Primary central nervous system lymphoma MRI

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

Overview

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
Diffusion-weighted imaging (DWI)/Apparent diffusion coefficient (ADC) *Typical restricted diffusion

References

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