present in those with severe immunosuppression --- commonly in those with [[AIDS]] --- and represents around 20% of all cases of lymphomas in HIV infection (other types being [[Burkitt's lymphoma]] and immunoblastic lymphoma).
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==
[[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.
[[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.<ref name="HaldorsenEspeland2010">{{cite journal|last1=Haldorsen|first1=I. S.|last2=Espeland|first2=A.|last3=Larsson|first3=E.- M.|title=Central Nervous System Lymphoma: Characteristic Findings on Traditional and Advanced Imaging|journal=American Journal of Neuroradiology|volume=32|issue=6|year=2010|pages=984–992|issn=0195-6108|doi=10.3174/ajnr.A2171}}</ref>
*Findings on MRI suggestive of primary central nervous system lymphoma include:<ref name="mrifeatiresprimarycnslymphoma1">Radiographic features of primary CNS lymphoma. Dr Amir Rezaee and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/primary-cns-lymphoma. Accessed on February 23, 2016</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width:650px"
| valign="top" |
|+
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|MRI component}}
! style="background: #4479BA; width: 370px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |T1
| style="padding: 5px 5px; background: #F5F5F5;" |
*Typically hypointense to white matter
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align="center" |T2
| style="padding: 5px 5px; background: #F5F5F5;" |
*Variable
*Majority are iso- to hypointense
**Isointense: 33%
**Hypointense: 20%
*Hyperintense: 15-47%, more common in tumors with [[necrosis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align="center" |T1 with gadolinium contrast
| style="padding: 5px 5px; background: #F5F5F5;" |
*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)
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align="center" |Diffusion-weighted imaging/apparent diffusion coefficient (DWI/ADC)
| style="padding: 5px 5px; background: #F5F5F5;" |
*Typical restricted diffusion
*More restricted diffusion and lower ADC values compared to [[glioma|high-grade gliomas]] and [[intarcerebral metatstases|metastases]]
|}
==Gallery==
<gallery>
Image:Primary central nervous system B-cell non-Hodgkin lymphoma mri image 1.jpg|<sub>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).<ref name=primarycentralnervousystemlymphomamriimage1>Primary central nervous system lymphoma. Wikipedia 2016. https://en.wikipedia.org/wiki/Primary_central_nervous_system_lymphoma. Accessed on February 23, 2016</ref></sub></gallery>


==References==
==References==
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Latest revision as of 17:28, 20 May 2019

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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.[1]
  • Findings on MRI suggestive of primary central nervous system lymphoma include:[2]
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)

Gallery


References

  1. Haldorsen, I. S.; Espeland, A.; Larsson, E.- M. (2010). "Central Nervous System Lymphoma: Characteristic Findings on Traditional and Advanced Imaging". American Journal of Neuroradiology. 32 (6): 984–992. doi:10.3174/ajnr.A2171. ISSN 0195-6108.
  2. Radiographic features of primary CNS lymphoma. Dr Amir Rezaee and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/primary-cns-lymphoma. Accessed on February 23, 2016
  3. Primary central nervous system lymphoma. Wikipedia 2016. https://en.wikipedia.org/wiki/Primary_central_nervous_system_lymphoma. Accessed on February 23, 2016


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