Primary central nervous system lymphoma MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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 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