The Multiple Faces of Nervous System Lymphoma. Atypical mri Features and Contribution of the Advanced Imaging

Primary central nervous system lymphoma (PCNSL) is an uncommon variant of extranodal non-Hodgkin lymphoma (NHL) that involves the brain, leptomeninges, eyes or spinal cord without evidence of systemic disease. In addition to a detailed history and physical examination, the evaluation of patients sus...

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Published inCurrent problems in diagnostic radiology
Main Authors Jiménez de la Peña, María del Mar, MD, Vicente, Lidia Gómez, MD, Alonso, Raquel Cano, MD, Cabero, Silvia Fuertes, MD, Suárez, Antonio Maldonado, MD, de Vega, Vicente Martínez, MD
Format Journal Article
LanguageEnglish
Published 2016
Subjects
Internal Medicine
Radiology
ADC
Tensor Diffusion Imaging
glioblastoma multiforme
Meningeal Lymphoma
B cell non-Hodgkin lymphoma
MTT
PCNSL
GBM
SPECTROSCOPY-MR
relative cerebral volume
Perfusion weighted imaging
DWI
EBV
Apparent diffusion coefficient
fraccional anisotropy
Epstein Bahr virus
Diffusion-Weighted Image
PWI
SWI
rCV
Secondary central nervous system lymphoma
Primary central nervous lymphoma
SCNSL
Spinal Cord Lymphoma
NHL-B
susceptibility weighted imaging
primary central nervous system lymphoma
PET-image
Diffusion tensor imaging
Perfusion-Weighted Image
Angiocentric Lymphoma
mean transit time
DTI
FA
Diffusion weighted imaging
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Summary:Primary central nervous system lymphoma (PCNSL) is an uncommon variant of extranodal non-Hodgkin lymphoma (NHL) that involves the brain, leptomeninges, eyes or spinal cord without evidence of systemic disease. In addition to a detailed history and physical examination, the evaluation of patients suspected of having a PCNSL should include a contrast enhanced MRI. Occassionaly PCNSL shows peculiarities on MRI, which delay the diagnosis and thus the start of treatment. It is essential that radiologists be aware of these less common presentations, such as isolated spine or meningeal lymphoma, angiocentric lymphoma, ocular lymphoma and Epstein-Barr virus-associated lymphoma. Advanced neuroimaging (diffusion and perfusion sequences, spectroscopy-MR and positron emission tomography metabolic imaging) are useful techniques for the differential diagnosis of PCNSL with processes such as brain glioblastoma, multiple sclerosis, metastases and brain abscesses, specially in atypical presentations. In this article, a review of unusual radiological findings for PCNSL in immunocompetent patients is made, highlighting the usefulness of functional and metabolic imaging for establishing an early presumptive diagnosis, which reduces delays in treatment
ISSN:0363-0188
1535-6302
DOI:10.1067/j.cpradiol.2016.04.004