Primary central nervous system lymphoma differential diagnosis
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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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Treatment |
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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
Primary central nervous system lymphoma must be differentiated from secondary CNS lymphoma, cerebral toxoplasmosis, glioblastoma multiforme, cerebral abscess, and tuberculoma.[1][2]
Differentiating Primary Central Nervous System Lymphoma from other Diseases
Primary central nervous system lymphoma must be differentiated from:[1][2]
- 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
- Tuberculoma
- Neurocysticercosis
- Intracerebral metastases
- Radiation necrosis
- Stroke
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.[3] 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. Below are helpful distinguishing features.[3]
| 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
- ↑ 1.0 1.1 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 Cerebral ring enhancing lesions. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radioapaedia 2016. http://radiopaedia.org/articles/cerebral-ring-enhancing-lesions. Accessed on February 17, 2016
- ↑ 3.0 3.1 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