Primary central nervous system lymphoma CT

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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

Head CT scan may be helpful in the diagnosis of primary central nervous system lymphoma. Findings on CT scan suggestive of primary central nervous system lymphoma include supratentorial hyperattenuating, enhancing, hemorrhaging mass with subependymal extension crossing the corpus callosum. Chest, abdomen, and pelvic CT scans may be used to exclude any occult systemic disease from the spread of primary central nervous system lymphoma.

Head CT

• Head CT scan may be helpful in the diagnosis of primary central nervous system lymphoma. Findings on CT scan suggestive of primary central nervous system lymphoma include:

• Supratentorial mass with subependymal extension
• Crossing the corpus callosum
• Lesions are hyperattenuating (70%)
• Enhancement present
• Hemorrhage is distinctly present
• Multiple lesions in patients with HIV/AIDS

• Enhancement on both CT scan and MRI is pronounced and usually homogeneous. Even with larger lesions, there is little mass effect for size and limited surrounding vasogenic edema.
• Low grade tumors differ from the more common high-grade primary central nervous system lymphoma in several ways:

• Deep locations and spinal involvement is more common
• Contrast enhancement is absent, irregular, or only mild

• Disseminated meningeal/intraventricular disease is uncommon, it is observed in 5% of cases at presentation and usually in high grade cases.
• It should be noted that in patients who are immunocompromised (typically HIV/AIDS or post-transplant), enhancement is more heterogeneous.

Gallery

• 
  _{Single image from a non-contrast CT scan demonstrating a vague bilateral hyperdensity crossing the midline.}

Chest, Abdomen, and Pelvic CT

• Chest, abdomen, and pelvic CT scans may be used to exclude any occult systemic disease from the spread of primary central nervous system lymphoma.

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