Primary central nervous system lymphoma differential diagnosis: Difference between revisions
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| style="padding: 5px 5px; background: #DCDCDC;" |'''Enhancement on CT and MRI''' | | style="padding: 5px 5px; background: #DCDCDC;" |'''Enhancement on CT and MRI''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Solid enhancement | | style="padding: 5px 5px; background: #F5F5F5;" |Solid enhancement, however primary CNS lymphoma patients with HIV/AIDS may demonstrate ring enhancement also. | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Ring or nodular enhancement | | style="padding: 5px 5px; background: #F5F5F5;" |Ring or nodular enhancement | ||
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| style="padding: 5px 5px; background: #DCDCDC;" |'''Magnetic resonance spectroscopy (MRS)''' | | style="padding: 5px 5px; background: #DCDCDC;" |'''Magnetic resonance spectroscopy (MRS)''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" |MRS: markedly increased [[choline]] (Cho) | | style="padding: 5px 5px; background: #F5F5F5;" |MRS: markedly increased [[choline]] (Cho) | ||
| style="padding: 5px 5px; background: #F5F5F5;" |MRS: decreased [[choline]] | | style="padding: 5px 5px; background: #F5F5F5;" |MRS: decreased [[choline|Cho]] | ||
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| style="padding: 5px 5px; background: #DCDCDC;" | | | style="padding: 5px 5px; background: #DCDCDC;" |'''Magnetic resonance perfusion''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |MR perfusion: increased relative cerebral blood volume (rCBV) | ||
| style="padding: 5px 5px; background: #F5F5F5;" |MR perfusion: decreased rCBV | |||
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Revision as of 19:31, 17 February 2016
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Primary central nervous system lymphoma Microchapters |
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Differentiating Primary Central Nervous System Lymphoma from other Diseases |
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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
Differentiating Primary Central Nervous System Lymphoma from other Diseases
Primary central nervous system lymphoma must be differentiated from:[1]
- Secondary CNS lymphoma: indistinguishable on imaging, however it tends to involve more leptomeninges (~2/3 of cases)
- Cerebral toxoplasmosis
- Glioblastoma multiforme (butterfly glioma)
- Tumefactive demyelinating lesion
- Cerebral abscess
- Neurosarcoidosis
It is a relatively common occurrence for radiologists to be asked to distinguish between cerebral toxoplasmosis and primary central nervous system lymphoma in patients with HIV/AIDS. Treatment is clearly different and thus accurate interpretation of CT and MRI is essential.[2] In many instances appearances are classic and pose little problem, however, in 50-80% of cases the appearances can be very similar requiring careful interpretation 1. Below are helpful distinguishing features.[2]
| Differentiating point | Primary CNS Lymphoma | Cerebral Toxoplasmosis |
|---|---|---|
| Characteristics of lesion | Single lesion with subependymal spread | Multiple lesions scattered though basal ganglia and corticomedullary junction |
| Enhancement on CT and MRI | Solid enhancement, however primary CNS lymphoma patients with HIV/AIDS may demonstrate ring enhancement also. | Ring or nodular enhancement |
| Hemorrhage | No hemorrhage before treatment | Hemorrhage occasionally occurs mostly in periphery of lesion |
| Single-photon emission computed tomography (SPECT) | Thallium SPECT positive | Thallium SPECT negative |
| Magnetic resonance spectroscopy (MRS) | MRS: markedly increased choline (Cho) | MRS: decreased Cho |
| Magnetic resonance perfusion | MR perfusion: increased relative cerebral blood volume (rCBV) | MR perfusion: decreased rCBV |
References
- ↑ Differential diagnosis of primary central nervous system lymphoma. Dr Amir Rezaee and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/primary-cns-lymphoma. Accessed on February 17, 2016
- ↑ 2.0 2.1 Toxoplasmosis vs CNS lymphoma. Dr Henry Knipe and Dr Praveen Jha et al. Radiopaedia 2016. http://radiopaedia.org/articles/toxoplasmosis-vs-lymphoma. Accessed on February 17, 2016