Primary central nervous system lymphoma other diagnostic studies

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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 CNS lymphoma is a primary intracranial tumor usually present in those with severe immunosuppression --- commonly in those with AIDS --- and represents around 20% of all cases of lymphomas in HIV infection (other types being Burkitt's lymphoma and immunoblastic lymphoma).

Other Diagnostics Studies

Because imaging techniques cannot distinguish the two conditions with certainty, patients usually undergo brain biopsy if the lesion is solitary or a trial of toxoplasmosis therapy is non-therapeutic. In the future, it may be possible to use PCR assay of cerebrospinal fluid for EBV DNA.

Magnetic Resonance Spectroscopy

• Magnetic resonance spectroscopy may be diagnostic of primary central nervous system lymphoma. Findings on MR spectroscopy suggestive of primary central nervous system lymphoma include:

• Large choline peak
• Reversed choline/creatinine ratio
• Markedly decreased N-Acetylaspartate (NAA)
• Lactate peak may also be observed

Magnetic Resonance Perfusion

• Magnetic resonance perfusion may be diagnostic of primary central nervous system lymphoma. Findings on MR perfusion suggestive of primary central nervous system lymphoma include a modest increase in relative cerebral blood flow (rCBV), much less marked than in high-grade gliomas, where angiogenesis is a prominent feature.

Scintigraphy

• Findings on scintigraphy suggestive of primary central nervous system lymphoma include:

• Thallium 201: increased uptake
• C11 Methionine PET: increased uptake

Biopsy

• Stereotactic biopsy is usually performed to confirm a diagnosis of primary central nervous system lymphoma, especially in people who do not have AIDS.

Bone Marrow Biopsy

• Bone marrow biopsy may be performed to detect metastases of primary central nervous system lymphoma to the bones.

References

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