Central Nervous System Lymphoma: Characteristic Findings on Traditional and Advanced Imaging

Abstract

SUMMARY: CNS lymphoma consists of 2 major subtypes: secondary CNS involvement by systemic lymphoma and PCNSL. Contrast-enhanced MR imaging is the method of choice for detecting CNS lymphoma. In leptomeningeal CNS lymphoma, representing two-thirds of secondary CNS lymphomas, imaging typically shows leptomeningeal, subependymal, dural, or cranial nerve enhancement. Single or multiple periventricular and/or superficial contrast-enhancing lesions are characteristic of parenchymal CNS lymphoma, representing one-third of secondary CNS lymphomas and almost 100% of PCNSLs. New CT and MR imaging techniques and metabolic imaging have demonstrated characteristic findings in CNS lymphoma, aiding in its differentiation from other CNS lesions. Advanced imaging techniques may, in the future, substantially improve the diagnostic accuracy of imaging, ultimately facilitating a noninvasive method of diagnosis. Furthermore, these imaging techniques may play a pivotal role in planning targeted therapies, prognostication, and monitoring treatment response.ABBREVIATIONS: ADC ϭ apparent diffusion coefficient; CBV ϭ cerebral blood volume; CE ϭ contrast enhancement; Cho ϭ choline; CNS ϭ central nervous system; Cr ϭ creatine; DWI ϭ diffusion-weighted imaging; FA ϭ fractional anisotropy; FDG ϭ fluorodeoxyglucose; HAART ϭ highly active antiretroviral therapy; HIV ϭ human immunodeficiency virus; MRI ϭ MR imaging; MS ϭ multiple sclerosis; NHL ϭ non-Hodgkin lymphoma; PCNSL ϭ primary CNS lymphoma; PET ϭ positron-emission tomography; PML ϭ progressive multifocal leukoencephalopathy; rCBV ϭ relative cerebral blood volume; SPECT ϭ single-photon emission CT; SPET ϭ single photon-emission tomography; SWI ϭ susceptibility-weighted imaging L ymphoma of the CNS consists of 2 major subtypes: secondary CNS involvement by systemic lymphoma (the most common) and PCNSL, in which the lymphoma is restricted to the brain, leptomeninges, spinal cord, or eyes, without evidence of it outside the CNS at primary diagnosis.

“Dazed and diffused”: making sense of diffusion abnormalities in neurologic pathologies

“…In addition, lesions are solitary in approximately 60-80% of cases [55,56], demonstrate homogeneous enhancement in up to 90% of cases and rarely demonstrate necrosis, haemorrhage or calcification [55,56,59]. Lesions are typically distributed in a periventricular location and may involve the corpus callosum [55,56]. Imaging of primary CNS lymphoma in the immunocompromised patient demonstrates similar findings, although multiplicity of lesions, peripheral enhancement, necrosis and haemorrhage are more often seen [55,59].…”

“…Lesions are typically distributed in a periventricular location and may involve the corpus callosum [55,56]. Imaging of primary CNS lymphoma in the immunocompromised patient demonstrates similar findings, although multiplicity of lesions, peripheral enhancement, necrosis and haemorrhage are more often seen [55,59].…”

“…Primary central nervous system (CNS) lymphoma accounts for 1-5% of all primary malignancies of the CNS, with diffuse large B-cell non-Hodgkin lymphomas representing .95% of primary CNS lymphomas [55,56]. The mean age at onset in immunocompetent patients is 50-60 years, whereas in immunocompromised patients, the mean age is in the thirties [56,57].…”

“…Lesions typically demonstrate restricted diffusion on MRI, a finding attributed to the high cellularity of the lymphomas [55,58] (Figure 7). In addition, lesions are solitary in approximately 60-80% of cases [55,56], demonstrate homogeneous enhancement in up to 90% of cases and rarely demonstrate necrosis, haemorrhage or calcification [55,56,59]. Lesions are typically distributed in a periventricular location and may involve the corpus callosum [55,56].…”

Can We Perform Spinal1H-MR Spectroscopy in Daily Clinical Practice?

“…We did not use electrocardiography or respiratory triggering or gating. The voxel size used was 10 ϫ 10 ϫ 20 mm 3 . TE was 30 ms and TR was 1500 ms; the number of averages was 160, resulting in a total scanning time of 4 minutes.…”