Clinical Study

Journal of Neuro-Oncology

, Volume 72, Issue 2, pp 169-177

First online:

Primary central nervous system lymphomas (PCNSL): MRI features at presentation in 100 patients

  • Wilhelm KükerAffiliated withDepartment of Neuroradiology, Medical School, University of TübingenDepartment of Neuroradiology, Radcliffe InfirmaryDepartment of Neuroradiology, The Radcliffe Infirmary Email author 
  • , Thomas NägeleAffiliated withDepartment of Neuroradiology, Medical School, University of Tübingen
  • , Agnieska KorfelAffiliated withDepartment of Hematology and Oncology, University Hospital Benjamin Franklin
  • , Stefan HecklAffiliated withDepartment of Neuroradiology, Medical School, University of Tübingen
  • , Eckhard ThielAffiliated withDepartment of Hematology and Oncology, University Hospital Benjamin Franklin
  • , Michael BambergAffiliated withDepartment of Radiation Oncology, Medical School, University of Tübingen
  • , Michael WellerAffiliated withDep-artment of Neurology, Medical School, University of Tübingen
  • , Ulrich HerrlingerAffiliated withDep-artment of Neurology, Medical School, University of Tübingen

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Abstract

To avoid an unnecessary extend of surgery in primary central nervous system lymphoma (PCNSL), the diagnosis should be suspected after MRI.

Pre-treatment MRI examinations of 100 immunologically competent patients with biopsy-proven PCNSL were evaluated. All patients had T2- and T1-weighted images with contrast enhancement. Diffusion-weighted MRI (DW-MRI) was available in 15, proton-MR-spectroscopy (1H-MRS) in four patients.

The number of lesions ranged from one (n=65 patients) to eight (n=1) with a mean of 1.7. The most frequent locations were the cerebral hemispheres (n=66), the basal ganglia (n=27) and the corpus callosum (n=24). In the 65 patients with a solitary lesion, hemispheric lesions were most frequent (n=23) followed by corpus callosum (n=18). Contrast enhancement was found in all but one patient. 1H-MRS revealed a uniformly pathologic pattern of metabolite concentrations in all patients.

Characteristic imaging features of PCNSL are contrast-enhancing lesions with a diameter of at least 15 mm in contact with the subarachnoid space. DW-MRI and proton spectroscopy may aid in differential diagnosis.

Keywords

brain neoplasm DW-MRI lymphoma MRI PCNSL spectroscopy