MRI Findings of Primary CNS Lymphoma in 26 Immunocompetent Patients

Abstract

ObjectiveTo record the MR imaging features of primary central nervous system lymphoma (PCNSL) and compare these features in monofocal and multifocal disease.Materials and MethodsTwenty-one cases of monofocal disease were compared to five cases of multifocal disease. All patients were examined by non-enhanced and contrast-enhanced MRI. Tumor location, tumor size, signal intensity, enhancement characteristics, age distribution, peritumoral edema, cystic changes, and the presence of calcifications were assessed. The MRI features were compared between the monofocal and multifocal disease cases.ResultsThe 26 cases, including both the monofocal and multifocal cases, exhibited 37 lesions. Contrast-enhanced images showed variable enhancement patterns: homogeneous enhancement (33 lesions), ring-like enhancement (2), and 'open-ring-like' enhancement (2). The 'notch sign' was noted in four of 33 homogeneously enhancing lesions. One case of hemorrhage and three cases of cystic formation were observed. Intra-tumoral calcification was not found. The frontal lobe, the corpus callosum and the basal ganglia were commonly affected in both the monofocal and multifocal groups. Tumor size differed significantly between the two groups (t = 3.129, p < 0.01) and mildly or moderately enhanced lesions were more frequently found in the monofocal group (p < 0.05). There was no statistical difference between perifocal edema (p > 0.05) and the signal characteristics (p > 0.05) between the two groups.ConclusionOur data show that PCNSL has a variable enhancement pattern on MR images. We first reported two lesions with an 'open-ring' enhancement as well as four cases with a 'notch sign'. Monofocal PCNSL cases typically have larger sized tumors with mild or moderate enhancement.

Primary Central Nervous System Lymphoma: A Clinicopathological and Cytomorpholgical Study from A Tertiary Care Centre in Chennai, India

“…An earlier multi-centric hospital based study from India had also showed that PCNSL occurs a decade earlier in Indian patients and is only very rarely associated with AIDS (Sarkar et al, 2005). A study from Korea also revealed a lower mean age of 51.5 (Zhang et al, 2010). This is quite similar to our study.…”

“…CT and MRI scan generally provide results suggestive but not conclusive for PCNSL (Koeller et al, 1997;Herrlinger et al, 1999). 2005; Zhang et al, 2010;Gelabert-González et al, 2012). A nationwide survey of PCNSL in Japan during the period 2000-2004 revealed that T-cell PCNSL accounted for 1.7% of all cases (Shibamoto et al, 2008), whereas a similar earlier study (1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994) from the same country showed a higher figure of 8.5% (Hayabuchi et al, 1999).…”

“…This is possibly due to earlier deaths of Indian patients due to AIDS associated opportunistic infections (Sarkar et al, 2005). Interestingly studies from Japan and Korea have also not shown any association of PCNSL with AIDS (Shibamoto et al, 2008 ;Zhang et al, 2010). A recent study estimated that in USA about 13% of CNS lymphoma cases were associated with AIDS in the period [2001][2002][2003][2004][2005][2006][2007].…”

“…At present, primary CNS lymphomas constitutes about 2.2% of all brain tumours in the USA (Dolecek et al, 2012). However studies from Asia and India have revealed certain differences in PCNSL features compared to the West (Sarkar et al, 2005;Shibamoto et al, 2008;Zhang et al, 2010). CNS cancers are increasing in India and to understand the etiology of these cancers, in depth, analytic epidemiological studies should be planned in the near future (Yeole, 2008) In the present study we analyze the clinicopathological features of 32 cases of PCNSL and also assess the utility of the crush smear preparation in the intra-operative diagnosis of PCNSL.…”

MRI findings in primary brain lymphoma in immunocompetent patients

“…If it involves the deep white matter, it may spread across the corpus callosum, similar to the pattern seen in glioblastoma multiforme. 8 Tumours appear solid, rarely there are liquefied components, and are iso intense to normal brain tissue in T2WI and T1WI in about two third of cases and usually homogeneously enhancing. Mild to moderate peritumoural edema is common in primary brain lymphoma and is generally less severe than in metastases and high grade glioma.…”